Topic: California update: Health and Human Services
Speaker: Julie Jackson, Chief Deputy Director, Department of Developmental Services
"It's hard to be representing Yoda" (Cliff Allenby)
"We need to do this more often."
1. The environment in Sacramento:
2. Major Initiatives and Issues
1. Fourth year of a budget "crisis." The economic environment affects everything in
Cost avoidance: Closure of Agnew's Developmental Center.
Cost Containment: 4-7% DDS population growth. Expenditure growth 10-15% per year. We're no longer considered a little fish. It took 20 years to reach a billion dollars, five more years to reach 2 B. Three years after that we're at 3.3B
'05-'06 4.7% increase in dollars. Metaphor used in department "Three-legged stool" - Eligibility, Utilization, Rates.
25 years of cost-management through rates.
In 2001, eligibility was altered
2001-2003, utilization through POS standards.
Frozen rates and resource development-Temporary measures.
Success in Federal Financial Participation. FFP has doubled over three years. Recently succeeded in additional $20Million for targeted case management.
Growth in autism, 60% of intakes are full-blown autism. Majority of caseload is under age 18. People with autism tend to be more costly to serve.
Medi-Cal redesign. "You need to keep on top of Medi-cal Redesign." Expanding medical managed care, which will deeply affect people with developmental disabilities. Cap on dental services.
Long-term care integration initiative: "Three counties to begin with, San Diego, Orange, Contra Costa." A regional center system for medical.
Medicaid Modernization Act Part D, for people who are dual-eligible will have to switch to Medicare. Will impact, not sure how. It will happen this fall. We're going to do everything we can to get information to people to prepare for the change.
Cost Containment is about flattening the rate of growth, not cutting.
CA will be submitting a self-directed services program for both Medicaid Waiver and state-only. There are still things that we're working hard on. How to balance the little red wagon of federal requirements with the desire for choice.
Significant policy: Closure of Agnews. Significance cannot be understated. In the past, closing facilities has primarily been a matter of consolidating institutions. In the case of Agnews 80-85% of Agnews clients will be placed in the community.
AB2100: Approval from administration on affordable housing for clients. Liked the concept of "Buy it once, own it forever."
Family Teaching Home model. Up to 3 individuals in a home, Designed for Bay Area proposal but available statewide.
For people with stable but enduring medical needs, proposing a new model to be licensed by Department of Social Services with montoring and credentialing by DDS/Regional Centers. Will be waiver-billable. It's a pilot with limits (120 people and homes.) Independent evaluation.
Another major policy: Use of state Developmental center staff in transition period to allow up to 200 state employees to transition to either provide training and technical assistance or as a last resort until a new provider could be set up. "Very gutsy policy."
Will be legislative proposals on the previous two policy initiatives. Hearing on February 16.
Quality Management (QM:) New CMS initiative (quality framework,) developed a conceptual framework for QM. "I like the quality framework that CMS did." Will begin work on establishing outcomes and expectations based on the values of the system. For vendors, DCs, regional centers and the system as a whole. Apply indicators and develop IT systems to report. Still a conceptual design.
Two comments: I have really enjoyed being here. We really need to pull together as a family. We have to have you. We are a system. As a family, there are sibling rivalries. Look for leadership for a new era. We have to find a next generation of management and leaders. I want to sit down with a delegation of our system to talk about what we're going to about leadership.
Q: The usual about we need better rates.
Q: What are the criteria for the 900o or so people who will be eligible for self-directed services waiver?
A: I don't have the specific criteria which will be available in a couple of months. It will be voluntary.
Q: You mentioned the rise of autism. Has DDS considered asking for more money for Doctors for people with autism.
A: The numbers are real, we don't know why. There has been some significant monies coming into UC Davis from the CDC for studies of why autism is rising.
Q: The medical and IHSS, how that will be affected for people who live on their own.
A: I'm not working on IHSS, but administration proposes state portion of IHSS to be lowered in the hope that Counties will pick up the slack. Hah hah. (Or, MWAAAAAAAAHAHAHAHA)
Q: Will people have to choose between regular MediCal and privatization. Is that correct?
A: In specific counties, the plan will be to enroll everyone in managed care. You will have the right to be seen by a Doctor. Federal MMA, part D. For people who are MediCal and Medicaid eligible. Those people will have to get drugs through Medicare plan.
Q: For people like me who have no medical insurance, what will you do for us?
A: I would have to know your individual case.
Q: Q? Q? What is the action plan for unfreezing rates and unfreezing resource development.
A: The department as part of the administration works within the administration to seek funding. Once the budget is released we are the administration.
Q: Can you tell us anything about the administration's plan to tap special needs trusts?
A: No, thank God.