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LAO 1998-99 Budget Analysis: Health and Social Services TOC
Analysis of the 1998-99 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
Healthy Families Program
New Program to Expand Health Coverage for Children
Federal Legislation Provides New Funding
California's Healthy Families Program Enacted
The Budget Request
Governor's Budget Proposes Net Spending Total of $197 million in 1998-99
Analysis and Recommendations
$1.4 Billion of Federal Funds Will Roll Forward
Federal Approval of Continuing Eligibility in Doubt
Requiring Children in the CCS Program to Enroll in The Healthy Families Program Would Result in Savings
Including Regional Center Services As a Healthy Families Benefit Should Be Explored
Departmental Issues
Department of Aging (4170)
Proposed Expansion Would Not Allocate Funds According to Need
Budget Does Not Reflect Savings From an Increase in Federal Funds
Department of Alcohol
And Drug Programs (4200)
Budget Does Not Reflect Increase In Federal Medi-Cal Sharing Ratio
Department of Health Services
State Operations (4260)
Armed and Over Budget
Filling Positions Would Generate Savings
Phantom Positions Undermine Legislative Oversight
California Medical
Assistance Program (Medi-Cal)
Medi-Cal Benefits And Eligibility
What Benefits Does Medi-Cal Provide?
How Medi-Cal Works
Who Is Eligible for Medi-Cal?
Medi-Cal Expenditures
1997-98 Budget Savings
Budget Year
Medi-Cal Spending and Caseload Trends
Spending Trends
Caseload Declines Change Case "Mix"
The Medi-Cal Estimate
Medi-Cal Estimate Includes Adjustments for Shift to Managed Care
Savings From Uncertainty Adjustments Appear Arbitrary
County Administration Estimate-- Caseload Growth Funding Unnecessary
Expanding Medi-Cal Coverage For Poor Working Families
Are Transitional Medi-Cal Participation Rates Too Low?
Additional Year of Transitional Medi-Cal in Doubt
Plan Needed for Implementing Medi-Cal Eligibility Under Section 1931(b)
Augmentation for 1931(b) Eligibility Determinations Not Justified
Long-Term Care
Department Plans New Payment Approach for Nursing Homes
Public Health
Proposition 99
Family Education Proposal--Redirecting Funds to Existing Program Would Increase Chances of Success
Childhood Lead Poisoning Prevention Program
Administration Renews Request to Implement Federal Abstinence Education Program
Funding Alternatives Available for Emerging Infectious Diseases and Food Safety Programs
Newborn Hearing Screening Proposal Has Merit, But Cost Estimate Needs Justification
California's Litigation Against the Tobacco Companies
Department of
Developmental Services (4300)
Community Services Program
Proposal to Augment Regional Center Case Management Staff Is Incomplete
Proposed Position "Upgrades" and Salaries Are Excessive
Care Facility Training Program Is Overbudgeted
Federal Waiver for Habilitation Services Could Result in State Savings
Legislature Needs More Information On Supported Living Augmentation
Technical Issue--Case Management For Community Placements Overbudgeted
Placement Decisions for DC Residents Should Be Reviewed
Continue Funding for Camarillo Maintenance
New Nursing Staff Should Be Budgeted at First Salary Step
Department of Mental Health (4440)
Inflation Increase Overbudgeted
Employment Development Department (5100)
Federal Welfare-to-Work Block Grant Program
Background
Governor's Proposal
Legislature Has Options
Department of Rehabilitation (5160)
Governor's Proposal Does Not Fund Statutory Rate Increase
Caseload Projections Do Not Reflect Trends
Legislative Oversight: Delay in Submission Of Supported Employment Cost Study
Federal Waiver for Habilitation Services Could Result in State Savings
Department of Social Services
CalWORKs Program (5180)
Current-Year Update of CalWORKs/TANF Program
Major Changes in 1997-98
Recent Federal Action on Welfare Reform
1998-99 Budget Issues
Budget Proposes to Continue Past Grant Reduction and Eliminate Cost-of-Living Adjustment
Defer Expenditure of State Match For Welfare-to-Work Program Until 1999-00
Impact of Budget Reductions in CalWORKs
Budget for CalWORKs Administration Does Not Reflect Savings From Projected Caseload Decline
CalWORKs Employment Services Are Overbudgeted
Establish a TANF Reserve
Foster Care
Budget Underestimates Proportion Of Cases Eligible for Federal Funds
Child Support Enforcement
Child Support Incentive Payment Systems
The Current State Incentive System
Mirroring the Proposed Federal System
Evaluation of the Proposed Federal System
An Alternative Incentive System
Evaluation of the Legislative Analyst's Office Alternative Incentive System
Impact of the Proposals on County Incentive Payments
Legislative Analyst's Suggested "Performance Enhancement Process"
Conclusion
Budgeting Issues
Budget Overestimates Child Support Incentive Payments
Budget Overestimates Effect of Arrearage Distribution Changes
Food Stamps Program
California Food Assistance Program
Supplemental Security Income/
State Supplementary Program
Caseload Growth Is Overestimated
Budget Proposes to Eliminate State Cost-of-Living Adjustment
In-Home Supportive Services
State Plan Amendment Would Result in General Fund Savings
Federal Funds Not Budgeted
County Administration
of Welfare Programs
Food Stamps Budget Does Not Reflect Savings From Projected Caseload Decline
Automation Projects
Special Programs
Licensed Maternity Home Care Program Overbudgeted
Adoptions
Budget Underestimates Proportion of AAP Cases Eligible for Federal Funds
State May Earn Federal Adoptions Incentive Payments
Community Care Licensing Division
Use Special Fund Balances to Increase Technical Assistance and Achieve General Fund Savings