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File #: 21-1444    Version: 1
Type: Agenda Item Status: Department Matters
File created: 8/27/2021 In control: Board of Supervisors
On agenda: 10/19/2021 Final action: 10/19/2021
Title: Health and Human Services Agency recommending the Board receive and file a presentation on the status of structural budget deficits (Public Health, Social Services, and Behavioral Health) within the agency, including a five-year projection of Realignment funding and expenditures, as well as a long-term plan to address all budget deficits. FUNDING: Public Health, Social Services, and Behavioral Health Realignment.
Attachments: 1. A - Realignment Budget Presentation (Sep 28, 2021 - Actuals) 10/26/21
Related files: 09-0220, 10-0186, 13-1067, 15-0742, 17-0195, 18-1644, 20-0171, 21-0298, 21-0409
Title
Health and Human Services Agency recommending the Board receive and file a presentation on the status of structural budget deficits (Public Health, Social Services, and Behavioral Health) within the agency, including a five-year projection of Realignment funding and expenditures, as well as a long-term plan to address all budget deficits.

FUNDING: Public Health, Social Services, and Behavioral Health Realignment.

Body
DISCUSSION / BACKGROUND:
In 1991, in response to a budget shortfall, the California State Legislature shifted significant fiscal and programmatic responsibility for many health and human services programs from the state to counties. This effort is referred to as 1991 realignment. Among the programs shifted to the counties were In Home Support Services (IHSS), Child Welfare, CalWORKs, low-income health care and Mental Health. Many more programs have been ‘realigned’ from the state to counties over the past 30 years, including 2011 realignment which affected programmatic, administrative, and fiscal responsibility for adult offenders and parolees, additional mental health services, substance abuse treatment, foster care & adoptions, and adult protective services. It should be noted that the 2011 realignment of programs was also done in response to a state budget shortfall.

At the time of these program realignments, the State of California believed these efforts would provide long-term benefits for counties including, more local flexibility for programs and services based on local needs, creating an incentive to encourage county innovation to achieve greater outcomes for clients, and by implementing a ‘county share of cost’, the State believed it would create an incentive for counties to control program costs.

These realignment efforts were based on four key principles at the time;
1. The counties’ share of cost reflect their ability to control costs to the program
2. Revenues generally cover costs over time
3. Flexibility to respond...

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