Here are some lowlights:
• A decrease of $110.1 million in 2010 11 and $646.3 million in 2011 12 from reducing CalWORKs grants by 15.7 percent and eliminating the Recent Noncitizen Entrants program, effective April 1, 2011.
• A decrease of $49.4 million in 2011 12 from reducing the level at which the state reimburses CalWORKs child care providers, effective March 1, 2011.
• A decrease of $1.4 billion from eliminating the CalWORKs program effective July 1, 2011. This General Fund savings is in addition to the savings resulting from the above CalWORKs reduction proposals, and net of General Fund to be provided to the various programs and departments outside of CalWORKs that currently receive federal Temporary Assistance for Needy Families Block Grant funds.
Proposition 98 Subsidized Child Care Reductions
• A decrease of 200.2 million in current year to eliminate all remaining General Fund support of subsidized child care programs, except for the State Preschool Program and CalWORKs Stage 2, effective April 1, 2011.
• Additionally, cost containment reforms are proposed for all child care programs effective March 1, 2011, that include reductions to current income eligibility limits (from 75 percent of the State Median Income to 60 percent) and reductions to voucher based provider reimbursement limits (from the 85th to the 75th percentile of the 2005 regional market rate survey data, and from 80 percent of the respective licensed limits to 70 percent for license exempt providers). While remaining Proposition 98 funding is eliminated, federal funding remains as budgeted for the neediest families under a less generous subsidy program going forward. These reductions are estimated to result in $1.1 billion in annual savings beginning in 2011 12, including elimination of CalWORKs Stage 2 child care effective July 1, 2011, to conform to the elimination of the CalWORKs program as discussed in the Health and Human Services section.
• Legislation is proposed to establish greater incentives for child care providers and administrative agents, including Alternative Payment agencies, to reduce administrative error rates, to establish sanctions for those agencies that do not meet federal error rate guidelines, and to deter fraud in child care programs by recipients and providers. This proposal will help reduce wasteful spending and, consequently, result in more needy families receiving services with remaining funding in the future.
Food and Other Nutrition Programs
• A decrease of $301 million in 2010 11 and $602 million in 2011 12 to the Food Stamp and Child Welfare Services programs from shifting county mental health realignment funding to county social services programs. This adjustment eliminates the majority of funding for county mental health services and retains only the amount necessary to fund mandated mental health services.
• A decrease of $15 million in 2010 11 and $69.4 million in 2011 12 from eliminating the California Food Assistance Program effective April 1, 2011.
• A decrease of $18.1 million in 2010 11 and $93.1 million in 2011 12 from eliminating all Drug Medi Cal programs with the exception of the Perinatal; Early and Periodic Screening, Diagnosis, and Treatment; and Minor Consent Programs. This elimination of services is assumed to be effective April 1, 2011.
Other Health and Human Services
Health and Human Services
Healthy Families
• A decrease of $2.3 million in 2010 11 and $11.3 million in 2011 12 by eliminating vision coverage. This proposal would take effect April 1, 2011, after appropriate provider and beneficiary notification.
• A decrease of $6.2 million in 2010 11 and $25 million in 2011 12 by increasing monthly premiums in families with incomes from 150 to 250 percent of the Federal Poverty Level (FPL). Premiums would increase for the income group from 150 to 200 percent of the FPL by $14 per child (from $16 to $30) and a family maximum for three or more children by $42 (from $48 to $90). Premiums would go up for the income group from 200 to 250 percent of the FPL by $18 per child (from $24 to $42) and a family maximum for three or more children by $54 (from $72 to $126). No increase would result for families with incomes under 150 percent of the FPL. This proposal is consistent with what other states have done and would take effect April 1, 2011, after appropriate provider and beneficiary notification.
• A decrease of $6.8 million in 2011 12 due to increasing co payments for emergency room visits from $15 to $50 ($5.3 million) and adding co payments on hospital inpatient services of $100 per day with a $200 maximum ($1.5 million) consistent with cost containment proposals in Medi Cal. This proposal would take effect August 1, 2011, after appropriate provider and beneficiary notification.
• Medi Cal
The Special Session proposes $3.2 million in 2010 11 and $980.3 million in 2011 12 in savings from various Medi Cal Cost Containment proposals. The following specific savings proposals would contain costs in the Medi Cal program (proposed policies require a state plan amendment or federal waiver):
• Limit services and establish utilization controls for $2.9 million in 2010 11 and $281.7 million in 2011 12.
• Eliminate certain over the counter drugs (such as cough and cold medicine) and nutritional supplements ($2.9 million in 2010 11 and $16.8 million in 2011 12). This proposal would take effect April 1, 2011, after appropriate provider and beneficiary notification.
• 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 ($12.4 million in 2011 12). This proposal would take effect July 1, 2011, after appropriate provider and beneficiary notification.
• Limit prescriptions (except life saving drugs) to six per month ($13.6 million in 2011 12). This proposal would take effect July 1, 2011, after appropriate provider and beneficiary notification.
• Limit the number of physician or clinic visits to 10 per year ($238.9 million in 2011 12). The proposed limits are consistent with the aggregate utilization of these services at the 90th percentile of Medi Cal enrollees. This proposal would take effect June 1, 2011, after appropriate provider and beneficiary notification.
• (2) Increase cost sharing for $0.3 million in 2010 11 and $698.6 million in 2011 12.
• $5 co payments on physician/clinic/dental/and pharmacy ($3 for the relatively lower cost preferred drugs and $5 for others) visits ($0.3 million in 2010 11 and $360 million in 2011 12). This proposal would take effect July 1, 2011, after appropriate provider and beneficiary notification.
• $50 co payment on emergency room visits ($142.1 million in 2011 12). This proposal would take effect July 1, 2011, after appropriate provider and beneficiary notification.
• $100 per day co payment and $200 maximum for hospital stays ($196.5 million in 2011 12). This proposal would take effect April 1, 2011, after appropriate provider and beneficiary notification.
• A decrease of $14.8 million in 2010 11 and $120.1 million in 2011 12 by eliminating Full Scope Medi Cal for Certain Immigrants. This proposal includes that elimination of full scope Medi Cal for adult Newly Qualified Immigrants (legal immigrants who have been residing in the United States less than five years), immigrants Permanently Residing Under the Color of Law, and Amnesty Immigrants who are not defined as eligible Qualified Immigrants under federal law. Pregnant women would be excluded from this policy. This proposal would take effect June 1, 2011, after appropriate provider and beneficiary notification.
• A decrease of $20.5 million in 2010 11 and $188.9 in 2011 12 by eliminating Optional Adult Day Health Care Benefits. This proposal would take effect June 1, 2011, after appropriate provider and beneficiary notification.
• A decrease of $2.3 million in 2010 11 and $16.1 million in 2011 12 by rolling back the rate increase for Family Planning Services. This proposal would rescind substantial discretionary rate increase authorized by Chapter 636, Statutes of 2007, for family planning services. This proposal would take effect May 1, 2011, after appropriate provider notification.
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