LAO 2004-05 Budget Analysis: Health and Social Services Issue-By-Issue TOC
Analysis of the 2004-05 Budget Bill
Health and Social Services
Issue-By-Issue Contents
Overview
Expenditure Proposal and Trends
Caseload Trends
Spending by Major Program
Major Budget Changes
Enrollment Caps and County Block Grant
Other Policy Changes
Crosscutting Issues
Child Care
Background
CalWORKs Child Care System
Non-CalWORKs Child Care System
Current-Year Child Care Reforms
Governor's Budget Proposes Additional Reforms
Eligibility Restrictions
Income Eligibility
Age Eligibility
Stage 3 Eligibility Limits
Eligibility Limits for Nonworking Parents
Weighing the Costs and Benefits of Restricting Child Care
Eligibility
Provider Reimbursement
Family Fees
Proposition 49: After School Education and Safety
Program
When Will Proposition 49 Trigger?
Health and Social Services Enrollment Caps
Most Enrollment Cap Proposals Flawed
Governor's Proposal
Caseload Limits a Standard Practice
Capping Enrollments Raises Issues
Analyst's Recommendation
County Block Grant Proposal
Programs Proposed for Block Grant Would Be a Poor Fit for
Counties
Key Features of the Governor's Proposal
Evaluating the Governor's Block Grant Proposal
Analyst's Recommendation
Quality Improvement Fees
Additional Federal Funds and State Savings Possible Through Provider Fee Mechanism
Background
The Governor's Managed Care Fee Proposal
State Has Opportunity to Expand on Fee Strategy
Analyst's Recommendations
Senate Bill 2
Budget Lacks Funding to Implement Health Insurance
Expansion Measure
Indigent Adult Program
Medically Indigent Adult Program And the Vehicle License
Fee (VLF)
Departmental Issues
Department of Aging (4170)
Consolidating Local Assistance Into Single Block Grant
Department of Alcohol and Drug Programs (4200)
Federal Funding Requirement May Not Be Met
"Remodeling" the Drug
Medi-Cal Program
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
Further Decrease in Current-Year Spending
Budget-Year Expenditure Reduction
Medi-Cal Cost and Caseload Trends
Budget Forecasts Caseload Increase and Dropping Costs
Overall Caseload Estimate Reasonable
Assessing the Governor's 2004-05 Budget Proposals
Litigation Places Savings From Some Rate Reductions in
Doubt
Reject Staff to Process Authorization Requests, But
Provide Necessary Flexibility on Workload
An Agenda for Long-Term Reform Of the
Medi-Cal Program
Proposals to Reform
Medi-Cal Should Be Pursued
Governor Proposes Sweeping Reforms
Restructuring
Medi-Cal Eligibility and Benefits
Expansion of Managed Care
Managed Care Proposal Raises Some Concerns
Analyst's Recommendations
Additional Opportunities for Reform Worth Considering
Failure of County Organized Health Systems Would Increase
State Costs
Background
Why Are COHS Plans in Bad Fiscal Health?
What Would Happen if COHS Plans Ceased Operation?
Options for Addressing COHS Plans' Financial Problems
Analyst's Recommendation
Moving California Toward a Model Antifraud Approach
Background
Toward a Model Fraud Control Strategy
Characteristics of a Model Fraud Control Strategy
A Report Card for the State's Fee-for-Service Antifraud
Efforts
Combating Fraud in Managed Care
A Systematic, Coordinated Antifraud Approach
The Governor's 2004-05 Antifraud Proposal
Analyst's Recommendations
Other Budget and Policy Issues
Additional Oversight Needed for Data Systems Contract
Contract to Monitor Los Angeles County Health Care System
Terminated
Public Health
Budget Proposals
Breast and Cervical Cancer Treatment Program
Transfer of Eligibility Work to Counties Would Be More
Expensive
Child Health and Disability Prevention Program
Background
Governor's Budget Proposal
Major Uncertainties in Gateway Budget Proposal
Genetic Disease Testing Program
Reports on Information System Project Not Submitted
Managed Risk Medical Insurance Board (4280)
Healthy Families Program
Background
Enrollment Cap Proposal Raises Policy Concerns
Budget Reflects Capped Enrollment in the Healthy Families
Program
Governor's Proposal Has Some Advantages
Several Issues Warrant Consideration
Analyst's Recommendation
Choice of Two-Tier Benefit System Worth Considering
Alternatives for Reducing Healthy Families Program Costs
Shifting AIM Mothers Into Healthy Families Could Save
State Resources
Family Contributions Could Be Increased
Benefits Package Could Be Trimmed
Some Children Could Be Shifted to County Coverage
Block Grant May Not Be Feasible
County Health Initiative Matching Fund
Background
Federal Approval of CHIM Still Pending
Access for Infants and Mothers
Background
Governor's Proposal
AIM Mothers Could Also Be Shifted to Maximize Use of
Federal Funds
Reserve Requirement Unnecessary
Department of Developmental Services (4300)
The Regional Center System: Spending Growth Rate Remains a
Fiscal Concern
Background
The Regional Center System
Regional Center Caseload Trends
Program Expenditure Trends
Major Initiatives to Control Costs Show Progress
Evaluating the Governor's 2004-05 Budget Proposals
Caseload Assumptions May Be Low
Title XX Funding Shift Appears Viable Now
Cost Containment Measures Lacking Key Details
Statewide Purchase of Services Standards
Implementation of Parental Copayments
Standardizing Rates
Expansion of the Independence Plus Waiver
Reductions in Regional Center Operations
Analyst's Recommendation
An Agenda for Further Reform
State's Auditing Capabilities Could Be Strengthened
Lanterman Act Could Be Clarified
Nursing Home Rate Restructure Could Increase Federal Funds
Contracted Regional Center Services Could Be Reduced
Conclusion
Developmental Centers Program
Developmental Centers May Be Underbudgeted
Department of Mental Health (4440)
State Hospital Issues
Activation of Coalinga Hospital Could Be Delayed
Background
Evaluating the Governor's Budget Proposal
Analyst's Recommendations
Capping Enrollment and Shifting Some SVPs To Counties
Could Make Better Use of Beds
Background
Governor's Budget Reduction Proposals
Analyst's Recommendation
Additional Funding for SVP Evaluations Not Justified
Background
Governor's Budget Proposal
Analyst's Recommendation
Budget Includes Beds Missing From CDC Budget
Community Program Issues
EPSDT Costs Still Soaring, but Some Progress in Sight
Background
Governor's Proposed Budget for EPSDT
Governor's Proposals for Reducing EPSDT Costs
Additional EPSDT Cost-Reduction Efforts Warrant
Consideration
Analyst's Recommendation
Additional Federal Funds and State Savings Possible
Through Provider Fee Mechanism
Department of Child Support Services (5175)
Update on Required Budget and Allocation Methodology
Improvements
Governor's Budget Proposes Keeping County Share of Child
Support Collections
Withhold Recommendation on Child Support Collections
California's Child Support Automation System
Project Background
Potential for Improved Accountability
Areas of Potential Benefits and Savings
Transferred CCSAS Project Must Include Current Staff and
Project Management
Administration Should Report on Project Transfer
Department of Social Services CalWORKs Program (5180)
Caseload and Grants
Caseload Decline Ends
Budget Suspends Statutory Cost-of-Living Adjustments and
Reduces Grant Payments
Expanding TANF Transfers Results in General Fund Savings
State Spending Budgeted at TANF Maintenance-of-Effort (MOE)
Floor
TANF Transfers
Budget Proposes Significant CalWORKs Reforms
Welfare Reform in California
Framework for Evaluating the Governor's Proposals
Work Participation Reforms
Proposal Requires Job Search While CalWORKs Application Is
Pending
Proposal Requires Aided Adults to Complete A
Welfare-to-Work Plan Within 60 Days of Aid
Proposal Requires 20 Hours of Core Work Activities
Grant Reductions for Sanctioned And Safety Net Cases
Proposal Would Reduce Grant for Sanctioned Cases
Proposal Would Reduce Grant for Safety Net Cases With a
Nonworking Adult
Update: Federal Welfare Reauthorization
Status of Federal Welfare Reauthorization
Major Provisions of Federal Proposals
State Participation Rates
Work Participation Requirements
Work Activities
Universal Engagement
Sanctions
Child Care
Impact on the CalWORKs Program
Federal Proposals Likely to Result in Participation Rate
"Gap"
Update on the State Fiscal Impact
Conclusion
CalWORKs Automation
Withhold Recommendation on Proposed Increased to
Consortium System
Adoptions
Program
Reforming the Adoptions Assistance Program
Background
Growth of AAP
Examining AAP Eligibility and Payment Levels
Overarching Considerations
Analyst's Recommendation
In-Home Supportive Services
Governor Proposes to Restrict Eligibility And Reduce
Provider Wages
Eligibility Restriction
Reducing State Participation in Provider Wages
Reducing Services for Recipients Living With Relatives
Future Proposal for Reducing Service Hours
Comments on the Governor's IHSS Proposal
Eliminating the Residual Program
Reducing Provider Wages
Reducing Services for Recipients Living with Relatives
Establishing a Quality Assurance Program
Analyst's Recommendation
Supplemental Security Income/State Supplementary Program
Budget Proposes COLA Suspensions
Enrollment Cap and County Block Grant For Program Serving
Immigrants
Food Stamps Program
California Food Assistance Program
(CFAP)
Revenue Loss Exceeds Administrative Savings From
Governor's Food Stamp Proposals
Child Welfare Services
Budget for Improving Children's Programs Should Reflect
Legislative Priorities
Governor's Budget Provides $39 Million for Improving
Children's Programs
Redesign Funding Should Be Eliminated
Child Welfare Services/ Case Management System
Background
CWS/CMS Does Not Meet SACWIS Requirements
Federal Government Reduces Funding
Administration Should Consider Two Alternatives
Administration Should Report on Alternatives and Revise
Proposal's Costs
Foster Care
Proposed Foster Care Reforms Lack Necessary Details
Governor's Proposal
Evaluating the Reform Proposal
Options for Reforming Foster Care
Governor's Budget Understates Savings Associated With
Recent Court Decision
Community Care Licensing
Increase Oversight by Establishing a Special Fund
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