CPR Principles:

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Health and Human Services in California
CPR Principles

• Put People First
• Be Visionary Innovative

• Be Accountable Efficient
• Be Performance Driven
• Save Taxpayer Dollars

www.cpr.ca.gov
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• 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

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• 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

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• 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

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• 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

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• 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

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• 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

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• HEALTH AND HUMAN SERVICES
• 33 issues
• 108 recommendations
• 4.9 Billion in savings over five years

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• Realignment Issues
• Eligibility processing is costly and outdated
• Health and Human Services Programs have
  fragmented responsibility
• Child Support Programs under-perform

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• 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

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• Childrens 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

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• 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

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

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• Public Health, Mental Health and Other Services
  Recommendations
• Use States 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

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• 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

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• 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

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• 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

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• 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

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• 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

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• 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