1. CPR Principles:  Put People First  Be Visionary & Innovative  Be Accountable & Efficient  Be Performance Driven  Save Taxpayer Dollars Health and Human Services in California www.cpr.ca.gov

2. California  Has the most racially and ethnically diverse state in the nation  Has 12% of the total United States population  4.2 million or 12.5% of the population is over age 62 and growing; 1.7 million more people are between ages 45 and 60 than in 1990, a 43% Increase

3. Health and Human Services in California  $64 Billion Total Budget for FY 2004-05  29% of all expenditures in the State Budget  The budget for HHS is greater than the total budget of 47 other states

4. Other Facts about California  Income support is provided to 2.4 million and 400,000 receive food stamps  Medi-Cal pays $3.2 billion for nursing home services or 65% of the total revenues for the industry in California  50.9% of persons with mental disorders also have an alcohol or drug disorder, 2.7 million people  HHS partners with businesses to provide jobs and consumer protection: 7000 public and private licensed health care facilities; 6350 licensed laboratories  Medi-Cal service costs per enrollee are the lowest in the nation

5. The HHS Team  20 current and former State employees  Four former Deputy Directors, One Former Director, and One former Under Secretary of HHS  Nearly 500 years of state experience

6. KEY PREMISE – PUBLIC PERCEPTION  Most Californians believe that government can be reduced without an impact on services  Key thought as we proceeded through the review

7.  In the past, budget reductions were made in benefits and services; CPR found ways to save over $1 billion annually without reducing services  CPR charted new territory; we looked across programs to focus the mission and combine efforts and resources without reducing services  CPR found scattered responsibility for services and confusing for the public

8. HEALTH AND HUMAN SERVICES  33 issues  108 recommendations  $4.9 Billion in savings over five years

9. Realignment Issues  Eligibility processing is costly and outdated  Health and Human Services Programs have fragmented responsibility  Child Support Programs under-perform

10. Realignment Recommendations  Use technology to consolidate eligibility processing  Convene a workgroup of State and County officials to develop clear responsibilities for Health and Human Services  Permit competitive bidding for the operation of local Child Support Programs

11. Children’s Services Issues  Child care system is cumbersome and complicated  Criminal background checks are not done on all child care providers  Child care reimbursement rates are not linked to quality standards  State foster care system is in crisis and needs leadership  Foster care children need permanent homes

12. Childrens’ Services Recommendations  Combine current child care into two systems: One for CalWORKS and one for subsidized low-income.  Limit payments for all providers who have do not have background checks  Reduce reimbursement rates for providers who do not have formal education or training  Create an assessment tool; Publish annual “Report Card” for foster care operations  Use celebrities for public service announcements promoting adoption; Streamline clearance requirements

13. Public Health, Mental Health and Other Services  Technology is not being utilized in programs  Funding for public health is too burdensome and complex  Protecting California’s public health needs better coordination  Separate administration of mental health and substance abuse does not maximize service  Vocational Rehabilitation does not perform well compared to other states  HIV reporting is unnecessarily complex

14. Public Health, Mental Health and Other Services Recommendations  Use State’s EBT network to deliver WIC benefits  Establish a statewide on-line immunization registry  Streamline administration of funding with local health departments  Create a State Public Health Officer  Consolidate State departments administering mental health and alcohol and drug programs  Align rehabilitation services with other state employment programs  Implement a names-based HIV reporting system

15. Licensing and Oversight Issues  Criminal background checks are inconsistent among state programs  Licensing and oversight for HHS functions are scattered throughout the state  Licensing fee collections are inefficient and not well documents  Licensure fee payers get slow service

16. Licensing and Oversight Recommendations Standardize Criminal Checks among programs Guarantee Fee payers receive services Improve revenue collections for health licenses Streamline oversight of Managed Health Care Plans Consolidate HHS Licensing functions

17. Medi-Cal Services Issues  Federal funds are not always maximized  Technology improvements have not been implemented  Competitive contracting can be used to save additional money  Current policies should be reviewed to insure proper focus

18. Medi-Cal Services Recommendations  Maximize Federal funds by modifying ICF-DD rates for services to the developmentally disabled  Use technology for other insurance coverage tracking, dual capitation for Medicare and TAR processing  Implement competitive contracting for DME purchases  Re-examine DSH policies to insure core Medi-Cal Services are provided  Transfer IHSS program to DHS to maximize Federal funds

19. Form Follows Function  Consolidate HHS departments with centers focused around core functions  Consolidate all HHS licensing activities into one area of government.  Consolidate health purchasing functions to assure best possible value  Emphasize public health messages

22. Conclusion  People of California are perceptive  $1.5 Billion per year can be reduced without affecting services  Federal funding can be increased  Government can use technology better  Coordination of services can improve