LAO 2001-01 Budget Analysis: Health and Social Services Issue-By-Issue TOC
Analysis of the 2001-02 Budget Bill
Health and Social Services
Issue-By-Issue Contents
Overview
Expenditure Proposal
and Trends
Caseload Trends
Spending by Major
Program
Major Budget Changes
Crosscutting Issues
Health
Insurance Portability and Accountability Act (HIPAA)
The Governor's
Budget Provides Funding for Compliance With Federal Law
Background
Organizational
Challenges Posed by HIPAA
Major Fiscal
Issues
What Is the
State Currently Doing?
Weaknesses
in the Administration's Approach
Recommendations
to Improve Legislative Oversight of HIPAA Activities
Implementation
of Proposition 36
Background
Issues, Challenges,
and Opportunities
Initial Implementation
Actions
Proposition 36
Budget Issues
Budget Actions
in DADP and CDC
Funding
Options For Implementing Proposition 36
Conclusion
California Spending
on Long-Term Care Services
Summary of Spending
and Caseloads
Background
Characteristics
of Long-Term Care
Delivery of
Long-Term Care Services
Long-Term Care
Expenditures and Caseloads
Long-Term Care
Spending Is Increasing
Coordination
of Long-Term Care Services
Long-Term Care
Budget Issues
Summary of the
Governor's 2001-02 Proposals
Evaluating the
Governor's Long-Term Care Proposals
State May
Be Eligible for Federal Grants to Fund New Projects
Staffing Level
of New Nursing Home Complaint Unit Not Justified
New Tobacco Settlement
Fund
Tobacco Settlement
Funds Earmarked for Health Programs
Tobacco Settlement
Fund Not A Reliable Long-Term Funding Stream
Child Health and
Disability Prevention Program
Program Fails
as Gateway to Affordable Health Care
Background
The LAO
Findings
Recommendations
for Improving the CHDP Gateway
Conclusion
Departmental Issues
California Medical
Assistance Program (Medi-Cal) (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
Rapid Spending
Growth in the Current Year
$204 Million
General Fund Deficiency in 2000-01
Budget-Year
Expenditure Growth Significant
Medi-Cal Cost
and Caseload Trends
Budget Forecasts
Growing Caseloads, But Costs Drop Slightly
Overall
Caseload Estimate Reasonable; One Component May Be Overestimated
Setting
Medi-Cal
Physician Rates—A More Rational Approach
Background
The Current
Rate-Setting System
Reforming
the Way Physician Rates Are Set
The Benefits
of the LAO Approach
Other Issues
Los Angeles
County Section 1115 Medicaid Demonstration Project
Medi-Cal
Estimate Should Be Redesigned
Report Needed
on Managed Care and Inpatient Rate Increases
Other Potential
Rate Increases Not Included in the Budget
Antifraud
Expansion Should Increase Savings
Public Health
Breast and
Cervical Cancer Prevention and Treatment Act
Background
Options
for Developing an Expanded Cancer Treatment Program
Options
for Improving Cancer Screening Services
Conclusion
Tobacco
Prevention Program Expansion
Background
Governor's
Proposal Is Flawed
Managed Risk Medical
Insurance Board (4280)
Healthy Families
Program
Expansion of the
Healthy Families Program to Parents
Background
California's
Proposed SCHIP Waiver
Proposal Misses
Opportunities to Improve Health Coverage
Options for
Improving the SCHIP Expansion
Healthy Families
Caseload Overestimated in the Budget Year
Department of Developmental
Services (4300)
Community Services
Program
Early Start
Coordination Not Clear
Developmental Centers
Program
Report on DC
Restructuring Due
Administrative Issues
The DDS Proposal
to Comply With Health Insurance Portability and Accountability Act (HIPAA)
Department of Mental
Health (4440)
The EPSDT Program
Costs Still Soaring
Background
Rising EPSDT
Costs a Continuing Concern
State Could
Take Steps to Address Rapid Growth in Program Costs
Conclusion
Community Services
Program Issues
Realignment
Revisited—An Evaluation of the1991 Experiment in State-County Relations
Report on Treatment
Resources for Out-of-Home Placements Overdue
Institutions
for Mental Diseases (IMDs) Project Could Be Funded With Federal Grant
State Hospital
Issues
Other Funding
Available for ADA Projects
Security and
Alarm Proposal
Administrative
Issues
Health Insurance
Portability and Accountability Act (HIPAA)
Employment Development
Department (5100)
Disability Insurance
Tax Rate Now Complies With Current Law
Unemployment Insurance
Benefits in California
Federal Welfare-to-Work
Block Grant Program
Legislature Needs
Spending Plan for Discretionary WIA Funds
National Emergency
Grant Program
Department of Child
Support Services (5175)
Total Automation
Penalties Could Reach $1 Billion
Child Support Automation
Penalties Overbudgeted
Child Support Automation
Proposal Lacks Detail
Pre-Statewide Interim
Systems Management (PRISM)
Permanent Positions
Are Needed to Support Child Support Automation Activities
Department of Social
Services State Operations (5180)
Department Should
Develop eGovernment Plan
Department of Social
Services CalWORKs Program
Caseload Decline
Slowing
Budget Underestimates
Cost of Providing Statutory Cost-of-Living Adjustment
Impact of MOE Requirement
Budget Proposes
Reductions in County Performance Incentives
Proposal for Current-Year
MOE Reduction Savings Should Be Incorporated Into 2001-02 Budget Process
Advance Drawdown
of TANF Funds May Not Comply with Federal Law
Mental Health and
Substance Abuse Spending Below Appropriations
Child Care Shortfall
Welfare-to-Work
Match Deadline Extended
Welfare-to-Work
Funds Should Be Incorporated Into County Budgeting Process
Over Half of Single-Parent
Adults Will Reach Federal Time Limit in 2001-02
Legislative Oversight:
Cal-Learn Final Report Overdue
Increase County
Flexibility to Assist Working Recipients
Foster Care
Foster Care
Length of Stay
Permanency
for Foster Youth
Children
Remain in FFA Placements Twice as Long as Other Placements
The FFA
Placements Are the Fastest Growing Component of Foster Care
Reducing
Children's Time in FFA Placements
Other Issues
Office
of the Ombudsman for Foster Care
Budget
Underestimates Foster Care COLA
Food Stamps
Program
California
Food Assistance Program
Recent Federal
Changes Create Options
The Vehicle
Asset Test
The Alternative
Vehicle Allowance
The Transitional
Benefit Alternative
Analyst's
Recommendation
Electronic
Benefits Transfer
Delays
May Result in Federal Penalty
Supplemental Security
Income/State Supplementary Program
Budget Underestimates
Cost of Providing Statutory COLA
Supplemental
Security Income/State Supplementary Program Grant Levels
Certain Legal
Immigrants Face Benefit Termination
In-Home Supportive
Services
Wage and Benefit
Increases for Certain IHSS Workers
Budget Does Not
Reflect Likely Savings
Child Welfare Services
Improving CWS Through
Structured Decision Making
Background
Research Indicates
SDM Improves Outcomes
California SDM
Implementation Challenges
Analyst's Recommendations
for Expanding SDM in California
Conclusion
The
CWS/CMS Needs
Strategic Plan
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