1991 Realignment Webinar Understanding the relationship between CCI, IHSS and 1991 Realignment Farrah McDaid Ting, CSAC Kirsten Barlow, CBHDA Michelle Gibbons, CHEAC Eileen Cubanski, CWDA 1 February 22, 2017
Goals of the Presentation To provide answers to the following questions: • How does 1991 Realignment work? • Why does elimination of the Coordinated Care Initiative (CCI) affect 1991 Realignment? • What are the impacts on counties? 2
What is 1991 Realignment? • 1991 Realignment is the transfer of funding responsibility for approximately $2.2 billion (at the time) of health, mental health, and social services costs from the state to counties • In exchange, counties receive dedicated funding sources to cover those transferred costs and some flexibility in spending the funds in order to meet local needs 3
Programs Realigned to Counties in 1991 Health, Mental Health, and Social Services February 22, 2017 4
1991 Realigned Health Programs County Indigent Health Public Health Programs • • Welfare and Institutions Code Communicable Disease Control • Chronic Disease Prevention Section 17000 obligation • Immunizations • • Direct health care services Maternal Child Adolescent Health provided at county public • Public Health Nursing hospitals and clinics or through • Public Health Labs contracting with private providers • Health Education • Previously funded through state allocations. 5
1991 Realigned Mental Health Programs Psychiatric inpatient Lanterman Petris hospitalization Short Act Institutions for Mental services for all Medi- responsibilities for Disease (IMD) Cal enrollees involuntary services for adults (Funded with 1991 Realignment evaluation and funds, responsibility transferred treatment to counties after 1991) State hospital Community mental treatment for health services, to the individuals committed extent resources are by courts under civil available, for indigent (non-criminal) code individuals 6
1991 Realigned Social Services Programs CalWORKs Foster Care Child Welfare Adoptions Assistance, Employment Assistance Services Assistance Services California In-Home County Administration County Services Children’s Supportive (CalWORKs Eligibility, Block Grant Foster Care, CalFresh) Services Services County Juvenile County Justice Stabilization Subventions Subventions (AB 90) 7
1991 Realignment Funding Structure February 22, 2017 8
Funding Sources for 1991 Realignment • Two funding sources • ½ cent sales tax • Dedicated Vehicle License Fee (VLF) revenue • Every 1991 Realignment subaccount includes funds from both sources 9
1991 Realignment – Sales Tax Distributions Sales Tax Source: ½ cent Sales Tax Sales Tax Growth Sales Tax Base Account Account (Revenues in Excess of Base Payments) Mental Health Child Poverty & Health CMSP Social Services Subaccount a Family Supplemental Subaccount Subaccount (Base Account) ($1.12 billion base funding from Support Subaccount 2011 Realignment revenue) CalWORKs MOE b CMSP Growth Caseload General Growth CMSP (2 nd call on Growth; 4.027% Family Support Subaccount County Allocations (capped at $1.12 plus 4.027% Subaccount (County Shares) (remaining Growth) (1 st call on Growth) of caseload growth paid if over billion) $20M) a) Now goes to CalWORKs MOE, capped at a total $1.12 B combined VLF/ST. Mental Health account is now funded with 2011 Realignment Revenues b) If CalWORKs MOE has reached cap, funds in excess go to Mental Health Child Poverty & Family Mental Health Health Supplemental Support (approx. 40%) (approx. 18.45%) (remaining growth)
1991 Realignment – Vehicle License Fee Distributions Vehicle License Fee Source: 74.9% Vehicle License Fees VLF Growth Account VLF Base Account (Revenues in Excess of Base Payments) Mental Health Child Poverty & Family Health CMSP Social Services Subaccount a Supplemental Support Subaccount Subaccount ($1.12 billion base funding from 2011 Subaccount (Base Account) (Base is $0 in 2013-14) Realignment revenues) CMSP Growth CalWORKs MOE b CMSP General Growth (1 st call on Growth; 4.027% County Family Support (capped at $1.12 plus 4.027% Allocations Subaccount (County Shares) (remaining Growth) of caseload growth paid if over billion) $20M ) a) Now goes to CalWORKs MOE, capped at a total $1.12 B combined VLF/ST. Mental Health account is now funded with 2011 Realignment Revenues b) If CalWORKs MOE has reached cap, funds in excess go to Mental Health Child Poverty & Family Mental Health Health Supplemental Support (approx. 40%) (approx. 18.45%) (remaining growth)
CalWORKs MOE Subaccount Changes to 1991 Realignment Account Structure • Created as part of 2011 Realignment • 1991 Realignment revenues that went to Mental Health Subaccount now go to CalWORKs MOE Subaccount up to a capped amount of $1.12 billion • Mental Health Subaccount now funded from 2011 Realignment • CalWORKs MOE Subaccount has reached capped amount, so additional growth funding goes to Mental Health Subaccount 12
AB 85 Changes to 1991 Realignment Account Structure • AB 85 (Ch. 24/13) was one of the ACA implementation bills • Redirected revenues from Health Subaccount • Created two new subaccounts – Family Support and Child Poverty and Family Supplemental Support • Changed and redirected general growth distribution 13
Growth Funding: An Overview • Growth funding is determined separately for sales tax and VLF revenues • Sales Tax Growth: • Caseload growth is only funded from sales tax growth and has first call on sales tax growth revenues • CMSP has second call on sales tax growth revenues • Any sales tax growth revenues available after funding caseload growth and CMSP are distributed as general growth • VLF Growth: • CMSP has first call on VLF growth revenues • Any VLF growth revenues available after funding CMSP are distributed as general growth 14
What is Caseload Growth? • Eight realigned Social Services subaccount programs are subject to caseload growth increases: • CalWORKs Assistance • CalWORKs Employment Services • Foster Care Assistance • Adoption Assistance • Child Welfare Services • IHSS (services) • County Administration (Foster Care, CalFresh, and CalWORKs Eligibility) • CCS • Caseload growth reflects changes in expenditures in the eight programs, not actual caseloads • Caseload growth has first call on sales tax growth revenues to ensure that the entitlement programs get funded first • Unlike the base, any unfunded caseload growth from one fiscal year carries over to future fiscal years until it is fully paid off 15
How Caseload Growth is Calculated • County-by-county calculation • Year-over-year increases or decreases in expenditures in each the eight programs are determined • Change in expenditures is then used to calculated the amount of cost change due to 1991 Realignment using the pre- and post-Realignment sharing ratios • The increases and decreases in each program are added together for each county 16
How Caseload Growth is Calculated (cont.) • If the sum is a positive amount, the county is due that amount in caseload growth funding and a like amount of funding is added to the county’s social services account base • If the sum is a negative amount, the county is “held harmless” – the negative amount is set to zero and not subtracted from the county’s social services account base • The total of all the positive caseload growth amounts becomes the statewide 1991 Realignment caseload growth amount for that fiscal year 17
Caseload Growth Timing • Caseload growth for a fiscal year is calculated based on expenditures from the prior fiscal year compared to expenditures compared to the two-year prior fiscal year • Example: 2017-18 caseload growth is 2016-17 expenditures over 2015-16 expenditures • Realignment revenue growth for a fiscal year will not be known until after the end of that fiscal year (i.e., until the following fiscal year • Example: Growth revenues to pay 2017-18 caseload growth will not be known until the fall of the 2018-19 fiscal year • As a result, counties front funding for cost increases in the realigned social services programs for over a year • Example: Cost increases incurred in 2016-17 become caseload growth for 2017-18 that is paid in 2018-19 18
General Growth – Pre AB 85 • Any sales tax growth revenues above that needed to fund caseload growth and all VLF growth revenues were distributed as general growth • General growth was allocated by formula to the Social Services, Health, and Mental Health subaccounts • General growth was roughly shared as follows: o Mental Health (40%) o Health (52%) o Social Services (8%) 19
General Growth – Post AB 85 • General growth to Social Services Subaccount was eliminated and to Health Subaccount fixed at 18.4545% each year (unchanged to Mental Health Subaccount) • The logic at the time was that the Social Services Subaccount no longer needed general growth funding because of the IHSS MOE and the 2011 Realignment growth funding available for APS, and the Health Subaccount needed less growth because of the Medi- Cal expansion and reduced indigent care costs • Redirected Social Services and Health subaccounts general growth revenues to the Child Poverty and Supplemental Support Subaccount 20
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