California State Budget - May Revise Update Chart
August 13, 2010

Department of Developmental Services (DDS)

$61.6 million in additional savings when the $334 million saved in the current year is annualized to a full year

Happened as a result of the budget approved in 2009-10

DDS

$60.9 million in savings, by extending the 3% payment reduction for regional center operations and for services provided through 2010‑11

Approved as part of the Special Session

DDS

$52.5 million in savings, because state funds will be replaced by new federal funds which will result from an amendment to the current state Medicaid plan

Happened as a result of the budget approved in 2009-10

DDS

State general fund savings of $200 million in the DDS budget through redirection of California Children and Families Act of 1998 (Proposition 10 funds). The Governor's proposal also redirects $300 million in Proposition 10 funds to Department of Social Services programs.

Rescinds this Proposal

A one-time increase of $50 million, provided by state and local First 5 California Children and Families Commission funding for children receiving services through the Department of Developmental Services

Backfilled with state general fund

DDS

$25 million in additional program cuts to be achieved through reforms developed by the existing stakeholder process which was initially pulled together last year by DDS/community to help achieve a reduction of 334 million. The goal for DDS this year is to achieve an additional $25 million in general fund savings, while maintaining the entitlement to services under the Lanterman Act and ensuring program and service integrity.

Pending as part of the 2010-11 budget

DDS has proposed to achieve these savings by increasing the discount on provider rates and an unallocated reduction to the regional centers from 3% to 4.25%.

Approved reduction of 3.65%

DDS

Cut $42.7 million in general fund dollars to regional centers, to be replaced by reimbursements from the federal Temporary Assistance for Needy Families (TANF) program

Pending

Pending in Conference Committee—fund shift only

--Senate proposes $34 million

DDS

Reduce the staffing levels in the Developmental Centers to coincide with the decrease in the developmental center population.

Pending as part of the 2010-11 budget

Approved

DDS

A decrease of $39 million in 2009-10 and prior years to Regional Centers, and $14.5 million in 2010-11 associated with the increased federal reimbursement for services provided by Intermediate Care Facilities (ICF-DD).

Approved

DDS

An increase of $13.2 million in reimbursement from DHCS to DDS for increased administrative costs and quality assurance fees relating to the active treatment and transportation services to regional center beneficiaries residing in ICF-DDs.

Approved

DDS

Increases funding by $5.2 million General Fund to upgrade the existing fire alarm system at Sonoma Developmental Center, to avoid potential licensing problems

Approved

Department of Education (DOE)

A decrease of $78.5 million for special education, Economic Impact Aid, Child Nutrition and the Charter School Categorical Block Grant

Prior year savings due to decline in enrollment

DOE

An increase of $65 million for the ongoing costs of mandated behavioral assessments and behavioral intervention plans

Pending as part of the 2010-11 budget

Conference Committee

--Rejected $65 million in funding

--Accepted reform through TBL to rid state of mandate while maintaining underlying statute.

DOE

One time shift of $32 million from federal Individuals with Disabilities Education Improvement Act (IDEA) funds to the Early Start program.

Pending as part of the 2010-11 budget

Technical adjustment

DOE

Eliminate funding for need-based, subsidized child care, except for state preschool. Some federal funds would be available for the neediest families under a revised program.

Rejected

DOE

Suspends the AB 3632 mandate so that counties will no longer be responsible for funding mental health services pursuant to a child’s Individualized Education Plan (IEP). While the provision of IEP authorized mental health services will have to be continued by local educational agencies, the transition from the county to educational agencies may create gaps in services for children.

Rejected

--Provides $133 million in State General Funds to fully repay county mental health all outstanding AB 3632

--Continuation of $70 million State General Funds to pay county social services for the residential treatment portion of the AB 3632 program

--Continuation of the $69 million in federal IDEA funds provided to county mental health for services in the budget year. 

Department of Health Care Services (DHCS)

The governor is asking the federal government to increase the permanent federal matching funds rate by 7%, from 50% to 57%. This would be in addition to the temporary 11.59% increase that is already in effect. He calculates that this will save the state an additional $1.8 billion. (The total federal/state cost of the Medi-Cal program is about $30 billion.)

Pending as part of the 2010-11 budget

Rescinded this proposal

DHCS

Cut $104 million by eliminating the Adult Day Health Care (ADHC) program

Rejected by Assembly Subcommittee #1

Rejected by Senate Subcommittee #3

Still on the table

Rejected

DHCS

Cut $118 million by eliminating Medi-Cal for adult immigrants who are lawful permanent residents (LPR) but who have been residing in the United States for less than 5 years. Medi-Cal would continue for immigrants who are permanently residing in the United States under color of law (PRUCOL), immigrants who are not citizens, but remain in the U.S. indefinitely with government permission.

Rejected by Senate Subcommittee #3

Reintroduces this proposal

Rejected

DHCS

Cut $750 million by: a) Limits on services and utilization controls b) Increased copayments, premiums, or both c) Other unspecified programmatic changes

Pending as part of the 2010-11 budget

The May Revise provides more details about the January proposal:

-eliminates over the counter drugs and sets annual caps on hearing aids, DME, etc.

-copayments on emergency room visits and in -hospital stays

copayments for physician/clinic/dental and pharmacy

-enrolls seniors and people with disabilities into managed care with no choice to opt out

Rejected

Rejected

Rejected

Adopted Senate version through 1115 Waiver Process, a process which allows states flexibility in how it spends Medicaid dollars if it is designed to expand coverage without increasing costs.

-state no longer pays Medicare Part D premiums for people who make less than $500 over the Medi-Cal eligibility threshold

Rejected

DHCS

Cut $55 million by delaying payments to institutional providers, such as hospitals and nursing homes

Approved as part of the 2009-10 Special Session

DHCS

Save $26.4 million through increased anti-fraud efforts

Approved as part of the 2009-10 Special Session

DHCS

Eliminates all Drug Medi-Cal programs with the exception of the Perinatal and Minor Consent programs, effective October 1, 2010

Rejected

DHCS

Restores Medi-Cal optometry services for adults that were eliminated in 2009, in order to comply with federal law

Approved

DHCS

A trigger cut to reduce Medi-Cal eligibility to the minimum allowed under current federal law. This would reduce income eligibility for low-income parents from an $18,310 for a family of three to around $13,000. While this cut would not be allowed under the stimulus package until January 1, 2011, it would eliminate coverage for 250,000 Californians in the first six months, 450,000 adults in the year after that, and hundreds of thousands more adults in future years

Would eliminate:

-The Medically Needy (MN) program
-The Medically Indigent (MI) program, and
-The 250% Working Disabled program

Rejected by Assembly Subcommittee #1

Rescinds this proposal because Federal Health reform prohibits it

DHCS

Increases emergency room visit copayments from $15 to $50, and adds a copayment on hospital inpatient services of $100 per day with a maximum of $200

Rejected

DHCS

Eliminate most remaining optional benefits not required by federal law including medical supplies like diabetic test strips, prosthetic limbs, orthotics, wheelchairs and other durable medical equipment, hearing aids and other benefits. This is in addition to other optional benefits that were eliminated as part of last year’s budget (dental services, speech therapy services, podiatric services, audiology services, chiropractic services, acupuncture services, optometric and optician services, psychology services and incontinence creams and washes)

Rejected by Senate Subcommittee #3; Rejected by Assembly subcommittee #1

Imposes caps on these benefits e.g.: hearing aids at $1,510; durable medical equipment at $1,659; urological supplies at $6,435; and wound care supplies at $391. Limits prescriptions to six per month; limits physician or clinic visits to 10 per year.

Rejected

DHCS

3.9% increase to nursing facilities covered by AB 1629

Provides for a two-year rate adjustment of 3.93 percent rate increase in 2010-

11 and up to 2.4 percent in 2011-12 by extending the sunset of the Quality

Assurance Fee to July 30, 2012.

Healthy Families

Reduce Healthy Families program eligibility from 250 percent to 200 percent of the federal poverty level. A decrease of $10.5 million in 2009‑10 and $63.9 million in 2010‑11

Pending as part of the 2010-11 budget

Rescinds this proposal because Federal Health Reform prohibits reducing eligibility

Healthy Families

Increases emergency room visit copayments from $15 to $50, and adds a copayment on hospital inpatient services of $100 per day with a maximum of $200.

Rejected

Healthy Families

Reduce Healthy Families program benefits and increase premiums by eliminating vision coverage and increasing monthly premiums in families with incomes from 151 percent to 200 percent of the federal poverty level by $14 per child or $42 maximum increase per family with 3 or more children.

Rejected by Assembly Subcommittee #1

Increases monthly premiums from $24 per child to $42 per child, and the family maximum from $72 to $126.

Rejected

Healthy Families

Trigger cut to eliminate the Healthy Families program

Rejected by Assembly Subcommittee #1

Rescinds this proposal because Federal Health reform prohibits it

CalWorks

Eliminates CalWORKs program

Rejected

Department of Mental Health (DMH)

Reduce the General Fund by $452.3 million for two years and shift funding for the EPSDT services program and a portion of the Mental Health Managed Care program to the Mental Health Services Act (MHSA/Proposition 63) to make up for the reduction.

Not adopted during 2009-10 special session

Not adopted for 2010-11 budget by Senate Subcommittee #3, pending for Assembly

Rescinds this proposal. Restores $452.3 million in General Fund to the Early and Periodic Screen Diagnosis and Treatment (EPSDT) and the mental health managed care program as a result of lack of adoption of the January proposal to redirect Proposition 63 funds to these programs.

Remains fully funded

DMH

Eliminate all remaining state funding for Medi-Cal county mental health services. These include inpatient hospital services, outpatient mental health services including residential services, and targeted case management.

Pending as part of the 2010-11 budget

Mental health services provided under Medi-Cal would be scaled back to only federally required in-patient treatment and medications for adults and EPSDT services for children labeled seriously emotionally disturbed. Only $435 million in county realignment funds would be available for this purpose along with federal funds. All other mental health services, such as outpatient clinic services, crisis management services, psychiatric therapies, and related medically necessary services would not be funded. (See discussion below about community mental health programs)

Rejected

DMH

Further reduce mental health funding in FY 2010-11 by $847 million with the intent to replace it with MHSA money

Not adopted during 2009-10 special session

Not adopted for 2010-11 budget by Senate Subcommittee #3, pending for Assembly

Rescinds this proposal

DMH

Redirects .6 billion in county mental health realignment funds to support food stamps and child welfare. This will eliminate the majority of the funding for county community mental health services. Retains only enough money to fund federally required Medi-Cal mental health services: in-patient treatment and medications.

Rejected

DMH

Suspends the AB 3632 mandate so that counties will no longer be responsible for funding mental health services pursuant to a child’s Individualized Education Plan (IEP). While the provision of IEP authorized mental health services will have to be continued by local educational agencies, the transition from the county to educational agencies may create gaps in services for children.

Rejected

--Provides $133 million in State General Funds to fully repay county mental health all outstanding AB 3632

--Continuation of $70 million State General Funds to pay county social services for the residential treatment portion of the AB 3632 program

--Continuation of the $69 million in federal IDEA funds provided to county mental health for services in the budget year. 

DMH

An increase to the General Fund of $5.7 million due to an adjustment in the State Hospital population.

Approved

IHSS

Cut $77.9 million in the current fiscal year (2009-10) and $872.6 million in 2010-11

Not adopted

Eliminates all previous proposals. Proposes 50% cut to general fund support for IHSS; specifics determined through stakeholder process by July 1

$250 million in savings --$150-190 million to come from a provider tax

--The remainder from yet to be determined sources

--trailer bill to create stakeholder group for additional long term reforms

IHSS

Using the functional index (FI) scores[1] to deny services to certain groups who, in the absence of the services, cannot perform the services themselves. Services would be reduced for individuals with functional index scores below 4

Not adopted

IHSS

Limiting state funding for provider wages to a percentage of the minimum wage of $8.00 per hour, plus $0.60 per hour for provider benefits

Not adopted

IHSS

Trigger cut: If the federal matching rate for Medi-Cal is not increased to 57%, and other federal funding increases are not forthcoming, the Governor proposes to eliminate the IHSS program

Rejected by Budget Sub Committee #3; Pending as part of the 2010-11 budget

Rejected

Supplemental Security Income/State Supplementary Program (SSI/SSP)

Reduce the Supplemental Security Income/State Supplementary Program (SSI/SSP) by $21.8 million in 2009-10 and $285.2 million in 2010-11 by cutting SSI/SSP grants for individuals to the federal minimum from $845 to $830 per month

Pending as part of the 2010-11 budget

Delays implementation of this proposal until October 1, 2010

Rejected

Cash Assistance Program for Immigrants (CAPI)

Eliminate the CAPI program that provides state-only benefits to 10,800 legal immigrants. This results in an $8.1 million savings in 2009-10 and a $107.3 million savings in 2010-11.

Pending as part of the 2010-11 budget

Delays implementation of this proposal until October 1, 2010

Rejected