California Performance Review Committee Holds Hearing on Health, Human Services Recommendations
The California Performance Review Commission on Friday at the University of California-San Diego held a hearing on its recommendations for health and human services, the North County Times reports (Sifuentes, North County Times, 8/20). The commission earlier this month released recommendations to Gov. Arnold Schwarzenegger (R) including the consolidation of several programs into a single Department of Health and Human Services, and 108 other recommendations addressing the Health and Human Services Agency (Marelius, San Diego Union-Tribune, 8/21).
The review proposes eliminating or consolidating more than 100 boards and commissions and modifying state business practices in an effort to save the state $32 billion over five years. The report aims to save almost $5 billion over five years by making changes to HHSA. Proposals in the 2,500-page review include: establishing a new Public Health Department; reducing the amount of oversight of HMOs; reorganizing some Department of Managed Health Care activities and placing all licensing boards under DMHC's authority; eliminating 17,000 county jobs and hiring private contractors to determine Medi-Cal beneficiaries' eligibility and administer many of the applications online; changing the HIV reporting system to use patient names rather than alphanumeric codes; and consolidating the Mental Health Department and alcohol and drug programs (California Healthline, 8/5).
Ray Mastalish, executive director of the California Commission on Aging, which would be eliminated under the proposal, said, the review "simply moves boxes around. It doesn't blow them up" (San Diego Union-Tribune, 8/21).
Steve Escoboza, president and CEO of the Healthcare Association of San Diego and Imperial Counties, said, "Realignment will only be successful if there is adequate funding for these services, regardless of where they are provided."
Dan Souza, director of behavioral health and recovery services for Stanislaus County, did not object to part of the review that recommended merging alcohol and drug treatment programs with mental health programs. However, he said, "Consolidating the two programs without addressing the problem of underfunding will not improve service."
Orange County Sheriff Mike Carona, who is a member of the commission, said, "If we simply move costs from one level of government to another, we really haven't done much" (San Diego Union-Tribune, 8/21).
Stephen Maulhardt, executive vice president of Aegis Medical Systems -- which operates 28 narcotics treatment clinics in 12 counties -- said, "I think the answer is collaboration, not consolidation."
Speakers also discussed a recommendation to convert the process for determining eligibility for Medi-Cal and other services to a single online application (Gresko, AP/Sacramento Bee, 8/20). The proposal would apply the Internet-based Health-e-App enrollment system used by the state's Healthy Families to Medi-Cal; CalWORKS, the state's assistance program for low-income residents with dependent children; and its food-stamp program. The report recommends consolidating eligibility processing on the state level. Currently, counties use at least 19 different technological platforms for eligibility processing, requiring the state to develop different interfaces for state eligibility data.
The Healthy Families Internet-based application model could be applied to other programs, according to the review. The Health-e-App system allows an applicant to apply from any location using an Internet connection. Healthy Families uses a single application to establish eligibility and check for duplicate enrollment in Medi-Cal. Three counties are currently preparing to adopt an enhanced version of Health-e-App, called One-e-App, for the three programs, as well as others, the report states ("California Performance Review", 8/3).
Sam Karp, director of health information technology for the California HealthCare Foundation, which developed Health-e-App, said, "To require a family to come into a welfare office and spend three hours enrolling in a program no longer works" (San Diego Union-Tribune, 8/21). In his testimony, Karp said that although the exact methods to implement the proposed changes are open for debate, "the need to fix [the system], to make sweeping changes to increase efficiency and access is indisputable and immediate." He added, "Despite these challenges, finding ways to package and deliver these benefits together via a simple application process, using various media," such as the Internet, mail and telephone, "is a worthwhile goal" (CHCF release, 8/20).
Commission member Terri Parker said, "If we were to design a system today we wouldn't do it like we did 60 years ago -- without phones, faxes and call centers."
Some speakers voiced concerns that seniors and low-income beneficiaries might not have access to computers or the skills to use them. Some also said that applicants could lose the chance to speak in person with the state worker making decisions about their case.
The next hearing on the review is scheduled for Aug. 27 in San Jose to discuss changes to general government programs, including information technology, management, procurement and personnel. Other meetings are scheduled for Sept. 9 on education, Sept. 17 on conservation and environmental protection and Sept. 27 on government reorganization (AP/Sacramento Bee, 8/20).
KPBS' "KPBS News" on Friday reported on the commission hearing. The segment includes comments from Parker ("KPBS News," KPBS, 8/20). The complete transcript is available online. The complete segment is available online in RealPlayer.
CPR's recommendations on eligibility processing are available online.