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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.
January 25, 2008 - Elizabeth Hill's Senate Testimony on ABX1 and its related initiative.
January 22, 2008 - We analyzed certain fiscal issues related to the health care reform (HCR) plan currently under consideration by the Legislature. We estimated the fiscal impact of HCR using two different assumptions of premiums: $250 per month per person and $300 per month per person. Under the $250 premium scenario there are sufficient revenues to support the program in the first year of operation (2010-11). However, by the fifth year of the program, annual costs exceed revenues by $300 million. Despite annual costs exceeding revenues in the fifth year, the program still has a positive cumulative fund balance because the collection of tobacco tax and employer fees start before program costs are incurred. Under the $300 premium assumption, costs exceed revenues by $122 million in the first year of operation and this shortfall increases to $1.5 billion by the fifth year of the program. In addition, the fund balance shows a deficit of almost $4 billion by the end of that period, even with the early collection of the tobacco tax and employer fees. In addition to the premium level, we have identified a number of other fiscal risks and uncertainties which could negatively affect the fiscal solvency of the plan by more than an additional $1.5 billion annually.
October 31, 2007 - Presented to Assembly Health Committee, Mervyn M. Dymally, Chair
April 23, 2007 - Presented to: Assembly Budget subcommittee No. 1 on Health and Human Services
February 21, 2007 - The Governor proposes to extend health care coverage to California’s uninsured population and to implement specific reforms. The Governor’s proposal would impose an individual mandate requiring all Californians to maintain a minimum level of health insurance, attempt to contain health care costs so that individuals could afford to purchase coverage, and promote various measures meant to improve the overall health of Californians. We conclude that the Governor has presented a comprehensive framework to expand coverage for the uninsured. In addition, the administration has made a serious effort to estimate the programmatic and fiscal impacts of its proposal. We identify a number of legal obstacles and policy issues and conclude that the plan creates fiscal risks to the state potentially reaching several billions of dollars annually.
February 21, 2007 - The budget plan implements Chapter 241, Statutes of 2006 (SB 162, Ortiz) that creates a new Department of Public Health (DPH) and Department of Health Care Services (DHCS) from the existing Department of Health Services. We recommend the Legislature require the administration provide additional information to ensure cost neutrality as required under Chapter 241.
February 21, 2007 - We estimate a shift of veterans from Medi-Cal to the federal Veterans Administration (V.A.) health system could save the state up to $250 million annually, while providing those veterans with quality health care services. We recommend that California join 42 other states participating in a federal data matching process that would facilitate achieving these goals.
February 21, 2007 - We review the proposal for a net reduction of $25 million for Proposition 36 programs, discuss why this reduction might eventually result in increased prison costs, and recommend redirecting funds in order to support Proposition 36 programs at their current level.
February 15, 2007 - Presented to the Senate Health Committee, Hon. Sheila Kuehl, Chair