State Budget Presentation

1
State Budget Presentation

• How the governors proposal impacts people with
  developmental disabilities and their families

2006 2007 Budget Year
2
Overview

• Health Human Services Chart
• Olmstead Commitment
• Developmental Services
• Education
• Health Services
• Mental Health
• IHSS
• Social Services
• Aging
• Managed Risk Medical Insurance Board

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Health Human Services
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Olmstead

• Advance Community Options through Integration
• Support Assisted Living Options for Medi-Cal
  Beneficiaries residential care facilities for
  the elderly and publicly subsidized housing.
• Expand Access to Nursing Services
• Adult Residential Facilities for Persons with
  Special Health Care Needs

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Developmental Services DCs

• In 2005-06, increase of 4.8 million from the
  2005 Budget Act
• The dc population projected to decline by 229
  consumers
• 1.2 million decrease in reimbursements from the
  rc to use 50 Agnews state employees in the
  community
• The rc budget is decreased by 4.3 million
  because ten fewer consumers will move
• 10.5 million increase to relocate Agnews
  residents, transition and train staff, prepare
  Sonoma dc for transferring residents, and use 100
  Agnews state employees to provide services in the
  community
• 25.2 million increase to rc budget to place 177
  Agnews residents into the community in 2006-07.

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Developmental Services RCs

• Population increase by 8,575 (4.2) consumers to
  213,740 consumers in 2006-07, which includes 177
  Agnews residents who will be moved into the
  community current number 205,165.
• 3.1 billion to support the regional centers, a
  net increase of 215.7 million (159.8 million
  General Fund) from the revised 2005-06 Budget.
• 3 cost of living increase
• Expansion of the Autism Spectrum Disorders
  Initiative
• Continue the temporary cost containment
• Cost controls through the contract process with
  rc.

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DDS 3 COLA

• 67.8 million for CCF, day programs, hab
  services, respite agencies, and vouchered
  respite, SLS, transportation, and look-alike day
  programs).
• Rates will be held to the 3 percent increase for
  cost containment.
• The Budget also includes 824,000 for a 3 percent
  rate increase to hab services administered by
  DOR.
• 8.3 million for minimum wage increase

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DDS ASD Initiative

• 2.6 million to expand the Autistic Spectrum
  Disorder (ASD) Initiative.
• This includes 1.9 million for rc to provide a
  new ASD program coordinator and clinical
  specialist in each rc.
• Includes funding for DDS to establish and
  coordinate ASD Resource Centers at the 38
  community FRCs and to implement and monitor this
  effort.
• Includes 680,000 for training professionals on
  best practice guidelines, screening, diagnosis,
  assessment of autism, and develop new best
  practice guidelines on the treatment and
  intervention.

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DDS Temporary Containment

• Continue the temporary cost containment
  measures
• Contracted services rate freeze
• Day Programs and In-Home Respite Rate Freeze
• Habilitation Services Rate Reductions and Freeze
• Community Care Facility Service Level Freeze
• Suspension of Non-Community Placement Plan
  Start-up
• Elimination of SSI/SSP Pass Through
• Also includes the continuation of the delay in
  intake from 60 to 120 days.

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DDS Contracting POS Standards

• 7.6 Million Expense
• 6 Million Clinical Administrative Staff to
  review to
• determine if the least costly or no cost
  alternatives could be obtained and determine
  service standards.
• make determination on the following services
  Supplemental services, Assistive Technology,
  Environmental Adaptations, Behavioral Services,
  Specialized medical or dental, and therapeutic
  services.
• This staff will also be involved in the
  anticipated increase in mediations and
  administrative hearings.
• 1.6 million in operations

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DDS Contracting POS Standards

• 3 Million GF Savings
• Scoring 14.3 million dollars savings by
• Using the least costly vendor who will meet the
  consumers needs
• Clarifying parents responsibility for purchasing
  services
• Specifying the preference for using less costly
  group, as opposed to individual, services if the
  consumers needs can otherwise be met
• Requiring regional centers to inform families and
  consumers annually of the services purchased on
  their behalf
• Ensuring regional centers establish and use an
  internal review process prior to authorizing the
  POS
• Establishing a maximum expenditure level for
  supported living services for an individual
  consumer

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DDS Other Items

• 2 million expense ICF Delay in certification
• 200 Thousand expense Medi-cal Dental Cap of
  1800 annual.
• SDS Waiver delay due to CADDIS Delay
• Rate Standardization Project and SLS regulation
  changes
• More money for Capitol People First case
• 30,000 to Sac State to do budget projections
• Changes to IDEA expected to cost regional centers
  more money due to requirement for child outcome
  data, new due process procedures, etc.
• Major CADDIS problems.

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Education

• 5.18 COLA 161.6 million for special education
• 6.5 million for special education to fully fund
  statutory ADA growth
• A local property tax increase of 17.4 million
  and an increase of 16 million in federal funds.
• A one-time increase of 4.5 million GF in 05-06
  to fund transition of the Special Education
  administrative hearings contract from a private
  vendor to the OAH.
• An augmentation of 288,000 federal funds to
  support 3 IT positions in 06-07.
• Continues 100 million in special education
  funding in the Department of Education budget for
  MH services to special education pupils as
  required by IDEA.
• 50 million non-Prop 98 GF set-aside in the
  Commission on State Mandates budget for funding
  MH services.

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Health Services

• 34.2 million more to promote and maximize
  enrollment in Medi-Cal and the Healthy Families
  Program (HFP), improve the retention of children
  already enrolled, and support county-based
  efforts to enroll eligible children in existing
  public programs.
• Emergency preparedness through public awareness
  efforts (14.3 million GF in 2006-07 and 3
  million General Fund in 2005-06).
• Public education to promote awareness of Medi-Cal
  and HFP, emphasize the importance of health care
  coverage to a child's health, and encourage
  parents to enroll their children.
• Increasing Enrollment of Seniors and Persons with
  Disabilities in Medi-Cal Managed Care
• Implementing Care Management Demonstration
  Projects for High-End Users

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Health Services

• Reform to combat fraud and maximize resources in
  Adult Day Health Care Program by hiring nurses to
  inspect facilities and eliminating the use of a
  flat rate - 19.3 million savings.
• Freeze states contribution to County
  Administration Salary and Overhead Reimbursements
  42.4 million savings
• Transfer the remaining unencumbered fund balance
  of 1.1 million from the Tobacco Settlement Fund
  to the General Fund.

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Mental Health

• Civil Rights for Institutionalized Persons Act
• Activation of Coalinga State Hospital
• Community Mental Health Services
• Early and Periodic Screening, Diagnosis, and
  Treatment Program
• Mental Health Services to Special
• Education Pupils (AB 3632)
• Mental Health Services Act (Proposition 63)

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IHSS

• 1.3 billion General Fund for the IHSS program in
  2006-07.
• 4.1 percent increase from the revised 2005-06
  budget.
• The average monthly caseload is estimated to be
  396,000 recipients in 2006-07,
• 6.4 percent increase over the 2005-06 projected
  level.
• First time in several years there is no proposal
  to cut.

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Social Services

• Revise Welfare Reform Methodology and
  Implementation
• Recover CalWORKs Child Care Expenditures
  Associated with Welfare Reform
• Delay CalWORKs Pay for Performance Allocation
• Reduce County Single Allocation for CalWORKs
• Limit Child Care Expenditures Counted Toward the
  Maintenance-of-Effort (MOE)
• Continue Sponsor Deeming Period for the Cash
  Assistance Program for Immigrants
• Continue federal Supplemental Security Income
  Cost-of-Living Adjustment (SSI COLA) General Fund
  Savings Adjustment
• Suspend the Fee-Exempt Live Scan Program

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Aging

• Benefiting from the minimum wage increase will be
  some non-state employees working in Health and
  Human Services programs whose compensation costs
  are directly funded through grants and other
  subventions to local service providers.
• 500,000 General Fund for Senior Community
  Employment Service, a program that provides
  subsidized employment to low-income seniors.

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MRMIB

• 1.2 billion for the MRMIB, which reflects an
  increase of 125.8 million above the revised
  2005-06 budget and 235.2 million above the 2005
  Budget Act.
• Managed Risk Medical Insurance Program
• Healthy Families Program
• Enrolling Eligible Children in Health Care
  Programs
• Access for Infants and Mothers

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MRMIP

• 40 million for health care coverage to medically
  high-risk individuals and the medically
  uninsurable who are denied coverage through the
  individual health insurance market.
• Program enrollment is capped at the level of
  annual funding provided - 80 persons on the
  waiting list.
• The program currently provides benefits to a
  total of 8,700 persons, with primarily serving
  their post enrollment waiting period.
• Subscribers who have been in the program for 36
  months are transitioned into guaranteed-issue
  coverage offered by health plans in the
  individual insurance market.

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Healthy Families Program

• HFP provides low-cost health, dental, and vision
  coverage to eligible children from birth to age
  19.
• an increase of 50 million General Fund, or 15.3
  are projected to grow
• Enrollment that is projected to grow from 827,300
  to 933,100 for a total increase of 105,800
  children, or 1 2.8 percent.

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Healthy Families Program
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Childrens Health Programs

• Activities to encourage the enrollment of
  eligible children into HFP
• Streamline Enrollment Processes for Children's
  Health Programs
• This program change will encourage the use of the
  electronic application Health-e-App)
• Increase the Number of Successful Applicants for
  Children's Health Programs

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Access for Infants and Mothers

• The expenditures for this program are projected
  to decrease from 11 7.4 million in 2005-06 to
  11 4.5 million in 2006-07, for a total decrease
  of 2.9 million, or 2.5 percent.
• The decrease in funding for 2006-07 is primarily
  the result of the enrollment of infants born to
  AIM mothers directly into HFP, which began in
  2004-05.
• Number of infants in the AIM will decrease from
  an average monthly enrollment of 6,300 in 2005-06
  to less than 700 in 2006-07, with the last child
  aging out by mid-year.
• During this period, enrollment of women is
  projected to increase from 10,700 in 2005-06 to
  12,100 in 2006-07 for a total increase of 1,400
  women, or 1 3 percent.

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Recommendations to the Board

• An immediate response to the Governors proposals
  to continue the cost containment measures and
• the contracting arrangement for POS standards