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


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



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


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


Governor’s Proposals

Nursing Positions Difficult to Fill

Implementing the Reinstatement of Inspections Against State Standards

Analyst’s Recommendations

Foodborne Illness Emergency Response


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


How Do RCs Provide Services for Their Clients?

RC Caseload Below Projected Levels


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


The Governor’s Proposal

JLBC’s Concerns

Analyst’s Recommendation

New Sexually Violent Predator Laws Drive Increased Costs


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


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


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


Analyst’s Recommendation