Transcript The Current Landscape for Children with Special Health

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
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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
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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
Bad News: Major Funding Cuts
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$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
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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
Good News: Deal Struck to Save Program
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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MRMIB rescinded decision to begin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)
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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
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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
Impact of Budget Reductions on Early Intervention
Services for Children Aged 0-3
Developmental
Status
Age at
Referral
High Risk Children*
* Previously eligible for
Early Start Program
Program Eligibility Criteria
New Prevention Program
0-23 mos
Presence of two or more risk factors using former at-risk
criteria: prematurity, low birthweight, seizures, assisted
ventilation, biomedical insult, prenatal drug exposure, etc.
24-35 mos
33-49% delay in any one area
0-35 mos
Child’s parent has a developmental disability
Developmental
Delay
Early Start Program
0-23 mos
33% delay in one or more areas
24-35 mos
50% delay in one area or 33% delay in two areas
Established Risk
Condition
Early Start Program
0-35 mos
Presence of Down syndrome, cerebral palsy, mental
retardation, autism, or epilepsy
Reductions in In-Home Support Services
Bad News: July, 2009 Final Budget Cuts
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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 Services
Good News: Legislature/Courts Mitigate Some Cuts
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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
Federal 1115 Waiver
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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
CCS Redesign
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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 Redesign
Next Steps
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1115 Waiver/CCS Redesign
-- Legislature must approve waiver design
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Federal CHIPRA Proposal
-- Special Care Center-based pilot project
for CSHCN
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State Budget
-- New roller coaster ride ahead
Resources
1115 Waiver/CCS Redesign Resources
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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/TechnicalWorkgroupSPD
s.aspx
State Budget Resources
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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/