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

1. 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

2. 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

3. 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

4. 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

5. 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2009 • State legislation created managed care plan provider tax for federal match generating funds for program • MRMIB rescinded decision to begin disenrollments • MRMIB re-opened enrollment to new applicants and cleared children on wait list

6. 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

7. 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

8. Impact of Budget Reductions on Early Intervention Services for Children Aged 0-3

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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/