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Be Visionary & Innovative
Be Accountable & Efficient
Be Performance Driven
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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
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Eligibility processing is costly and outdated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