Overview

Expenditure Proposal and Trends

Caseload Trends

Spending by Major Program

Major Budget Changes

The Governor's Realignment Proposal

Other Policy and Structural Changes in Programs

Crosscutting Issues

Realignment

Realignment Proposal Affects Health and Social Services Programs

California Children's Services

Missed Opportunities for General Fund Savings in the CCS Program

Background

Services Provided

Eligibility Rules

Benefits

Program Funding Structure

The Budget Proposal

State Has Missed Opportunities to Save General Fund

Caseload and Costs Continue to Rise

CCS Not Taking Advantage of Available Federal Funds

Missed Opportunities in Use of General Fund Resources

Maximizing the State's Opportunity to Improve CCS

Departmental Issues

Department of Aging (4170)

Consolidate All Aging Programs In the Department of Social Services

California Medical Assistance Program (4260)

Medi-Cal Benefits and Eligibility

What Benefits Does Medi-Cal Provide?

How Medi-Cal Works

Who Is Eligible for Medi-Cal?

Most Medi-Cal Spending Is for the Elderly or Disabled

Medi-Cal Expenditures

Spending Growth in Current Year Despite Cuts

Budget-Year Expenditure Reduction

Medi-Cal Cost and Caseload Trends

Budget Forecasts Caseload Decline and Dropping Costs

Overall Caseload Estimate Reasonable

Eligibility Administration Issues

County Eligibility Determinations: Options for Cost Savings

Background

Issues With the Existing System

The Governor's Proposal to Improve Eligibility Administration

Other Options for Improving County Eligibility Determinations

Analyst's Recommendations

State Should Assess Shift to Veterans Administration Benefits

Background

Veterans on Medi-Cal Rolls

Analyst's Recommendation

Disease Management Could Reduce Medi-Cal Costs

What Is Disease Management?

Potential Benefits of Disease Management

Moving California Toward Disease Management

Other Budget and Policy Issues

Funding Request for Medi-Cal Estimate Redesign

Department Needs to Take More Steps to Ensure Fair Prices

Public Health

Budget Proposals

Child Health and Disability Prevention Program

Background

CHDP Gateway Proposal

Uncertainties in Gateway Implementation

Managed Risk Medical Insurance Board (4280)

Access for Infants and Mothers

Background

Healthy Families Program

Background

Budget Reflects Growing Children's Caseload

Tobacco Settlement Funds Could Fall Short

Rural Health Demonstration Projects

Background

Programs Could Be Consolidated

Developmental Services (4300)

State Should Restructure Developmental Center System

Introduction

Full Range of Care Provided

Funding

A Costly System in Decline

Population Trends

Cost Trend Analysis

Why Costs Have Grown

Trend Likely to Continue

Many DC Residents Could Be Served in the Community

Community Care Can Be Less Costly Than DCs

Other States Are Downsizing Institutional Care

Policy Direction on DCs Unclear

Recommendations and Options for Restructuring DCs

Initiate Closure of Two DCs

Planning a Successful Transition to the Community

Future Restructuring Issues

Conclusion

Community Program Issues

Parents Would Share Costs

Background

The Governor's Copayment Proposal

An Analysis of the Governor's Fee Proposal

Improving the Governor's Copayment Plan

Budget Proposes Efficiencies in Habilitation Services Program

Background

Governor's Proposal

Analyst's Recommendation

Community Services Program Deficiency Expected to Increase

Governor's Proposal

Assessing the Governor's Request

Analyst's Recommendation

Self-Determination Projects Could Benefit Clients and the State

Background

Assessing the Governor's Proposal

Analyst'sRecommendation

Department of Mental Health (4440)

State Hospital Issues

Patient Caseload Overbudgeted

Funding for Operating Expenses Requires Further Review

Another Delay for Salinas Valley Facility

Community Program Issues

New Projection Method Increases EPSDT Costs

Department of Community Services and Development (4700)

Budget Proposes Eliminating the Department

Department of Rehabilitation (5160)

Budget Achieves Savings From Rate Reductions and Freezes

Budget Shifts Habilitation Services Program to Regional Centers

Department of Child Support Services (5175)

Legislature Needs Better Budget Information

County Share for Federal Child Support Penalty

Department of Social Services CalWORKs Program (5180)

Caseload and Grants

Caseload Projection is Overstated

Budget Suspends Statutory Cost-of-Living Adjustments and Reduces Grant Payments

Grant Reduction Proposal—Budget Internally Inconsistent

Maintenance-of-Effort Spending Requirement And TANF Surplus

Achieving General Fund Savings While Meeting MOE Requirement

Count Additional Spending Toward MOE Requirement

Additional Maintenance-of-Effort Expenditures And TANF Surplus Create Options

Other Budget and Policy Issues

Update on County Performance Incentives

Withhold Recommendation on Time Limit Savings

Prospective Budgeting: Delay in Federal Approval Creates Budget Uncertainty

Legislature Needs Better Participation Data

Supplemental Security Income/State Supplementary Program

Budget Proposes Grant Reductions and COLA Suspensions

In-Home Supportive Services

Governor Proposes to Suspend State Participation in Wage Increase

Foster Care

California Fails Foster Care Program Performance Assessment

Adoptions Programs

Adoptions Assistance Program Caseload Overstated

Child Welfare Services

Budget for Child Welfare Services Does Not Reflect Savings From Projected Caseload Decline

Food Stamps Program

Federal Eligibility Restorations Reduce California Food Assistance Program (CFAP) Costs

Withhold Recommendation on Reprogramming Costs

Prospective Budgeting: Delay in Federal Approval Creates Budget Uncertainty