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February 20, 2008 - Provides details of the LAO alternative budget for expenditure issues. The savings shown are relative to the Governor’s workload budget. In total, these proposals would reduce state costs by $1.8 billion in 2007‑08 and $9 billion in 2008‑09. For each proposal, we provide either (1) a rationale for our inclusion of the item in the alternative or (2) a reference to where we provide such a rationale (typically our companion publication, the Analysis of the 2008‑09 Budget Bill).
February 20, 2008 - The administration proposes to (1) limit the amount of revenues that the General Fund could receive in any year and (2) implement a system by which the administration could trigger across-the-board reductions if the state’s budget situation declined. Although the measure would help even out the state’s revenues from year to year, it would also be inflexible to legislative decision making on a year-to-year basis and would fail to prioritize state spending. Consequently, we recommend that the Legislature reject the proposed changes. We provide, instead, some alternatives it could consider which build upon the positive aspects of the Governor’s proposal.
February 20, 2008 - The Governor’s budget includes almost no new revenue-raising proposals. Given the magnitude of the budget problem, we examine the state’s existing tax structure in the same way as the spending side--with an eye towards reducing inefficient or ineffective provisions. In this section, we discuss proposals that look at the revenue side of the budget. In so doing, we have applied the same approach as with direct spending programs--that is, we have examined tax-related provisions referred to as tax expenditure programs (TEPs)--and recommended changes to those that are not achieving their stated purposes or are of a lower priority.
February 20, 2008 - In contrast to the administration’s across-the-board reduction budget-balancing approach that fails to prioritize state spending, we offer an alternative approach for the Legislature’s consideration. By making more targeted reductions; eliminating or modifying ineffectiveness or nonessential programs; and adding ongoing revenue solutions, we believe this approach offers the Legislature a better foundation to begin crafting a 2008-09 budget that focuses on essential services. This piece provides an overview of the key components of this alternative approach. Our alternative budget would end the 2008-09 fiscal year with a $1.3 billion reserve, and remain balanced through 2012-13.
February 20, 2008 - The cost of mental health drugs in the Medi-Cal Program continues to grow. We estimate the state can save about $5 million General Fund annually by reducing inappropriate prescribing practices. Accordingly, we recommend the Legislature consider the following two options: (1) encourage county participation in the California Mental Health Care Management (CalMEND) Program and (2) expand the use of fixed annual allocations to counties that include the cost of prescription drugs. We further recommend the Legislature approve the Governor’s CalMEND proposal to support three limited-term positions and expand program activities.
February 20, 2008 - The Legislature relies on departments to promulgate regulations to implement laws. The Department of Public Health is slow to promulgate such regulations and consequently, state laws are not being enforced or applied consistently across the state. We recommend the department report at budget hearings on the status of the development and promulgation of unissued regulations.
February 20, 2008 - The state’s current process for administration and funding of over 30 public health programs at the local level is fragmented, inflexible, and fails to hold local health jurisdictions (LHJs) accountable for achieving results. This reduces the effectiveness of these programs because these services are not coordinated or integrated and LHJs cannot focus on meeting the overall goal of improving the public’s health. We recommend (1) the consolidation of certain public health programs into a block grant. and (2) the enactment of legislation that would direct the Department of Public Health (DPH) to develop a model consolidated contract for these and other public health programs (which are not consolidated into the block grant). In addition, we recommend that outcome measures for these programs be developed and that DPH work with counties in using a consolidated contract.
February 20, 2008 - As health care costs continue to face upward cost pressures, many federal, state and private health care programs have turned to pay-for-performance programs as a way of both ensuring the practice of effective and efficient medicine and of controlling costs. Our analysis indicates that the implementation of pay-for-performance program in Medi-Cal could eventually reduce General Fund costs by as much as tens of millions of dollars annually and significantly improve care for patients.
February 20, 2008 - The Governor’s budget proposes to reduce provider reimbursements by $688 million General Fund in 2008-09. We review the potential effects of this proposal and generally find that the proposed reductions might reduce patient access to care or cause patients to obtain care through other more costly access points such as emergency rooms. We recommend that the Legislature reject the proposed reductions for all providers except hospitals. We also recommend additional actions to generate savings in certain areas.
February 20, 2008 - Although IHSS wages represent a significant cost to the state, current law grants local county boards the flexibility to establish IHSS wage levels and requirements for providers who choose to be listed on county registries. In order to improve the IHSS labor force and services to recipients, we recommend, prior to 2010-11, enactment of legislation to modify the structure for state participation in wages to reflect the training and tenure of IHSS providers.
February 20, 2008 - The Governor’s budget proposes to delete the June 2008 and 2009 state statutory COLAs and pass-through the federal COLAs. The Governor estimates that the deletion of these COLAs will result in savings of $23.3 million in 2007-08, and $300.3 million in 2008-09. Based on more recent data, we estimate savings in 2008-09 will increase by $5.3 million to a total of $305.6 million in the budget year. As part of the LAO budget alternative, we recommend reducing grants for couples to 125 percent of the federal poverty level.
February 20, 2008 - The budget proposes to reduce CWS county allocations, resulting in General Fund savings of $83.7 million in 2008-09. We describe the potential impact of this proposed reduction on social worker caseloads and possible subsequent policy consequences resulting from fewer resources. We provide three alternatives to the Governor’s proposal that more narrowly target the reductions in CWS expenditures.
February 20, 2008 - Pre-assistance programs focusing on preparing recipients to enter the labor force within four months and a community service requirement for adults who have received five years of assistance are two policies which would increase participation with less budgetary savings than the Governor. We discuss these alternatives, estimate their impacts, and present an alternative package of CalWORKs reforms which meet the anticipated work participation shortfall.