LAO 2007-08 Budget Analysis: Health and Social Services TOC
Analysis of the 2007-08 Budget Bill
Health and Social Services
Issue-By-Issue Contents
Overview
Expenditure Proposal and Trends
Caseload Trends
Spending by Major Program
Major Budget Changes
Other Policy Changes
Crosscutting Issues
Evaluating COLAs for Cash Assistance Programs
How Are COLAs Calculated?
Governor's Proposal
Comparing Grant Levels
Targeting Anti-Poverty Funds
Analyst’s Recommendation
Departmental Issues
Alcohol and Drug Programs (4200)
The Substance Abuse and Crime Prevention Act:Proposition 36 Under Policy Change
Program and Funding Background
Administration’s Budget Proposes a Reduction
Reduced Funding for Proposition 36 Would Increase State Prison Costs
Funding Shift to Implement Policy Changes May Meet Legal Opposition
Analyst’s Recommendation
Medi-Cal (4260)
Overview of Medi-Cal Budget Proposal
Key Changes in Current-Year Spending
Governor’s 2007-08 Budget Proposal
Budget Projects Modest Caseload Growth
Data Match Increases Veterans’ Access To Benefits and Reduces State Costs
Introduction
Background
Medi-Cal Screens for Veterans
Quality and Access of Veterans Administration (VA) Healthcare Services
PARIS Could Identify Veterans Enrolled in Medi-Cal
Implementing PARIS Could Lower Medi-Cal Costs Related to Veterans
Implementing PARIS Could Also Improve Program Integrity for Certain Health and Social Services Programs
Implementation Plan Key to Ensure Effectiveness of PARIS
Other States’ Experiences
Some Additional Resources Necessary to Implement PARIS
Analyst’s Recommendations
Significant Medi-Cal Fraud Continues
Some Requests for Added Staff Excessive
Evaluating the Governor’s Budget Requests
Department Already Has More Positions Than It Can Fill
Justification Lacking for Some Budget Requests
Analyst’s Recommendations
Residential Care Models Allow Shift From Institutions to Community
Department of Public Health (4265)
Key Budget Proposals
New Department of Public health
Background
Proposed New Organizational Structure
Budget Implications
Reorganization Milestones
DPH’s New Structure Likely an Improvement, but Accountability Still an Issue
Analyst’s Recommendations
Licensing Proposals
Background
Governor’s Proposals
Nursing Positions Difficult to Fill
Implementing the Reinstatement of Inspections Against State Standards
Analyst’s Recommendations
Foodborne Illness Emergency Response
Background
Administration Proposes More Resources for Foodborne Illness Emergency Response
Balanced Approach of Investigation and Prevention Needed
Analyst’s Recommendation
Prostate Cancer Treatment Program
Health Care Infection Control Program
Oral Health Assessment
Developmental Services (4300)
Regional Center System: Rapid Spending Growth Continues
Background
How Do RCs Provide Services for Their Clients?
RC Caseload Below Projected Levels
Background
Governor’s Budget Proposal
Analyst’s Recommendation
ICF/DD Rate Restructure Would Leverage Federal Funds
Rate Reform Progressing Slowly
Developmental Centers Program
Residential Care Models Allow Shift From Institutions to Community
State Shifting From Institutional Care Model to Community-Based Care
Governor’s Proposal
Analyst’s Recommendation
Department of Mental Health (4440)
Community Program Issues
Early and Periodic Screening Diagnosis and Treatment Program: Estimate and Claims Processing System Need an Overhaul
Background
The Governor’s Proposal
JLBC’s Concerns
Analyst’s Recommendation
New Sexually Violent Predator Laws Drive Increased Costs
Background
Governor’s Budget Proposal
Analyst’s Concerns
Analyst’s Recommendation
Department of Rehabilitation (5160)
Automation Proposal Poses Future General Fund Risk
Department of Child Support Services (5175)
Federal Penalty Held in Abeyance
Budget Proposes to Absorb Federal Administration Fee
Child Support Pass-Through Options
California Work Opportunity and Responsibility to Kids (5180)
Budget Suspends Statutory COLA
Redirecting SSI/SSP COLA Funding to CalWORKs
LEADER Computer System Replacement
TANF Transfer to CWS Contrary to Legislative Approach
Maintenance-of-Effort and Caseload Reduction Credit
Current Work Participation Requirement and Status
Background
Deficit Reduction Act Effectively Increases Participation Requirements for States
Current Participation Status
Impact of Recent Policy Changes on Participation
California Likely to Meet Work Participation Requirements in FFY 2008
TAP Implementation Issues
Governor’s Sanction Proposal
Full-Family Sanction
Comments on the Governor’s Full-Family Sanction Proposal
Alternative Approach to Strengthening the CalWORKs Sanction
Analyst’s Recommendation
Governor’s Time-Limit Proposals
Increasing Participation Through Food Stamps Benefits
In-Home Supportive Services
IHSS Caseloads Overbudgeted
Freezing State Participation in Provider Wages
Alternatives to the Governor’s Proposal
Enhancing Program Integrity
Background
Quality Assurance Initiative
Hourly Task Guidelines
County Quality Assurance Units and Reviews
Expanding Quality Assurance to Service Delivery
Current Law
Current Practice
Bottom Line: Unclear Expectations for Recipients and Providers
Analyst’s Recommendations
Clarify Expectations in Statute
Make Certain Certifications Mandatory to Establish Payment
Supplemental Security Income/ State Supplementary Program
Budget Overestimates Cost of Providing Statutory COLA
Redirecting SSI/SSP COLA Funding to the California Work Opportunity and Responsibility to Kids (CalWORKs)
SSI/SSP Grant Levels
Caseload Overstated for CAPI
Child Welfare Services
Despite Substantial Improvement, Federal Financial Penalties Likely in 2007-08
Federal Review System for Child Welfare and Foster Care
California’s Current Performance
Balancing the Risk and Potential of the Federal IV-E Waiver Project
Federal Funding of CWS
How Will the Title IV-E Waiver Work?
Risks and Opportunities
Current Plans for State Implementation
Analyst’s Recommendation
CWS Budget Methodology
Current CWS Budget System
Concerns About High Social Worker Caseloads
Legislature Requested Review of Budgeting
Key Questions for Assessing CWS Budgeting Changes
Community Care Licensing
Automation Project Does Not Meet Legislatures Goals
Background
Analyst’s Recommendation
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