Overview

• Expenditure Proposal and Trends
• Caseload Trends
• Spending by Major Program
• Major Budget Changes
• Other Policy Changes

Departmental Issues

• Department of Alcohol and Drug Programs (4200)
• Reductions to Drug Diversion Programs Likely to Result in Increased State Costs
• Background
• Governor’s Budget Proposes 10 Percent Reductions
• Proposition 36 Programs And Drug Courts Reduce State Costs
• Analyst’s Recommendations
• Reductions Could Be Offset With Other Funds
• Department of Health Care Services (4260)
• Medi–Cal
• Overview of Medi–Cal Budget Proposal
• Key Changes in Current–Year Spending
• The Governor’s 2008–09 Budget Proposal
• Medi–Cal Local Assistance
• DHCS State Operations
• Budget Forecasts Decline in Caseload
• Administration’s Caseload Projections
• Evaluation of the Governor’s Caseload Proposals
• Analyst’s Recommendations
• Some Proposed Reductions to Provider Reimbursement Could Further Limit Access to Care
• Background
• Savings From Rate Reduction Overstated
• Rate Reductions Could Reduce Access to Care
• Other Options to Achieve Savings Are Available
• Analyst’s Recommendations
• Pay–for–Performance Could Reduce Medi–Cal Costs and Improve Patient Care
• What Is Pay–for–Performance?
• Goals of P4P Programs
• Components of Successful P4P Programs
• Current Status of P4P
• Federal Medicare Program Is Experimenting With P4P Programs
• Some State Medicaid Programs Now Operate P4P Programs
• Many P4P Programs Already Operate Within California
• Three Major Types of Managed Care Plans
• Benefits of a Statewide P4P Program in California
• P4P Programs Promote Change
• A Way to Selectively Reward the Best Doctors and Plans
• Moving California Towards P4P
• Providing HIV/AIDS Medications Should Be a Priority
• Department of Public Health (4265)
• Key Budget Proposals
• Reforming Categorical Funding for Public Health Programs
• Background
• Public Health Programs Are Funded By the State in Two Primary Ways
• Categorical Funding for Public Health Programs Creates Problems
• Benefits of Reforming Public Health Funding
• Placer County’s Consolidated Health Contract Pilot Program
• Block Grants Can Unify Program Objectives, Freeing Locals to Achieve Goals
• Reforming the Public Health Funding System
• Conclusion
• Failure to Promulgate Regulations Leads to State Laws Not Being Enforced
• Budget Reduces Direct Sexual Health Related Services
• Managed Risk Medical Insurance Board (4280)
• Healthy Families Program
• Background
• Withhold Recommendation on Budget–Balancing Reductions
• Federal Funding Expires in Budget Year
• Federal Funding Level Temporarily Sufficient
• Level of Federal Funding Uncertain in Budget Year
• Options for Managing Enrollment Consistent With Available Funding
• Developmental Services (4300)
• Regional Center System: Spending Growth Continues
• Background
• How Do RCs Provide Services for Their Clients?
• Governor’s Budget Proposal
• Analyst’s Recommendation
• Report on Potential RC Savings Measures Overdue
• Department of Mental Health (4440)
• The SVP Caseload Likely to Be Below Projected Levels
• Mental Health Managed Care Caseload Possibly Overstated
• Expanded Efforts Could Further Reduce Cost of Mental Health Drugs
• Background
• Cost of Mental Health Drugs Continues to Grow
• Inappropriate Prescribing Increases State Costs
• Medicare Part D
• State Is Taking Some Steps to Reduce Costs and Improve Care
• CalMEND Program Expands Efforts to Improve Care and Reduce Costs
• San Mateo’s Capitated Rate for Mental Health Services
• State May Be Able to Further Reduce Costs for Mental Health Drugs
• Department of Child Support Services (5175)
• Increasing the Child Support Pass–Through
• Revenue Losses Exceed Savings for Certain Proposals
• Fiscal Risks of Delayed Single System Implementation
• California Work Opportunity and Responsibility to Kids (5180)
• Budget Underestimates Cost of CalWORKs COLA
• Maintenance–of–Effort and Caseload Reduction Credit (CRC)
• New Federal Regulations
• Current Work Participation Requirement and Status
• Background
• Deficit Reduction Act Effectively Increases Participation Requirements for States
• Current Participation Rate
• Projected Participation Shortfalls
• Governor’s Reforms Address Participation Shortfall and Achieve Budgetary Savings
• Overview of Governor’s Proposal
• Graduated Full–Family Sanction
• LAO Assessment of Graduated Full–Family Sanction
• Five–Year Time Limit for Children in Safety Net
• Work Incentive Nutritional Supplement (WINS)
• Child–Only Time Limit
• Governor’s Proposals Address Participation
• Governor’s Proposals Likely to Result in MOE Shortfall
• Alternatives to the Governor’s Proposals
• Pre–Assistance Program for Entering CalWORKs Recipients
• Community Service Requirement After Five Years of Assistance
• LAO CalWORKs Reform Package
• Child Welfare Services (5180)
• Budget Proposes Reduction in CWS Allocations to Counties
• Background
• Governor’s Proposal
• Staffing Level Impacts of Proposed Reduction to CWS
• Potential Consequences of Fewer Resources
• Alternatives to the Governor’s Proposal
• Conclusion
• Rethinking the Future of CWS Automation
• Current System
• Federal Statewide Automated Child Welfare Information System (SACWIS)
• Technical Architecture Analysis Alternatives (TAAA)
• TAAA Report Did Not Consider All Possible Alternatives
• Decision to Procure New System
• LAO Alternative
• Comparing New System to LAO Alternative
• Analyst’s Recommendation
• Foster Care (5180)
• Budget Proposes To Reduce Foster Care Rates
• Background
• Potential Impacts of Rate Reductions
• Alternatives to the Governor’s Proposal
• Conclusion
• Supplemental Security Income/ State Supplementary Program (5180)
• Budget Deletes State Cost–of–Living Adjustments
• Background
• Deleting the June 2008 COLA
• Deleting the June 2009 COLA
• Combined COLA Deletion Savings
• SSI/SSP Grant Levels
• In–Home Supportive Services (5180)
• Reducing Domestic and Related Care Hours For IHSS Recipients
• Background
• Governor’s Proposals
• County Administration Proposal
• Domestic and Related Care Reduction
• Projected Savings May Not Be Achieved
• Other Means of Achieving Savings
• Conclusion
• Improving the IHSS Workforce Through Tiered State Participation in Wages
• Background
• Flexibility Leads to County Variance
• County Experience With Tiered Wages
• Opportunity for the Legislature to Condition State Participation in Wages
• Analyst’s Recommendation
• County Administration and Automation Projects (5180)
• The Future of County Welfare Automation Consortia
• Background
• Establishment of the County Consortia Structure
• Consortia Systems Technology
• Recent Re–Procurement Decisions
• How Many Consortia Systems in the Future?
• Legislative Oversight of Consortia Contracts
• Analyst’s Recommendation
• Community Care Licensing (5180)
• Proposed Reduction in Random Inspections Could Impact Compliance With Existing Statute