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 Childrens 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 Childrens 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
• -- gt80,000 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• MRMIB rescinded decision to begin disenrollments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 Childrens
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
Developmental Status Age at Referral Program Eligibility Criteria
High Risk Children New Prevention Program
Previously eligible for Early Start 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 Childs 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
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

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Resources

• 1115 Waiver/CCS Redesign Resources
• State Waiver Renewal Website http//www.dhcs.ca.g
  ov/provgovpart/Pages/WaiverRenewal.aspx
• CCS Technical Workgroup Webpage
  http//www.dhcs.ca.gov/provgovpart/Pages/Technical
  WorkgroupCCS.aspx
• Seniors and Persons with Disabilities Technical
  Workgroup Webpage http//www.dhcs.ca.gov/provgovp
  art/Pages/TechnicalWorkgroupSPDs.aspx
• State Budget Resources
• California Department of Finance
  http//www.dof.ca.gov/
• Legislative Analysts Office http//lao.ca.gov/la
  oapp/main.aspx
• California Budget Project http//www.cbp.org/