2021-22 Proposed Budget: Impact on California’s Older Adults and People With Disabilities

summary

On January 8, 2021, California Governor Gavin Newsom released the 2021-22 proposed budget. The proposal includes program changes that impact services for older adults and people with disabilities.

Date Updated: 01/20/2021

Overview

On January 8, 2021, Governor Gavin Newsom released the 2021-22 proposed budget, outlining the state’s projected revenues and spending plan for the fiscal year beginning on July 1, 2021, and ending June 30, 2022. The overall economic impact and forecast has improved since enactment of the Budget Act of 2020 with revenue estimates for budget year 2021-22 increasing by $28.2 billion. The proposed budget includes total General Fund (GF) resources of $170.6 billion and anticipated expenditures of $164.5 billion, with the rest held in reserve. The proposed budget reflects a Budget Stabilization Account* balance of $15.6 billion, and a Safety Net Reserve balance of $450 million.2,3

Symbol of California with coins.

Governor Newsom’s 2021-22 proposed budget outlines his top priorities for the year ahead—including health care access, affordable housing, economic security, and other initiatives that impact older adults and people with disabilities. The budget also includes a $14 billion investment in economic recovery related to COVID-19.2

Priorities Elevated in the Budget

Master Plan for Aging: On January 6, 2021, Governor Newsom released the Master Plan for Aging (Master Plan), creating an opportunity to address the needs of aging Californians through a thoughtful, comprehensive, person-centered, and outcomes-oriented strategy. Initiated by the governor’s call for a Master Plan in Executive Order N-14-19, the state engaged stakeholders in a 14-month planning process. The Master Plan serves as a ten-year blueprint for public and private entities at the state, regional, and local levels to address system challenges and transform services across issues, such as housing, transportation, health care, and long-term services and supports. The governor’s proposed budget begins to support key components of the Master Plan to improve the systems of care with a focus on addressing ageism, ableism, and systemic racism.2,4

Focus on Equity: The COVID-19 pandemic has laid bare system inequities and disparities, as evidenced by its impact on older adults and people with disabilities, especially in Black, Native American, Asian and Pacific Islander, and Latino communities. The governor’s proposed budget, as well as the Master Plan for Aging, highlights equity as a critical value to elevate throughout the state’s budget and policy initiatives. Specifically, the proposed budget focuses on addressing need for a more culturally and linguistically competent, as well as responsive, care delivery system through the development of data, quality metrics, and service delivery standards.2

Budget Proposals Impacting Older Adults and People With Disabilities

The governor’s proposed budget includes significant new investments that impact California’s older adults and people with disabilities while maintaining funding for established programs and services. Several investments are supported by the use of one-time funds and continued COVID-19 stimulus funding.2,5 Table 1 provides an overview of those proposals that align with initiatives in the Master Plan.

 

± Represents allocation of one-time funds in the proposed budget for 2021-22.
Table 1: Proposed Budget Items Aligned With the Master Plan for Aging2,4-6
PROGRAM AND LINK TO MASTER PLAN PROPOSED BUDGET ACTION ESTIMATED INVESTMENT
State Leadership
Senior Advisor on Aging,
Disability, and Alzheimer’s
Master Plan Initiatives 96 and 99
Establishment of a position within the governor’s office to lead on cross-Cabinet initiatives and cross-sector partnerships
Office of Medicare Innovation
and Integration
Master Plan Initiatives 34 and 35
Establishes the Office of Medicare Innovation and Integration, which will
focus on Medicare-only and dual-eligible policy opportunities
Proposal to be submitted in spring 2021
Master Plan Leadership/Operations
Master Plan Initiative 104
State implementation of the Master Plan $5 million GF
Health and LTSS
Telehealth
Master Plan Initiative 115
Expand and make permanent certain telehealth COVID-19 flexibilities, and add remote patient monitoring services as a Medi-Cal covered benefit $94.8 million
($34 million GF)
California Advancing and
Innovating Medi-Cal (CalAIM)
Master Plan Initiative 36
Implementation of CalAIM beginning January 1, 2022. The investment includes:

  • Enhanced care management
  • In lieu of services benefit
  • Multipurpose Senior Services Program
    carve out to fee-for-service
$1.1 billion
($531.9 million GF)
Aging and Disability Resource
Center (ADRC)
Master Plan Initiative 98
Statewide expansion of ADRC program and development of a statewide portal—subject to suspension on December 31, 2022 $7.5 million GF
Geriatric workforce
Master Plan Initiative 54
Funds for the Office of Statewide Health Planning and Development to grow and diversify the geriatric medicine workforce $3 million GF±
In-Home Supportive Services (IHSS)
Master Plan Initiative 39
Extends the IHSS COVID-19 backup provider system and wage differential to avoid disruptions to caregiving through December 2021 $5.3 million GF±
Alzheimer’s Disease
Alzheimer’s disease
provider training
Master Plan Initiative 55
Expanded health care provider training in Alzheimer’s disease and standards of care $2 million GF±
Alzheimer’s disease research
Master Plan Initiative 62
Research addressing disparities and equity in Alzheimer’s disease $4 million GF±
Alzheimer’s disease brain
health campaign
Master Plan Initiative 63
Department of Public Health public education campaign on brain health $5 million GF±
Alzheimer’s disease
caregiver training
Master Plan Initiative 112
Caregiver training and certification program $4 million GF±
Dementia-friendly communities
Master Plan Initiative 23
Grants to communities to become
dementia-friendly
$2 million GF±
Housing
Housing and Services
Master Plan Initiative 117
Department of Social Services to acquire and rehabilitate Adult Residential Facilities and Residential Care Facilities of the Elderly to expand housing for homeless, older adults or those at risk for homelessness $250 million GF±
Housing/Homelessness
Master Plan Initiatives 1 and 2
Investments in housing grants, loans, tax credits, property acquisitions, and supportive services to meet Housing for All goals $8 billion

Due to the improved revenue estimates and federal COVID-19 funding, the budget does not include any reductions to programs or services targeted to older adults and people with disabilities. Table 2 highlights several key investments beyond core health and supportive service program funding that do not have a direct connection to the Master Plan.

± Represents allocation of one-time funds in the proposed budget for 2021-22.
Table 2: Other Key Budget Investments 2,4,5
PROGRAM PROPOSED BUDGET ACTION ESTIMATED INVESTMENT
Equity
Equity California Health and Human Services Agency to conduct an analysis of the intersection of COVID-19, health disparities, and health equity to help inform any future response $1.7 million GF
Health and LTSS
IHSS IHSS program funding that includes a 10% GF increase over the revised 2020-21 level $16.5 billion
($5.3 billion GF)
IHSS Delays suspension of the across-the board 7% reduction in service hours until December 31, 2022 $449.8 million GF
Medi-Cal Optional Benefits Extension of Medi-Cal optional benefits, such as audiology and speech therapy services, incontinence creams and washes, optician/optical lab services, and podiatric services—subject to suspension on December 31, 2022 $47 million
($15.6 million GF)
Economic Security
Supplemental Security Income/
State Supplemental Payment
(SSI/SSP)
In 2021, maximum SSI/SSP grant levels are $955 per month for individuals and $1,598 per month for couples, and are projected to increase by $17 and $26 respectively as of January 2022 $2.69 billion GF
Food Access
Senior Nutrition
Program
Additional funding for SNP through December 31, 2022 $17.5 million GF±
Food banks Support for Emergency Food Assistance Program providers, food banks, tribes, and tribal organizations to mitigate increased food needs related to COVID-19 $30 million GF±
Supplemental Nutrition
Benefit and Transitional
Nutritional Benefit
Adjustments to benefit amounts to mitigate the effects of the elimination of the SSI Cash-Out policy $22.3 million GF
California Food Assistance
Program Emergency Allotments
Allows households to receive maximum allowable allotment based on household size $11.4 million GF±

Next Steps in the Budget Process

California’s 2021-22 Governor’s Budget requires approval by the Senate and the Assembly prior to being sent to the governor for his signature. Below is a list of key budget dates:

  • May 2021 – Release of Governor’s Budget May Revision
  • June 15, 2021 – Deadline for Legislature to approve final budget
  • July 1, 2021 – Deadline for governor to sign the budget7,8

Download the publication for all visuals and complete references.

Continue Reading

High quality, cost effective health care delivery is all about targeting – the right care, by the right provider, at the right time, in the right place, and for the right cost. It sounds straightforward, almost easy. The challenge to getting it right is understanding the range of variables in a person’s life that drive health care use and costs. Find out more in this week’s Perspectives.

In this brief, the California Medicaid Research Institute documents its process to acquire and link all the data sources necessary to evaluate long-term care services utilization, costs, and outcomes in California. This provides useful information about how data currently flows in the state and how system transformation can be supported.

Chances are you know and love an older person with needs. Maybe it’s that neighbor of yours whose trash cans you help bring in once a week. Perhaps it’s your grandparent or even a parent who needs help understanding the bills or getting the groceries up the stairs. The reality is the population of older adults in this country is growing rapidly due in large part to the aging of baby boomers – a demographic shift that affects us all. Advancements in health care and technology have also spurred this phenomenon, yet we know that a longer life also brings a greater likelihood of facing multiple chronic health conditions and possibly needing help with everyday activities.