2010-11 State Budget To Date: Health & Human Services Impacts
September 21, 2010
PROGRAM / GOVERNOR’SPROPOSAL / COUNTY IMPACTS / Legislative Action / Conference Committee action / DEMOCRATS’ AUGUST BUDGET PROPOSAL /
CalWORKs / The Governor proposed the outright elimination of the CalWORKs program on October 1, 2010
State GF savings of $1.1 billion in 2010-11.
Loss of $4.2 billion in federal funds. / Up to $2 billion cost shift to counties.
The CalWORKs program injects $3.7 billion in federal TANF funds annually into the California economy, and 75 percent of recipients are children. If the program is eliminated, more than 540,000 families would seek County General Assistance. Counties are solely responsible for funding General Assistance, and could see a nearly $2 billion increase in costs as a direct result of the elimination of CalWORKs. Would also increase costs for homeless assistance and foster care. / Assembly rejected on 5/19/10
Senate rejected on 5/25/10 / Not in Conference / Maintains current CalWORKs program
CalWORKs / Would lower the maximum monthly grant amount for a family of three from $694 to $585. Would eliminate eligibility for approximately 8,400 families.
$604 million in 2010-11 / Unknown county costs.
Threatens the CalWORKs mission of moving families into self-sufficiency and will push families and children deeper into poverty. Will likely also increase homelessness.
Reducing grants reduces the economic multiplier effect of the grants in local economies.
Would also significantly impact California’s benefit of an extension of the federal ARRA TANF Emergency Contingency Funds. The enhanced emergency matching rate is 80 cents for every 20 cents spent by the state. Grant cuts erode the benefit of the extension. / Assembly rejected on 5/26/10
Senate rejected on 5/25/10 / Not in Conference / Maintains current CalWORKs grant levels
CalWORKs / Eliminate benefits to legal immigrants who have been in the U.S. less than five years.
Approximately 24,000 recipients (in 9,500) cases would lose eligibility for CalWORKs benefits and services as of October 1, 2010.
$40.6 million GF in
2010-11
$54.5 million GF in 2011-12 / Millions of dollars in increased costs to counties.
Will increase General Assistance costs for counties as ineligible families seek aid.
Also, eliminates welfare-to-work services for ineligible families.
Reducing grants reduces the economic multiplier effect of the grants in local economies. / Assembly rejected on 5/26/10
Senate rejected on 5/25/10 / Not in Conference / Maintains current CalWORKs benefits for this population
CalWORKs – Child Care / Child Care RMR Rates: Reduce the reimbursement rate limits from 85th percentile of the market rate to the 75th percentile. The Administration is also proposing to decrease funding in 2010-11 for Stage 1 Child Care by $103 million.
Stage 3 Cut: The Governor had proposed in January to enact a unallocated reduction of $122.9 million to Stage 3 Child Care, but released a different plan in July: reduce the family income limit for all subsidized child care programs (except state preschool) from 75 percent of the State Median income to 60 percent.
Rates (RMR) - $41.1 million in 2010-11
Stage 1 cut - $103 million
Stage 3 cut - $122.9 million
(revised – see description) / Threatens the CalWORKs mission of moving families into self-sufficiency if child care slots are not available. / Assembly rejected on 5/27/10
Senate:
RMR Rates: rejected but also reduced the Governor’s proposal by $1000 to put the issue before the Conference Committee on 5/27/10
Stage 3: rejected but approved $1000 reduction and placeholder language to consider changes to the family fee structure and approved a $1000 reduction to Stage 3 child care to put it into conference. / RMR Rates: Rejected Governor’s proposal; kept reimbursement rate ceilings as follows:
- 85th percentile of the RMR for licensed providers
- 90 Percent of the 85th percentile for unlicensed providers
Stage 3: rejected Governor’s proposal
8/4/2010 / Conforms to Conference Committee action
Child Care / Eliminate the remainder of state funding for need-based, subsidized child care except preschool, for a loss of subsidized slots for approximately 142,000 children; $594 million in federal funds would remain for 78,000 children.
$1.2 billion GF / Unknown county costs.
Currently 200,000 children are on wait lists for subsidized child care.
Potential county costs associated with increased homelessness and foster care as families lose employment. / Assembly rejected on 5/19/10
Senate rejected on 5/25/10 / Not in Conference / Maintains current subsidized child care program
Cash Assistance Program for Immigrants (CAPI) / This proposal would eliminate benefits for 10,886 aged, blind, and disabled legal immigrants.
$73.6 million GF in 2010-11
$100.7 million GF in 2011-12 / Millions of dollars in increased costs to counties.
This is a direct cost shift to counties, as many former CAPI recipients would be eligible for county General Assistance programs.
The cumulative impacts of the CAPI, CFAP and CalWORKs legal immigrant eliminations could cost counties approximately $12.5 million per month. / Assembly rejected on 5/26/10
Senate rejected on 5/25/10 / Not in Conference / Assumes maintenance of CAPI program at current levels
California Food Assistance Program / Eliminate food benefits to low-income legal non-citizens, affecting approximately 37,258 legal immigrants.
$45.1 million GF in 2010-11
$49.5 million GF in 2011-12 / Some of these recipients may be eligible for county General Assistance programs. / Assembly rejected on 5/26/10
Senate rejected on 5/25/10 / Not in Conference / Assumes maintenance of CFAP program at current levels
Mental Health: Realignment Funding / The Governor proposed eliminating $602 million in Realignment funding for local mental health programs.
Under this proposal, the state would redirect Realignment funding from the Mental Health subaccount that is generated by sales tax to the Social Services subaccount.
No state General Fund savings to mental health. Would generate $602 million GF savings in Child Welfare and Food Stamps Administration. / $602 million cut to county mental health funding.
Counties would no longer have revenues to pay for Institutes for Mental Disease (IMDs), state hospitals, acute psychiatric, jail medical, or indigent services. Expect costs shifts to county jails, state prisons, emergency rooms. Will destroy the continuum of mental health services available in California. / Assembly rejected on 5/20/10
Senate rejected on 5/26/10 / Not in Conference / Maintains current Mental Health Realignment Funding
Social Services:
New County Shares of Cost / Decrease GF expenditures on children’s programs and Food Stamps Administration by $602 million and replace with mental health realignment funds.
$602 million GF savings in Child Welfare and Food Stamps Administration. / This is a direct cost shift of $961 million to counties.
Counties would assume $961.4 million in new shares of costs. Under the proposals the new shares of cost would be:
§ Foster Care: 20% state/80% county (currently 40% state/60% county)
§ Foster Care Administration: 52% state/48% county (currently 70% state/30% county)
§ Adoptions: 20% state/80% county (currently 75% state/25% county)
§ CWS: 20% state/80% county (currently 70% state/30% county)
§ Food Stamps Administration: 19% state/81% county (currently 70% state/30% county)
Proposal assaults the existing realignment structure.
Proposal destroys the state-county partnership.
There is no policy basis for the proposal and it is simply a cost-shift to counties.
Proposal fails to identify and describe the programs that would be eliminated and the effects on existing service populations.
Proposal does not work mechanically. This proposal would require 58 different sharing ratios or it will be inequitable among counties.
Proposal does not work legally. The County Counsels’ Association has determined that the savings redirection proposed by the Governor violates Proposition 1A (2004).
Realignment funded programs have already experienced $800 million in reductions. With the declining economy resulting in reduced local revenues, the existing realignment funded programs have experienced year-over-year losses in funding, totaling $800 million. / Assembly rejected on 5/20/10
Senate rejected on 5/26/10 / Not in Conference / Maintains current social services cost sharing structure
Social Services:
New County Shares of Cost Related to IHSS “Savings” / Use savings from the IHSS May Revision proposal to decrease GF expenditures on children’s programs and Food Stamps administration.
The Administration proposes redirecting the county “savings” created by IHSS cuts.
$257 million in county savings resulting from the May Revision IHSS proposal to offset state costs in Foster Care ($91 million), Foster Care Administration ($6 million), and AAP ($160 million). / See above. / The Legislature rejected the redirection of any IHSS savings. / Not in Conference / Does not include redirection of IHSS “savings”
(see IHSS below)
Child Welfare Services / The May Revision continues the 2009-10 $80 million GF veto in children’s services programs.
$133 million ($80 million GF) / $133 million reduction to CWS programs.
There are fewer social workers; caseloads that are far higher than is legally or morally acceptable. Counties do not have adequate programs and support services to offer to families in crisis, and foster children and foster parents are making do without help, too. Programs such as home visitation and family resource centers, which are proven to reduce instances of child abuse and neglect by up to 75 percent, have been cut. Prevention, in the form of family services and early intervention training, is now a thing of the past in many counties. In short, more children are now exposed to harm. / Assembly restored the full $80 million on 4/28/10
Senate restored the full $80 million on 5/24/10 / Not in Conference / Includes the $80 million veto restoration
Child Welfare Services / Rate increase for group homes and additional state GF.
The enhanced state funding reflects the costs associated with the 32% group home rate increase resulting from the California Alliance of Child and Family Services v. Cliff Allenby court ruling.
The May Revision includes revenue of $268.5 million ($93.9 million GF) in 2010-11 / Counties will have an increased share of cost associated with the rate increase. / Assembly approved on 5/26/10
Senate approved on 5/24/10 / Not in Conference / Not clear; seems to assume increased rates to cover costs
AB 3632: Mental Health Services for Special Education Pupils. / Suspending the AB 3632 mandate
Under federal law, responsibility to provide mental health services to special education services will fall back to schools. In short, the state expects counties to provide only mental health services that are reimbursable through Medi-Cal, which draws down federal funding.
$52 million GF in 2010-11 / Could save counties money to the extent that counties take action to stop providing services.
Suspending the mandate involves stopping payments and disrupting services to children and youth in active treatment.
Schools will need to figure out how to provide services, which may or may not involve contracting back with counties. This will shift costs to schools.
Counties employ staff that work on AB 3632, in addition to the private providers that counties contract with for services. Counties will need to layoff staff and eliminate contracts. Depending on contract terms, services will not be able to halted on the date that the budget goes into effect.
County mental health structure that is eliminated will not be able to be rebuilt if the Legislature re-funds the mandate in a year or two.
It is unclear what kind of recourse parents will have if treatment for their special education pupils is disrupted to the elimination of contracts.
It is unclear whether the concerns that prompted the Legislature to make counties responsible for mental health services continue to exist in schools. / Assembly rejected proposal, but provided $52 million and requested budget bill language that specifies these funds to be used for 2010-11 claims on 5/26/10
Senate rejected the proposal and reduced the appropriation by $1000 to put the issue before the Conference Committee on 5/27/10 / The Conference Committee approved several things in this area:
The Committee rejected the Governor’s proposal to eliminate the state mandate on counties.
The Committee
Approved a deduction of $52 million in General Funds (non-98) to the Department of Mental Health for payment of AB 3632 mandate claims in 2010-11.
The Committee provided an augmentation of $133 million in General Funds (non-98) to the Commission on State Mandates for payment of prior year AB 3632 mandate claims in 2010-11.
The Committee appropriated $3.0 million in one-time federal special education (IDEA) funds and adopted BBL to direct the Department of Education to contract for statewide technical assistance to Special Education Local Planning Areas (SELPAs) regarding best practices in mental health related service delivery for students with disabilities beginning in 2010-11. / Incorporates Conference Committee recommendations
Medi-Cal:
PRUCOL / Eliminate the PRUCOL program for immigrants and people who are Residing Under the Color of Law.
$38.5 million GF in 2010-11 / Unknown county costs.
This proposal will impact county hospitals, clinics, and indigent programs. Patients will present at county hospitals and clinics with more acute medical conditions due to a lack of preventative and routine care. / Assembly rejected on
5/6/10
Senate rejected on 4/26/10 / Not in Conference / Assumes continuation of current PRUCOL program
Medi-Cal
Eliminate Over-the-Counter Drugs / Eliminate reimbursements for certain over-the-counter drugs (such as acetaminophen or cough and cold medicine) and nutritional supplements.
$26 million ($13 GF million) / Unknown county costs.
This proposal may impact county hospitals and clinics. Patients will present at county hospitals and clinics with more acute medical conditions due to a lack of preventative and routine care. / Assembly rejected on 5/27/10
Senate rejected on 5/26/10 / Not in Conference / Maintains current Medi-Cal benefits
Medi-Cal:
Caps on Durable Medical Equipment / Establish a maximum annual benefit dollar cap on hearing aids at $1,510, durable medical equipment at $1,604, incontinence supplies at $1,659, urological supplies at $6,435 and wound care supplies at $391 million.
$7.4 million ($3.8 million GF) / Assembly rejected on 5/27/10
Senate rejected on 5/26/10 / Not in Conference / Maintains current Medi-Cal benefits
Medi-Cal:
Limit Number of Prescriptions / Limit prescriptions, except life-saving drugs, to six per month. Please note that psychotropic drugs are exempt from the cap. $8.4 million ($4.2 million GF) / Unknown county costs.