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Health and Human Services in California

www.cpr.ca.gov

California

Has the most racially and ethnically diverse state in the nation

Has 12% of the total United States population

4.2 million or 12.5% of the population is over age 62 and growing; 1.7 million more people are between ages 45 and 60 than in 1990, a 43% Increase

Health and Human Services in California

$64 Billion Total Budget for FY 2004-05

29% of all expenditures in the State Budget

The budget for HHS is greater than the total budget of 47 other states

Other Facts about California

Income support is provided to 2.4 million and 400,000 receive food stamps

Medi-Cal pays $3.2 billion for nursing home services or 65% of the total revenues for the industry in California

50.9% of persons with mental disorders also have an alcohol or drug disorder, 2.7 million people

HHS partners with businesses to provide jobs and consumer protection: 7000 public and private licensed health care facilities; 6350 licensed laboratories

Medi-Cal service costs per enrollee are the lowest in the nation

The HHS Team

20 current and former State employees

Four former Deputy Directors, One Former Director, and One former Under Secretary of HHS

Nearly 500 years of state experience

KEY PREMISE – PUBLIC PERCEPTION

Most Californians believe that government can be reduced without an impact on services

Key thought as we proceeded through the review

In the past, budget reductions were made in benefits and services; CPR found ways to save over $1 billion annually without reducing services

CPR charted new territory; we looked across programs to focus the mission and combine efforts and resources without reducing services

CPR found scattered responsibility for services and confusing for the public

HEALTH AND HUMAN SERVICES

33 issues

108 recommendations

$4.9 Billion in savings over five years

Realignment Issues

Eligibility processing is costly and outdated

Health and Human Services Programs have fragmented responsibility

Child Support Programs under-perform

Realignment Recommendations

Use technology to consolidate eligibility processing

Convene a workgroup of State and County officials to develop clear responsibilities for Health and Human Services

Permit competitive bidding for the operation of local Child Support Programs

Children’s Services Issues Child care system is cumbersome and complicated

Criminal background checks are not done on all child care providers

Child care reimbursement rates are not linked to quality standards

State foster care system is in crisis and needs leadership

Foster care children need permanent homes

Childrens’ Services Recommendations Combine current child care into two systems: One

for CalWORKS and one for subsidized low-income. Limit payments for all providers who have do not

have background checks Reduce reimbursement rates for providers who do

not have formal education or training Create an assessment tool; Publish annual “Report

Card” for foster care operations Use celebrities for public service announcements

promoting adoption; Streamline clearance requirements

Public Health, Mental Health and Other Services Technology is not being utilized in programs Funding for public health is too burdensome and

complex Protecting California’s public health needs better

coordination Separate administration of mental health and

substance abuse does not maximize service Vocational Rehabilitation does not perform well

compared to other states HIV reporting is unnecessarily complex

Public Health, Mental Health and Other Services Recommendations

Use State’s EBT network to deliver WIC benefits

Establish a statewide on-line immunization registry

Streamline administration of funding with local health departments

Create a State Public Health Officer Consolidate State departments administering

mental health and alcohol and drug programs Align rehabilitation services with other state

employment programs Implement a names-based HIV reporting system

Licensing and Oversight Issues

Criminal background checks are inconsistent among state programs

Licensing and oversight for HHS functions are scattered throughout the state

Licensing fee collections are inefficient and not well documents

Licensure fee payers get slow service

Licensing and Oversight Recommendations

• Standardize Criminal Checks among programs

• Guarantee Fee payers receive services

• Improve revenue collections for health licenses

• Streamline oversight of Managed Health Care Plans

• Consolidate HHS Licensing functions

Medi-Cal Services Issues

Federal funds are not always maximized

Technology improvements have not been implemented

Competitive contracting can be used to save additional money

Current policies should be reviewed to insure proper focus

Medi-Cal Services Recommendations Maximize Federal funds by modifying ICF-DD rates

for services to the developmentally disabled

Use technology for other insurance coverage tracking, dual capitation for Medicare and TAR processing

Implement competitive contracting for DME purchases

Re-examine DSH policies to insure core Medi-Cal Services are provided

Transfer IHSS program to DHS to maximize Federal funds

Form Follows Function

Consolidate HHS departments with centers focused around core functions

Consolidate all HHS licensing activities into one area of government.

Consolidate health purchasing functions to assure best possible value

Emphasize public health messages

Conclusion People of California are perceptive

$1.5 Billion per year can be reduced without affecting services

Federal funding can be increased

Government can use technology better

Coordination of services can improve