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The Current Landscape for Children with Special Health Care Needs: Riding the Roller Coaster. Laurie A. Soman Lucile Packard Children’s Hospital March 2, 2010. State FY 08-09 and FY 09-10: The Roller Coaster Accelerates. FY 08-09 18-month budget plan for FY 08-09 and FY 09-10

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the current landscape for children with special health care needs riding the roller coaster

The Current Landscape for Children with Special Health Care Needs: Riding the Roller Coaster

Laurie A. Soman

Lucile Packard Children’s Hospital

March 2, 2010

state fy 08 09 and fy 09 10 the roller coaster accelerates
State FY 08-09 and FY 09-10: The Roller Coaster Accelerates

FY 08-09

  • 18-month budget plan for FY 08-09 and FY 09-10
  • Governor signed budget clearing $41 billion deficit on 2/20/09
  • Longest budget battle and elimination of largest deficit in state history
  • Numerous reductions in health and other services

FY 09-10

  • Continued economic slide results in revised budget for current Fiscal Year 2009-2010
  • Governor signed budget clearing $20 billion deficit on 7/28/09
  • Deep reductions in health and other services
budget cuts and their impact on cshcn the roller coaster ride in 2008 2010
Budget Cuts and Their Impact on CSHCN: The Roller Coaster Ride in 2008-2010
  • Healthy Families Program
  • California Children’s Services (CCS)
  • Early Start Program
  • In-Home Supportive Services (IHSS)
  • Medi-Cal
reductions in healthy families funding bad news good news
Reductions in Healthy Families Funding: Bad News, Good News

Bad News: Major Funding Cuts

  • $194 million deficit in program funding, including $50 million vetoed by Governor in July, 2009
  • MRMIB created wait list for new applicants

-- >80,000 children on list as of September, 2009

-- total wait list estimated to reach 335,000 by June,

2010

  • MRMIB voted to implement disenrollment of current program enrollees beginning October, 2010

-- total disenrollment estimated to reach 585,000 by

June, 2010

reductions in healthy families funding
Reductions in Healthy Families Funding

Good News: Deal Struck to Save Program

  • State First 5 Commission contributed $81 million for coverage of children aged 0-5
  • Increases in HFP premiums and co-pays (e.g. health/vision/dental co-pays to $10) as of November 1, 2009
  • State legislation created managed care plan provider tax for federal match generating funds for program
  • MRMIB rescinded decision to begin disenrollments
  • MRMIB re-opened enrollment to new applicants and cleared children on wait list
reductions in funding for california children s services ccs
Reductions in Funding for California Children’s Services (CCS)
  • Reductions in funding for Medical Therapy Program
  • “Capped allocations” to county CCS programs for local administration of CCS
  • Average reduction of 17% to counties but some counties reduced as much as 58%
  • Reductions resulted in loss of staff and activities:

-- PHLs eliminated in many counties

-- Layoffs of social workers, eligibility workers, and

nurse case managers

-- Cutbacks to Medical Therapy Program services

-- Scaling back or elimination of family-centered

care activities

reductions in funding for regional centers early start program
Reductions in Funding for Regional Centers/Early Start Program
  • 3% reduction in funding for Regional Centers’ operations and for Purchase of Service payments to vendors (2/09)
  • $100 million in “cost containment” for Regional Centers (2/09)
  • $234 million in additional “cost containment” for Regional Centers (7/09)
  • $50 million vetoed by Governor specifically for Early Start Program (7/09)
  • Cuts resulted in major changes to Early Start Program
  • Families of young children now required to access private or public insurance before receiving most Regional Center therapies
reductions in in home support services
Reductions in In-Home Support Services

Bad News: July, 2009 Final Budget Cuts

Elimination of IHSS domestic and related services for recipients with Functional Index rankings below 4

Elimination of all IHSS services for recipients with Functional Index scores below 2

Additional savings anticipated through “fraud prevention”, including requiring IHSS providers to be fingerprinted and have background checks

Governor vetoed an additional $29.8 million from IHSS, meaning more reductions in IHSS eligibility

reductions in in home support services1
Reductions in In-Home Support Services

Good News: Legislature/Courts Mitigate Some Cuts

  • Legislature defeated Administration proposal to eliminate 90% of IHSS caseload
  • October 19, 2009: US District Court blocked implementation of eligibility cuts based on Functional Index scores
  • Another suit blocked reduction of IHSS worker wages
  • Third suit is challenging list of crimes that disqualify IHSS provider participation
changing the current landscape federal 1115 waiver and ccs redesign
Changing the Current Landscape: Federal 1115 Waiver and CCS Redesign

Federal 1115 Waiver

  • Seniors and Persons with Disabilities and Managed Care (including children)
  • CSHCN/CCS
  • Adults with Severe Mental Illness
  • Dual Eligibles (Medicare/Medi-Cal)
  • Expansion of managed care to rural regions
changing the landscape federal 1115 waiver and ccs redesign
Changing the Landscape: Federal 1115 Waiver and CCS Redesign

CCS Redesign

  • Title V Needs Assessment
  • CCS Redesign: Technical Workgroup under 1115 Waiver Stakeholder Group
  • CHIPRA Grant Proposal: Provider-based model of care for CSHCN
changing the landscape federal 1115 waiver and ccs redesign1
Changing the Landscape: Federal 1115 Waiver and CCS Redesign

Next Steps

  • 1115 Waiver/CCS Redesign

-- Legislature must approve waiver design

  • Federal CHIPRA Proposal

-- Special Care Center-based pilot project

for CSHCN

  • State Budget

-- New roller coaster ride ahead

resources
Resources

1115 Waiver/CCS Redesign Resources

  • State Waiver Renewal Website: http://www.dhcs.ca.gov/provgovpart/Pages/WaiverRenewal.aspx
  • CCS Technical Workgroup Webpage: http://www.dhcs.ca.gov/provgovpart/Pages/TechnicalWorkgroupCCS.aspx
  • Seniors and Persons with Disabilities Technical Workgroup Webpage: http://www.dhcs.ca.gov/provgovpart/Pages/TechnicalWorkgroupSPDs.aspx

State Budget Resources

  • California Department of Finance: http://www.dof.ca.gov/
  • Legislative Analysts Office: http://lao.ca.gov/laoapp/main.aspx
  • California Budget Project: http://www.cbp.org/