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February 27, 2013 - In 2012, the Legislature authorized the Coordinated Care Initiative (CCI) as an eight-county pilot to demonstrate the integration of Medi-Cal and Medicare benefits for "dual eligibles"--beneficiaries eligible for both benefits. The CCI will also integrate long-term services and supports (LTSS) under Medi-Cal managed care in the eight counties for dual eligibles and seniors and persons with disabilities covered only by Medi-Cal. The Governor's budget delays the start date of CCI implementation to September 1, 2013, resulting in lower 2013-14 savings than initially anticipated. Joint federal-state decisions regarding key financing and operational aspects of CCI are pending, creating uncertainty regarding the timely and successful implementation of CCI. We recommend that the Legislature clarify the legal status of CCI to go forward and consider authorizing CCI to test greater integration of In-Home Supportive Services--a particular LTSS--under managed care.
February 19, 2013 - Under the Patient Protection and Affordable Care Act, also known as federal health care reform, the state has the option to expand its Medicaid program (known as Medi-Cal) to cover over one million low-income adults who are currently ineligible. Currently counties have the fiscal and programmatic responsibility for the care of the low-income adult population that would be covered by the expansion. The Governor has proposed to adopt the optional expansion, but has outlined two distinct approaches to implementing the expansion—a state-based approach and a county-based approach—and has not indicated a preference for either approach. Under both approaches, the Governor indicates that the expansion will require a reassessment of the state-local fiscal relationship. We find that the expansion would have significant policy benefits, including improved health outcomes for the newly eligible Medi-Cal population. We estimate that fiscal savings to the state as a whole are likely to outweigh the cost of the expansion for at least a decade, although these estimates are subject to significant uncertainty. Despite the significant uncertainty about long-term costs and savings, on balance, we believe the policy merits of the expansion and fiscal benefits to the state as a whole likely will outweigh the costs and potential fiscal risks. We therefore recommend the state adopt the expansion. We also find that the state is in a better position to effectively deliver health services to the newly eligible population. Therefore, we recommend the Legislature adopt a state-based expansion, shifting the fiscal and programmatic responsibility of providing physical health care to the expansion population from counties to the state. Given this shift of responsibility, we further recommend the Legislature redirect a portion of funding currently allocated to counties under 1991 realignment for indigent health care.
November 9, 2012 - Presented to Assembly Budget Subcommittee No. 1 on Health and Human Services, Hon. Holly J. Mitchell, Chair
October 23, 2012 - Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services, Hon. Mark DeSaulnier, Chair and Senate Human Services Committee, Hon. Carol Liu, Chair
May 25, 2012 - Presented to Assembly Budget Subcommittee No. 1 on Health and Human Services, Hon. Holly J. Mitchell, Chair
May 22, 2012 - Presented to: Senate Budget and Fiscal Review Subcommittee No. 5 on Corrections, Public Safety and the Judiciary, Hon. Loni Hancock, Chair.
May 2, 2012 - Presented to: Assembly Budget Subcommittee No. 1 on Health and Human Services Hon. Holly J. Mitchell, Chair
May 1, 2012 - Presented to: Assembly Health Committee, Hon. William W. Monning, Chair and Assembly Revenue and Taxation Committee, Hon. Henry T. Perea, Chair
April 30, 2012 - The FI$Cal project recently completed a procurement and selected the vendor who will build FI$Cal, the state's single, fully integrated financial information system. Project staff has submitted several documents to the Legislature, including a special project report that updates the project plans, a report to the legislature that includes information on the procurement, and a budget request for $89 million ($54 million General Fund) and 86 new positions in order to begin the first year of system development. This report (24 pages): (1) provides an extensive background on the project; (2) describes the innovative procurement process that state staff conducted to secure vendor services to build the FI$Cal system, including information on the procurement results; (3) reviews the FI$Cal project plans as explained in project documents; and (4) analyzes features of the project’s proposed plans and offers recommendations to the Legislature as it considers the budget request and the future of the system. Based upon our analysis of the proposed plans and review of project status, we believe that the benefits of proceeding with FI$Cal development at this time outweigh the costs of the project. In addition to the inherent benefits derived from having a modern, fully integrated financial information system for the state, proceeding with FI$Cal would also avoid substantial costs associated with replacing various individual financial management systems over the next several years. However, we recognize the tight budget times requiring the Legislature to make difficult decisions regarding programmatic reductions. Therefore, should the Legislature wish to proceed with the project, we offer alternative funding options that reduce the state’s reliance on General Fund monies to pay for the project in the short term. These options include the state's GS $Mart loan program, vendor financing, and advanced payments from the special funds for the first few years of system development. Additionally, we point out ways the project’s change management and staffing plans to implement FI$Cal statewide could be improved to reduce risk and maximize project benefits.
April 11, 2012 - Presented to Assembly Accountability and Administrative Review Committee, Hon. Roger Dickinson, Chair
March 27, 2012 - Presented to Senate Human Services Committee, Hon. Carol Liu, Chair
March 19, 2012 - The In-Home Supportive Services (IHSS) program—administered at the state level by the Department of Social Services (DSS)—provides in-home care for persons who cannot safely remain in their own homes without such assistance. Since 2009-10, the IHSS program has experienced significant budget-related changes intended to achieve General Fund savings. As part of the 2012-13 budget, the Governor proposes significant changes to the IHSS program. First, the Governor proposes to transition IHSS from a fee-for-service benefit to a managed care benefit. In addition, the Governor proposes to eliminate domestic and related care services for most IHSS recipients who live with another person. We find that this reduction presents significant legal and implementation challenges, and we therefore offer the Legislature two savings alternatives for its consideration. The first alternative is to consider extending a 3.6 percent across-the-board reduction in service hours that is set to expire at the end of the current year. The second alternative is to consider reenacting a reduction in state participation in provider wages to a level, determined by a study, that does not impact recipient access to services.
March 8, 2012 - Presented to: Senate Budget and Fiscal Review Subcommittee No. 4 on State Administration and General Government, Hon. Gloria Negrete McLeod, Chair
March 7, 2012 - Presented to Joint Oversight Hearing on Long-Term Care Integration and Medi-Cal Managed Care, Assembly Budget Subcommittee No. 1 on Health and Human Services and Assembly Committee on Aging and Long-Term Care
March 7, 2012 - Presented to Joint Oversight Hearing on Long-Term Care Integration and Medi-Cal Managed Care, Assembly Budget Subcommittee No. 1 on Health and Human Services and Assembly Committee on Aging and Long-Term Care