Implications for Older Adults and People with Disabilities
Background and Updated Budget Picture
The final budget outlines fiscal year 2013-14 expenditures of approximately $96.3 billion, revenues of $98 billion, and a $1 billion reserve. Despite there being no new reductions to health and human services programs, the budget neglects to restore many of the previously-implemented reductions to programs serving older adults and people with disabilities.
Items Impacting Older Adults and People with Disabilities
The following budget items impact older adults and people with disabilities, as well as the broader long-term services and supports (LTSS) service delivery system.
Revisions to the Coordinated Care Initiative
Enacting Legislation, “CCI Trailer Bill”: The Budget “Trailer Bills” outline the statutory authority
through which to implement components of the budget. For the CCI, the Trailer Bill Language (TBL)
includes significant policy elements that impact the program and its implementation, as follows:10
• De-Linking of CCI Components: The TBL “de-links” the three components of the CCI, which are: 1)
establishment of Cal MediConnect; 2) mandatory enrollment of dual eligibles into Medi-Cal managed
care; and 3) implementation of Medi-Cal managed LTSS. This separation in statute permits the three
components of the CCI to proceed independently.
• “Poison Pill” Provision:
• Initial Determination: The TBL permits the Department of Finance (DOF) to determine, at least 30
days prior to enrolling beneficiaries in the CCI, whether the overall CCI program will lead to net
General Fund (GF) savings. Should DOF determine that the CCI will not generate net GF savings,
all components of the CCI will be suspended immediately and the CCI shall become inoperative
July 1, 2014.
• Annual Determination: Assuming the CCI is implemented, the DOF will estimate by January 10th
of each year after implementation the amount of net GF savings associated with the CCI. If the
DOF determines that the CCI will not generate net GF savings, the CCI will become inoperative
January 1 of the following calendar year.
• If the CCI beomes inoperative: If the CCI becomes inoperative, then Department of Health Care
Services (DHCS) will be responsible for providing notifications to affected parties.
Enacted Budget: Under the enacted budget, beneficiaries in the eight CCI counties will enroll into Medi-
Cal managed care plans no sooner than January 1, 2014. Los Angeles County will phase-in beneficiaries
over 12 months, subject to further discussions with the federal government. San Mateo County will enroll
beneficiaries in January 2014. All remaining counties (Alameda, Orange, Riverside, San Bernardino, San
Diego and Santa Clara) will pursue a phased-in enrollment process over a 12-month period.11 The budget
projects GF savings of $119.6 million in 2013-14 for CCI implementation, which is attributed to the
Across-the-Board Reductions to In-Home Supportive Services (IHSS)
Enacted Budget: The enacted budget includes savings of $176.4 million GF in 2013-14 as a result of the
IHSS settlement provisions.