Yountville VA Home

SACRAMENTO – The U.S. Veterans Administration has been a font of scandal in recent years, with various reports showcasing the way the agency charged with caring for our nation’s veterans has fallen down on the job. A new report from California’s official watchdog agency, the Little Hoover Commission, shows that the California Department of Veterans Affairs, known as CalVet, fails to provide adequate help, as well. The heart of the report is not about scandal – but about a set of priorities that hasn’t changed much in a century.

In particular, the report spotlights California’s $306 million program to provide housing to those veterans and their spouses who cannot take care of themselves. The commission took a 16-month look at the state’s eight homes and concluded that “fewer than 1 percent of the state’s 1.7 million veterans benefit from the 2,610-bed program … .” It points to a variety of measures that could stretch that funding to help a larger pool of needy veterans.

As the report points out, the current budget amounts to a “staggering” per-bed cost of $117,241, with the state footing the bill for $71,000 per bed each year when Medicaid and Medicare revenues are figured in. Although most of the people who are in the state-home system are veterans of World War II and the Korean War, an increasing number are Vietnam War veterans, and they tend to have more complex “physical and mental health needs.” The homes also are serving a larger percentage of veterans from more recent conflicts such as Iraq and Afghanistan.

The report finds that residents typically are admitted on a first-come, first-served basis rather than being admitted based on their financial hardships and health needs, although there are some priorities for homeless veterans and Medal-of-Honor recipients.

Basically, California runs an aging bricks-and-mortar system at odds with current trends in long-term care, which focus more on community settings rather than large institutions, according to the commission. Those newer local-oriented models “generally cost less than institutional care, and also allow families to avoid potential hardships stemming from separation that is unavoidable in institutional-care settings.”

This “opportunity cost” issue is key. If the state is spending the bulk of its funding on large veterans’ homes that serve a small number of people, it’s unable to spend those dollars on other services targeting a more broad-based clientele. “California’s veterans home beds come at a cost, both in terms of the high price tag of health care, as well as the opportunity cost of not investing elsewhere,” according to the report. A New Approach to California’s Veterans Homes offers a wide-ranging reform plan.

The first recommendation would require legislative action. The commission calls for legislators to amend the Military and Veterans Code to ensure veterans’ homes are able to provide first access to the neediest veterans. It calls for developing an admission system that ranks disabilities, financial status and other admission factors. It also calls for the Legislature to amend the code to end “domiciliary care” – i.e., supervised living arrangements – and focus instead on providing “high-level medical care, such as skilled nursing care.”

Veterans homes built with federal funding must operate for 20 years, but the commission calls for CalVet to evaluate these facilities as that 20-year mark approaches and consider whether to keep them in operation. The state can immediately stop building new homes, however, as it moves toward a different service model. As the agency “repurposes” these buildings, the commission argues savings should be redirected toward home and community-based services.

The report’s main recommendations share the theme of moving away from the existing institutional model and moving toward community care. It also calls for more transparency in CalVet’s budgetary reports, and calls for amending current regulations “to specify consequences for residents who do not maintain adequate insurance coverage or otherwise pay their share of the costs.”

The goal is to serve a larger number of needy veterans, as summed up by Little Hoover Commission Chairman Pedro Nava’s statement: “We must start questioning assumptions and past decisions about what kind of care veterans want and need and how it is best delivered.” That fits with the commission’s charge of helping the state take a fresh look at how its bureaucracies are operating.

CalVet is trumpeting a new rating from the Centers for Medicaid and Medicare Services giving its Chula Vista and Yountville veterans’ homes a four-star rating, “placing them among the highest performing facilities throughout the state.” That’s good news, but the Little Hoover Commission’s latest effort is focused less on the quality of care provided at any of the state’s facilities, and more on the way to stretch the department’s resources to help other veterans.

The commission also wants the veterans’ homes to become more self-sufficient and less dependent on the general fund. In some cases, the report argues, veterans’ homes could operate without any general-fund support whatsoever. The commission last reviewed the veterans’ homes in 2013.

Assemblywoman Jacqui Irwin, D-Thousand Oaks, who chairs the Assembly Veterans Committee, requested the latest review in 2015. She’s pointed to progress over the past few years, but noted a number of ongoing personnel and budgetary problems. She argued that CalVet’s Veterans Services Division, which helps connect veterans with available benefits, only receives 25 percent of the department’s budget “due to the expense of the homes.” The homes are important, she wrote, but only serve a tiny portion of California’s 1.7 million veterans.

In recent years, the Legislature has been more focused on creating new funding sources for the veterans’ homes than rethinking the entire veterans’-home model. This year, Irwin has introduced a bill that would implement the “needs assessment” recommendation in the commission’s report. And bills from other Assembly members would implement other recommendations, including measures promoting fiscal transparency. So perhaps the Little Hoover Commission’s latest report finally will spark a more wide-ranging discussion.

Steven Greenhut is Western region director for the R Street Institute. Write to him at sgreenhut@rstreet.org.

The prime means the state uses to pay for such capital investments is through the bond process. State bonds don’t directly raise taxes, but the bond payments come out of the general fund. So increases in bond spending nudge out other types of spending, and lead to pressure to increase taxes to make the payments. By contrast, local bonds directly impose new tax commitments on property owners.

While supporters of individual bond measures argue over the specific merits of each proposed measure, both sides often ignore this crucial question: How efficiently do current bonds achieve the goals promised in the measures? California voters approve an overwhelming majority of the bond initiatives placed before them on the ballot, but too often there’s little attention paid to how the authorized funds actually are spent.

The state’s independent watchdog agency, the Little Hoover Commission, last week released a report that reinforces that point. In the past decade, voters have approved $70 billion in state bonds and more than $138 billion in local school-facilities bonds – numbers that have increased after the state lowered the voter threshold for approval, it explained.

“Spreading the costs of major infrastructure projects across generations makes sense,” the commission’s chairman Pedro Nava added. “But as Californians have put more and more on the tab, a day of reckoning will arrive.” The commission cautions that these payments on the debt service will remain after the next recession hits and called for a re-evaluation of “whether current oversight mechanisms are enough to ensure both state and local bond proceeds are spent as efficiently as possible and as voters intended.”

The commission had produced a similar report in 2009, where it called for greater oversight and transparency specifically for natural-resources bonds. It noted that 23 departments in the state Natural Resources Agency administer 16,000 projects, so it’s a Herculean task to try to oversee and track the billions of dollars in spending.

Regarding statewide bond measures, it called for the creation of bond-oversight committees in both houses of the Legislature, independent audits funded from the bond proceeds, and a greatly improved web-based system for tracking expenditures and outcomes based on uniform reporting standards. It also called for the establishment by state officials of some fundamental bond criteria that could then be used to create a “report card” that grades each bond proposal.

After the last report, some efforts were taken to improve accountability, but the commission was not satisfied with the level of changes. The Schwarzenegger administration had proposed a detailed accountability plan, but it has not led to a consistent approach. There is no report card, as proposed. Furthermore, the new report takes aim at the state’s website, although it is encouraged by new legislation that would advance that goal. It points to overall progress, but of an inconsistent nature.

The commission offered two recommendations this year. The first should get heads nodding, although it is lacking in detail: “The governor and the Legislature should adopt a consistent system to improve transparency and oversight of all statewide bonds, particularly the 2008 high-speed rail and the 2016 school facility construction bonds, which currently lack such requirements, as well as all future statewide bond measures.”

The second is more specific and calls for adequate financial support for Senate Bill 1029, a new law which requires the Treasurer’s Office to track and report on all local and state debt spending until the debts are paid off or redeemed.

Although the report doesn’t discuss this, the high-speed rail example offers a reminder of how difficult it will be for the public to get a handle on how its bond proceeds are being spent. Voters approved Proposition 1A in 2008 by a nearly 57 percent to 43 percent margin. The initiative authorized the California High-Speed Rail Authority to issue $9.95 billion in general-obligation bonds to fund the start of a bullet-train project linking Los Angeles with the Bay Area. The project now is estimated to cost $68 billion.

The rail line’s backers included a number of specific promises to voters to help secure their support for such a large bond measure. For instance, supporters touted a 2-hour and 40-minute travel time from L.A. to San Francisco, but the latest plan – using shared lines with commuter trains in both major metropolitan areas – puts the time well over 3 hours. Other promises regarding cost, completion times and subsidies seem unlikely to come to fruition.

“Substantial legal questions loom in the trial court as to whether the high-speed rail project the … authority seeks to build is the project approved by voters in 2008,” explained a state appellate court in 2014, yet the court gave the project the go ahead. Other legal challenges remain, but even one of the rail system’s original proponents has come out against the current iteration of the plan by arguing that it doesn’t resemble the project approved by voters.

In other words, the problem with this major bond issuance isn’t necessarily oversight given that the details of the authority’s spending are fairly well known by now. The problem, critics say, is the courts allow the spending to continue even after it’s known that the tightly written promises within the bond measure aren’t always being followed.

Regarding local bonds, the commission in 2009 recommended the creation of local oversight committees. It modeled its suggestion on the largely unheeded testimony from the California League of Bond Oversight Committees. “Unfortunately, but understandably, many locally-elected government officials who must make multimillion- and multibillion-dollar decisions on bond issuances lack experience in municipal finance,” according to the report. This situation, it wrote, is like “playing with financial matches.”

The commission’s new report points to a 2012 scandal at the Sweetwater Union High School District in San Diego County. The new leadership has since created an oversight committee that the commission sees as a statewide model.

“Bond oversight committees in many communities act simply as cheerleaders for the district, often because members simply do not understand their roles or know what actions they can take,” the report explains. The key to their success, it added, “is adequately training members so that they understand their role and the tools they have at their disposal to ensure they are effective.” The key is independent oversight and “performance audits tailored to results.”

The report also calls for a variety of measures ranging from better online tracking of spending to the ability to impose sanctions on districts that fail to live up to constitutional and statutory spending restrictions, as detailed in Proposition 39. That’s the 2000 statewide ballot measure that reduced the supermajority vote requirement to 55 percent for the passage of local school bonds. It included a variety of spending safeguards in exchange for making it easier for districts to pass these spending measures.

It’s unclear whether the state will embrace the commission’s suggestions and how successful any of the specific recommendations might be. But there’s little question that state officials need to pay more attention not only to how much money the state has to repair and improve its infrastructure – but how those dollars are being spent.

Steven Greenhut is Western region director for the R Street Institute. Write to him at sgreenhut@rstreet.org.

State watchdog agency pushes for licensing reform

Good morning. Since it’s only Tuesday, we’ll start with a dose of bipartisanship to inch us closer to the weekend.

One of the rare issues where politicians on the left and right increasingly agree involves occupational-licensing requirements – the oftentimes cumbersome government-approval processes that many workers must go through to become certified to work legally in their profession.

Both sides have come to recognize that excessive rules limit employment opportunities for the poor, quash economic development and force people into the underground economy.

Advocates for reform don’t argue against training and regulations per se, but they recognize that it’s unnecessary to, say, force African-style hair braiders to spend thousands of dollars and go through hundreds of hours of traditional barbershop training when the hair treatment they provide has nothing to do with the certification they receive.

There’s broad understanding that people within existing professions often impose unnecessary barriers to entry as a way to reduce competition and artificially inflate wages. Defenders of the system say the rules are needed, however, to protect health and safety.

California’s independent state oversight agency, the Little Hoover Commission, this month released a report on licensing barriers that could serve as a blueprint for the state Legislature when it returns to session in January.

CalWatchdog has more.

In other news:

• “Lawsuit filed Friday by a San Diego deputy city attorney claims a supervisor has been sexually harassing her for three years, including telling her to keep quiet about getting harassed previously by former Mayor Bob Filner,” reports The San Diego Union-Tribune. 

• “Lt. Gov. Gavin Newsom said on Monday that billionaire activist Tom Steyer is already ‘spending a fortune’ on the 2018 race for governor of California, despite not having declared his candidacy. ‘He’s running. He’s been running,’ said Newsom, who has announced he plans to run.” Politico has more. 

• “A proposition to legalize pot raises DUI concerns,” reports the Los Angeles Times.

• “More than half of voters on both sides of the aisle say the 2016 presidential race is a major source of stress, according to a report just released from the American Psychological Association. There are even physical reactions — headaches, spikes in blood pressure, stomachaches, sleep loss,” reports The San Jose Mercury News. 

Legislature:

• Gone ’til December. 

Gov. Brown:

• In Palm Springs for an 11 a.m. memorial service for Palm Springs Police Department Officers Jose Gilbert Vega and Lesley Zerebny.

Tips: matt@calwatchdog.com

Follow us: @calwatchdog @mflemingterp

New follower: @jfwildermuth

Advocates for reform don’t argue against training and regulations per se, but they recognize that it’s unnecessary to, say, force African-style hair braiders to spend thousands of dollars and go through hundreds of hours of traditional barbershop training when the hair treatment they provide has nothing to do with the certification they receive. There’s broad understanding that people within existing professions often impose unnecessary barriers to entry as a way to reduce competition and artificially inflate wages. Defenders of the system say the rules are needed, however, to protect health and safety.

California’s independent state oversight agency, the Little Hoover Commission, this month released a report on licensing barriers that could serve as a blueprint for the state Legislature when it returns to session in January. In his letter to the governor and Legislature, the commission’s chairman, Pedro Nava, made it clear what licensing is all about:

“One out of every five Californians must receive permission from the government to work. For millions of Californians, that means contending with the hurdles of becoming licensed. Sixty years ago the number needing licenses nationally was one in 20. … What was once a tool for consumer protection, particularly in the healing arts professions, is now a vehicle to promote a multitude of other goals.”

Some of those goals are reasonable and well-intentioned: professionalizing industries, guaranteeing a level of quality and so forth. But they also “have had a larger impact of preventing Californians from working, particularly harder-to-employ groups such as former offenders and those trained or educated outside of California, including veterans, military spouses and foreign-trained workers,” Nava explained. Furthermore, the standards are not always equal. He pointed to manicurists, who need 400 hours of education, whereas tattoo artists are required to register and conform to some minimal requirements, take a single class and pay $25.

According to the report, California actually has a lower percentage of licensed people than other states. That 20 percent figure places it in 30^th place. One-third of Iowans have a license and nearly 31 percent of workers in Nevada have one, also. But California’s rules are more onerous than other states “in the amount of licensing it requires for occupations traditionally entered into by people of modest means,” according to the report. For these types of professions (pest control, manicurist, etc.), the required rate of licensure is a whopping 61 percent.

The commission held hearings this year to review the state’s occupational-licensing system. The commission found the licensing requirements to be “obvious to many” when it comes to health-care professions such as nursing. But it also heard testimony from those in “seemingly less-intuitive industries to speak about health and safety considerations.” It quoted a representative from the cosmetology industry, who defended the licensing requirements because “many of the procedures cosmetologists do can result in irreparable damage.” These include skin peels and the use of strong hair chemicals. But critics “say that there is a spectrum of activities to manage health and safety risks and that licensing should be considered the nuclear option.”

One alternative would be private certification. In those situations, a private authority (think of automotive mechanic organizations) sets standards. People are free to follow them or not – but being certified by that body confers a sense of legitimacy that consumers can consider when choosing to patronize a business. The commission quoted an attorney with the reform-oriented Institute for Justice, who noted: “Outside of driving, he said, eating out is one of the most harmful activities the average consumer will do on a regular basis. But the state doesn’t license food handlers.” That certainly puts the concept in perspective.

Critics argue that licensing unnecessarily raises prices. It also quashes innovation. The commission used the example of a barber who found a need for mobile barbershops, but state regulations only allow barbers to operate out of a permanent location. “Eventually he gave up on his idea even though he had data indicating demand for that service.” More is lost there than just a job. A person had to give up his entrepreneurial dream. Furthermore, the commission noted that excessive regulations inhibit mobility, given that a person trained in one state would have to go through enormous training again to operate in another state.

“Occupational licensing regulations are made in the name of protecting the public interest,” according to the commission. “The reality, witnesses told the commission, is that occupation regulation often amounts to rent-seeking. Briefly defined, rent-seeking is an attempt to influence the political, social or other environment to achieve an economic gain for oneself without contributing to productivity.”

That’s an economic way of saying that people who already work in an industry often band together and lobby to keep new competitors out of that industry. The commission refers to it as “gatekeeping.” And it’s really tough on poorer people trying to get their foot on the economic ladder.

The commission offered a variety of recommendations for the state government: collecting more demographic data on license applications; seeking federal grants to review the current licensing requirements; requiring reciprocity for license holders from other states; seeking sunset provisions on licensing regulations; creating a research institute to study new licensing laws; improving training for veterans; and creating apprenticeship rules that would allow people to work while they address their licensing requirements.

As mentioned above, the commission argues that the current situation poses particular burdens on former offenders, who “typically must demonstrate that their convictions were not substantially related to the duties of the occupation.” The commission pointed to those who reported “some arbitrariness in licensing authorities’ decisions.” Military spouses face problems as they follow their partners to other states, where their licenses don’t always transfer. Veterans and foreign-trained workers often have the requisite skills, but need to go through the entire licensing process anyway. The Legislature has in the past few years passed several bills designed to help veterans and military spouses, but the problem still exists for them, too.

Reformers call for wide-ranging changes. The last real attempt at this came in 2004, when then-Gov. Arnold Schwarzenegger introduced the California Performance Review. “Facing insurmountable hurdles, Governor Schwarzenegger withdrew the plan from consideration a month later,” according to Nava. But times are different now.

There’s rarely much bipartisanship in the state Legislature, but there are occasional promising signs. This year, legislators approved – and the governor signed into law – a measure that would reform the way police departments take private property without a conviction (asset forfeiture). Legislators from both parties saw that the burden fell heavily on poor Californians and that the process seemed to violate constitutional rights.

Likewise, liberals recognize that excessive licensing regulations harm opportunities for poor people and conservatives often see the rules as an affront to a market-based economy. The time may be ripe for reform and perhaps Little Hoover’s suggestions will lead the way.

Steven Greenhut is Western region director for the R Street Institute. He is based in Sacramento. Write to him at sgreenhut@rstreet.org.

In August, a California appeals court ruled against the Marin County Employees’ Association in its case challenging a 2012 state law reining in pension-spiking abuses – i.e., those various end-of-career enhancements (unused leave, bonuses, etc.) that public employees use to gin up their final salary and their lifetime retirement pay.

One of the few areas of widespread agreement at the Capitol on public-employee pensions involves spiking. Gov. Jerry Brown signed into law the Public Employees’ Pension Reform Act of 2013, known as PEPRA, to reduce escalating pension liabilities. Most of its provisions applied to new hires only. The governor also signed related legislation, Assembly Bill 187. Its goal was to “exclude from the definition of compensation earnable any compensation determined … to have been paid to enhance a member’s retirement benefit.”

This limitation on pension spiking was implemented by the Marin County Employees’ Retirement Association to help the county reduce its pension debt. As the court explained, “Reaction to the change in policy was almost immediate.” Five public-employee associations filed suit, claiming that a ban on these spiking conditions reduced promised levels of pay to their members. They argued this was an impairment of their “vested rights.” Vesting confers ownership rights.

Even though the dollars at issue are relatively minimal, the case has become a major flashpoint. California courts have long abided by something known as the “California Rule.” It’s not a law or even a rule, actually. It refers to a series of court rulings concluding that once a pension benefit is granted to public employees by a legislative body (board of supervisors, city council, state legislature), it can never be reduced – even going forward.

In the private sector, for instance, courts allow employers to reduce pension benefits, starting tomorrow. Employees could be paid everything promised to the point of the benefit change, but they can have certain benefits removed or reduced in the future. That’s seen as reasonable given they haven’t earned them yet. It’s different in the public sector.

In California (and a number of other states that follow a similar rule), these benefits can never be reduced. The problem, from a public-finance point of view, is that reducing benefits for new hires only won’t address the bulk of the debt problem until those employees start retiring in 25 or 30 years. Fixing the current debt problem requires dealing with current employees.

Ironically, almost all of the benefit increases public agencies have granted to union members since the 1999 passage of Senate Bill 400 have been done “retroactively.” In other words, the courts have allowed public agencies to give a boost in pensions to public employees for years they previously have worked – but they won’t allow those same agencies to reduce future benefits for years that have yet to be worked. This is politically controversial, but there’s little debate that such a rule has been followed by the courts.

“Public employees earn a vested right to their pension benefits immediately upon acceptance of employment and … such benefits cannot be reduced without a comparable advantage being provided,” according to the plaintiffs, as quoted in the appeals court decision. “A corollary of this approach is that public employees are also entitled to any increase in benefits conferred during their employment, beyond the benefit in place when they began.” In this view, compensation is a one-way ratchet.

This understanding has largely undermined every major reform proposed in California. For instance, the courts gutted the city of San Jose’s voter-approved 2012 pension-reform initiative because it rolled back future benefits for current employees. And the “California Rule” has been the obstacle that has stopped reformers from coming up with other similar approaches.

In this case, Justice James Richman ruled, “(W)hile a public employee does have a ‘vested right’ to a pension, that right is only to a ‘reasonable’ pension – not an immutable entitlement to the most optimal formula of calculating that pension. And the Legislature may, prior to the employee’s retirement, alter the formula, thereby reducing the anticipated pension. So long as the Legislature’s modifications do not deprive the employee of a ‘reasonable’ pension, there is no constitutional violation. Here, the Legislature did not forbid the employer from providing the specified items to an employee as compensation, only the purely prospective inclusion of those items in the computation of the employee’s pension.”

The judge pointed to conclusions from California’s watchdog agency, the Little Hoover Commission, pointing to uncontrollable unfunded pension liabilities. As the commission explained, “To provide immediate savings of the scope needed, state and local governments must have the flexibility to alter future, unaccrued retirement benefits for current workers.” The commission pointed to spiking as a particular problem. This report, he wrote, is part of what motivated the state Legislature and governor to implement reform.

Furthermore, the judge pointed to previous cases acknowledging that government entities have the right to “make reasonable modifications and changes in the pensions system ‘to permit adjustments in accord with changing conditions and at the same time maintain the integrity of the system and carry out its beneficent policy.’” This echoes what myriad pension reformers have argued: agencies are not stuck watching their systems go over the cliff. They have the right and duty to make adjustments to assure their future solvency.

If the California Supreme Court sides with the unions, then local governments will have fewer options left to gain control of their pension debts. If the court agrees with Judge Richman, then pension reform could be a brand new ballgame – although it’s unclear whether the court might toss the California Rule entirely or simply allow localities to change some of the benefits within the framework of that rule.

The court has 60 days to decide whether to consider the matter, according to reports. Unions and reformers will no doubt be watching the court’s decision closely.

Steven Greenhut is Western region director for the R Street Institute. Write to him at sgreenhut@rstreet.org.

A state audit report in December 2014 chronicled the California Department of Health Care Services’ years of dental neglect of California’s low-income and disabled residents, including more than 5 million children. “Health Care Services’ information shortcomings and ineffective actions are putting children enrolled in Medi-Cal – child beneficiaries – at higher risk of dental disease,” the report said.

More than 12.5 million low-income and disabled Californians receive health coverage from Medi-Cal. The program has a $94 billion budget; $1.3 billion of which goes to Denti-Cal.

Lack of Denti-Cal Providers

The biggest problem for Denti-Cal patients, particularly those in rural areas, is lack of access to a dentist. Fifty-five percent of California counties may have “an insufficient number of dental providers willing to accept new Medi-Cal patients,” the audit said. That includes five counties, which may not have any Denti-Cal providers, and 11 other counties that have Denti-Cal providers but they are not accepting new Denti-Cal patients.

The reason is that dentists lose money treating Denti-Cal patients. California’s reimbursement rates for 10 common dental procedures averaged $21.60 in 2012, according to the audit. That’s only 35 percent of the national average of $61.96 in 2011. California has not raised its dental reimbursement rates since 2000.

The result has been a depressed level of dental care for low-income California residents compared to the rest of the nation. Only 44 percent of the 5.1 million children enrolled in Denti-Cal received dental care through the program in 2012-13, the audit said. The national average utilization rate was 47.6 percent of patients, ranging from a low of 23.7 percent in Ohio to a high of 63.4 percent in Texas.

Little Hoover Commission examines program

Denti-Cal’s problems were the focus of a Sept. 24 hearing by the state watchdog agency the Little Hoover Commission. The commission took up the issue at the request of Sen. Richard Pan, D-Sacramento, who is a pediatrician, and Assemblyman Jim Wood, D-North Coast, who is a retired dentist. “Millions of low-income Californians on Denti-Cal are suffering because the promise of dental coverage by the state is not being fulfilled by Denti-Cal,” they said in an April 6 letter to the Commission.

Pan kicked off the four-hour hearing noting that one third of Californians are covered by Medi-Cal, and pointing out that tooth decay is preventable with regular dental care. “Unfortunately, every indication is that the Denti-Cal program has been neglected for decades – it is broken,” said Pan.

He’s made phone calls on behalf of Medi-Cal patients having trouble finding a dentist. “I shared their frustration when I … couldn’t reach a dentist to get them dental care,” he said.

The problem has been going on for years. In 2008 only one-fifth of the children in Sacramento County’s Denti-Cal program actually received dental care, Pan said. “It was clear that DHCS did not seem to exercise very much oversight or knew what was happening – or not happening actually – to our children in that time.”

DHCS has not, as required by law, annually reviewed its reimbursement rates “to ensure the reasonable access to dental services by Medi-Cal beneficiaries,” the audit said. The department also has not complied with its pledge to annually compare Denti-Cal’s performance with results from national and statewide surveys. Denti-Cal “thought another division was responsible for completing the dental metrics in the monitoring plan,” the audit said.

Blame placed on low reimbursement rates

Pan, along with several other industry experts testifying at the hearing, said that reimbursement rates need to be increased to make it worthwhile for dentists to take on the extra work. Reimbursement is so low that some dentists find it is less burdensome to directly provide charity care to poor patients rather than going through Denti-Cal and dealing with its paperwork and other bureaucratic hurdles.

“When you have payment rates that do not adequately cover practice expenses, there’s pressure on providers then to make that up – if they are going to be viable – to perform high volumes and particularly more highly paid services and procedures,” Pan said. “The department then responds, when they see this higher volume, to create even more barriers to payment, which drives out more providers. And basically who are you left with? People who have figured out how to work the system to do high volumes just to keep the practice viable.”

Similar testimony was provided by numerous dental professionals. All of which put the woman representing the Denti-Cal program – Rene Mollow, DHCS deputy director of Health Care Benefits and Eligibility – on the hotseat.

“I first do want to acknowledge the challenges that we’ve had in the program and to represent the commitment … in working through and making sure we do improve the management and administration of the program,” said Mollow. “I think, based upon responses that we have made to the state auditor, we have demonstrated our commitment to making the improvements.”

She said there’s been a lot of discussion on reimbursement rates. She also acknowledged that the problems are more extensive, including cumbersome paperwork requirements. For example, the Denti-Cal application for dentists is 40 pages long. Denti-Cal preauthorization, based on documentation including x-rays, is often required before some procedures are allowed to be performed. Several professionals also complained about the ratcheting up of anesthesiology regulations.

But Mollow sought to put a positive spin on the situation.

“We pride ourselves on ensuring program integrity while also ensuring access to services and maintain the viability of the program given the expenditures of the program and the population that we do serve,” she said. “We do recognize the challenges with the administrative processing in terms of claims and provider enrollment. We are looking at ways to do some streamlining.”

Pressure for specific solutions

Commissioner David Beier asked Mollow about the audit. “Did you view that as a three-alarm or four-alarm fire that required an urgent response?” he said.

Mollow responded, “Yes, the audit raised concerns. But the findings of the audit were things we were already working on. So these were things based upon the administrative simplification, issues with provider enrollment, all of the things people were raising to us as concerns.”

Beier wanted to hear more specifics about corrective measures. “In your testimony there’s a lot of ‘looking ats’ and ‘considering,’” he said. “What are the major changes that have been implemented in almost a year since the audit?”

Mollow responded, “We’ve looked at improving upon our contract oversight and management of the fiscal intermediary. We have required the provision of the beneficiary and provider outreach plans. We are now working with stakeholder review of those plans. We are working with stakeholders on beneficiary and provider performance metrics. We have a very robust process in place.”

Influx of new patients

Also robust is the number of new patients coming into the Medi-Cal program due to changes in federal and state laws that expand coverage. An additional 2.7 million Denti-Cal patients – perhaps as many as 6.4 million – are expected to be added in the coming years. “[That] make[s] us question whether California will have enough available dental providers to meet the needs of Medi-Cal beneficiaries,” the audit said.

Sen. Anthony Cannella, R-Ceres, who is also a Little Hoover commissioner, was unconvinced by Mollow’s assurances that the department is on top of the problems.

“I just think that it doesn’t seem like we are taking this as serious as we should when we have people with real needs,” he said. “And these have real consequences. Children that have problems with their teeth, it’s a stigma that they carry for the rest of their lives. So we are creating more and more problems that I think can be solved pretty easily.”

Commission Chairman Pedro Nava quizzed Mollow about why her department hasn’t fixed the problems or sought help from the Legislature. Mollow responded that changes must first go through the regulatory process. That didn’t satisfy Nava.

“As a former legislator, this is where I would say to the department, ‘Where the hell you been?’” he said. “In a nice way. The push to make the change should come from the department. Because the last thing you want is an uneducated legislator deciding they want to fix it. Because then there’s unintended consequences that the Little Hoover Commission has to come back in and look at five years later.

“One of the things that ought to happen when you leave here is to meet and talk about your legislative package and come up with a bipartisan legislative proposal. Without some movement on the legislative front, you don’t want us coming back and asking, ‘How come you ain’t done it yet?’”

The commission plans to release a report to the Legislature on the Denti-Cal problems and recommendations for solutions.

Those results from a Public Policy Institute of California survey are similar to the dissatisfaction with and distrust of state government that Californians expressed 10 years ago. The reason for that disaffection and what should be done about it was the focus of the Jan. 22 meeting of the state watchdog agency the Little Hoover Commission.

The findings in the survey of 1,704 adults conducted from Nov. 10-17 (with a sampling error of 3.7 percent):

• “Do you think the people in state government waste a lot of the money we pay in taxes, waste some of it, or don’t waste very much of it?” 54 percent – waste a lot, 35 percent – waste some of it, 8 percent – don’t waste very much of it. Seventy-eight percent of Republicans, 60 percent of independents and 46 percent of Democrats believe state government wastes a lot.
• “Would you say the state government is pretty much run by a few big interests looking out for themselves, or that it is run for the benefit of all of the people?” 67 percent – run by a few big interests, 28 percent – run for the benefit of all of the people.
• “How much of the time do you think you can trust the state government in Sacramento to do what is right?” 61 percent – only some of the time, 25 percent – most of the time, 7 percent – just about always, 5 percent – none of the time.

The results were similar for all three questions across regional and demographic groups and similar to a survey conducted a decade ago. But they are slightly better than an even worse skepticism of state government in an October 2010 survey.

Federal and state governments

State officials can take minor consolation that Californians are even more skeptical about the federal government. On the other hand, Californians are less distrustful of local government, particularly in the area of wasting tax dollars, according to a May 2011 PPIC survey.

“In summary, negative perceptions about the effectiveness, responsiveness and efficiency of state government are pretty consistent over time and widely held in the public today,” PPIC President/CEO Mark Baldassare told the commission. He listed four implications of the results:

• “Californians will continue to value the citizens’ initiative process as they seek to have a say in the major decisions made by their state government.
• “Many Californians will be skeptical about the need for higher taxes and more state revenues, given their feelings about waste.
• “Proposals to move authority and control to the local level from the state level are the kinds of proposals that will resonate with Californians today.
• “Last but not least, civic disengagement will continue to be a problem. The kind of civic disengagement that we saw in the record low turnout in last year’s election. And we may not have seen the lowest of low turnouts yet, given the disengagement Californians feel from state government today.”

Only 30.9 percent of California adults voted in the Nov. 2014 general election and just 18.4 percent in the June primary, according to Baldassare, who said in his blog: “Millions of Californians who could register to vote did not, and millions of Californians who could vote opted out. These numbers clearly point to a California public that is disconnected from their state government today.”

Hopeful

But Baldassare, perhaps anticipating the PPIC survey released this week showing increased optimism that the state is heading in the right direction, closed his remarks on a more hopeful note.

“In the wake of a growing improvement in our economy and fiscal situation, which has led to higher approval ratings of the governor and Legislature than we’ve seen for several years, and also at a time when we’ve just gone through a series of major legislative and fiscal reforms that the voters have approved in recent elections, the public is signaling their support for those reforms as well as efforts to move some activities from the state to the local level through both the local control of school funding and our corrections realignment,” he said.

Asked to explain the reasons for residents’ disconnection with government, Baldassare said part of it is a general skepticism of all institutions, particularly by independent voters. He added it’s also due to Californians’ unsatisfactory experiences dealing with state government. “They do have real experiences which confirm these broadly held beliefs,” he said. “That’s where you have control.”

The question of what the state can do to win the confidence of residents became the focus of the rest of the 2½-hour hearing.

“We should focus on the things which state government can directly affect,” said Commissioner David Beier. “To me that’s the building of trust through the delivery of governmental services. One of my business school colleagues said, ‘Building trust is a question of two things: intention and competence.’ I don’t think anybody has any question about the intention of state officials to deliver high quality services and positive outcomes.

“The question is one of competence. And it’s not a question of the qualification to deliver high quality goods and services. There are better, smarter ways to deliver service. And if we can identify the top agencies and the frequency of interaction with citizens, I think we can affect at least that component of government trust.”

No respect

A big part of the problem is that the message Californians receive from state government, whether via the Internet or waiting in line at the DMV, is that state officials don’t respect them, according to Cyd Harrell, a user experience expert with Code for America, which specializes in government technology.

“Design sounds like icing on the cake or making things pretty,” she said. “But at the core, design is creating an effect on purpose. People compare the best the private sector has to offer in the same space, the five-inch screen, where it gets Facebook, Amazon or an online game. When the government experience doesn’t live up to the level of experience of the other institutions they interact with, there’s an assumption that the effect is being created on purpose.

“That’s part of where that distrust in government comes from. There’s an assumption that if I have difficulty reading it or difficulty filling out a form or it doesn’t speak in a language that I easily understand, then that’s an effect the government intends, or at least is comfortable creating as part of the design.

“In the private sector, we have companies competing to offer people the best experience for their money. Government is different, naturally. If I don’t like the experience of interacting with the government when registering my car or seeing if I’m eligible for benefits, I can’t exactly take my business elsewhere. So in some ways that can be seen as a free pass [for government officials]: ‘Don’t worry about it, where else can they go?’

“But I truly think there’s a moral imperative. Government needs to serve all of the people. It needs to offer them experiences that respect their time and dignity and their abilities, whatever those may be.”

Currently, few government agencies practice what Harrell calls human-centered design. But she said it’s not that expensive to implement. It just takes commitment from top government officials to want to do it. “So the critical thing, in my opinion, is a mind shift,” she said.

Worst enemy

Other experts at the meeting agreed that government is often its own worst enemy when it comes to working smarter and better. Bob Stone, a performance adviser for the city of Los Angeles, provided an example of the Los Angeles Fire Department’s procedure for providing two replacement pieces of uniform for each firefighter annually.

“If you were to be awarded two pieces of clothing, most people would go to the Internet, Amazon or Wal-Mart and they would buy it,” said Stone. “What the city does: the firefighter fills out a form, gets a supervisor to approve it, gets a station chief to endorse it. It’s sent to the battalion chief across town, he endorses it, sends it to the procurement office. They gather up all these things and put in an order with the supplier. A big box of supplies comes into the central yard. We pay somebody to unpack the boxes, and these go to Van Nuys and these to San Pedro, send these to West Los Angeles. That’s the way we do things.

“It’s crazy. It was a sensible way to do things in the 1950s. What they are doing, and they are going to start hopefully in the next month, they are going to give the supplier a list of fire department members who have this entitlement. And they are going to tell each of these people, ‘You’re entitled to two pieces of clothing that we’ll pay for. Go to the supplier’s website, they know who you are, identify yourself and order what you want. If you want more than two, you can buy whatever you want, you just have to pay for it. We’ll pay for the first two.’

“And this happened because we told the people that were working there, ‘Don’t do anything crazy on purpose. We do enough things crazy by accident. If you’re doing something dumb, stop it and do something smart.’ So they did this. And I’m hopeful that there are going to be thousands of examples like this.”

The Little Hoover Commission plans to submit its recommendations to the state in a report, probably later this year.

Will the Little Hoover Commission begin issuing subpoenas in 2015 to compel Gov. Jerry Brown and California legislative leaders to meet green energy accountability requirements spelled out in its 2012 report, “Rewiring California: Integrating Agendas for Energy Reform”?

The commission is the state’s independent state oversight agency. And 13,000 megawatts is the estimated amount of new green energy, according to “Rewiring California,” p. vii, coming on line in the course of the next decade in California under AB32, the Global Warming Solutions Act of 2006 and other state laws.

On Oct. 24, Little Hoover sent a letter to Brown to hold the governor accountable on answering the much-avoided question about mandated green energy: How much is it going to cost, beginning in 2015?

Thus far, Brown has ignored the letter.

Bills

Neither has the Legislature passed the two electricity reform bills recommended by the Commission:

Assembly Bill 1763 is by Assemblyman Henry Perea, D-Fresno. It requires the California Energy Commission to consult with other state and local agencies to develop “a report containing a state energy plan for 2030 and 2050 that promotes economic growth, ensures reliable, sustainable and affordable energy resources, and complements the state’s environmental stewardship goals.” The report then would be submitted to the governor and the Legislature.

No action was taken on AB1763 this year, and a hearing on it was canceled.

Assembly Bill 1779 is by Assemblyman Ted Gaines, R-Roseville. Taking into account the implementation of AB32 and other state laws, it requires the CEC to “prepare a new, annual report to assess the effect in the aggregate of specified policies on electricity reliability and rates and whether these policies are achieving their stated environmental and economic goals.”

Back in April, AB1779 failed to pass the Assembly Natural Resources Committee. After that, nothing happened.

It’s not clear whether the bills, or similar ones, will be reintroduced into the new legislative session that began on Dec. 1.

Subpoena Power 

If there is no further action, can Little Hoover really issue subpoenas to get answers? Yes.

California Government Code Section 8541-8542 authorizes the Little Hoover Commission:

• “To issue subpoenas to compel the attendance of witnesses and the production of books, records, papers, accounts, reports and documents…
• “To direct the sheriff of any county or any marshal to serve subpoenas, orders and other process…
• “To certify to the superior court of any county in which proceedings are held, the facts concerning the disobedience or resistance, by any person, of any lawful order, or the refusal of any person to respond to a subpoena … and to receive the assistance of the court in enforcing orders and process.”

The governor appoints five of the nine members of the Little Hoover Commission. So it is highly unlikely it would subpoena him on this or any other matter.

And two members are appointed by the Assembly speaker, with the final two appointed by the chairman of the state Senate Committee on Rules. So it’s also unlikely legislators would be subpoenaed.

Little Hoover potentially could compel testimony from lower-level state policymakers, such as California Air Resources Board Chair Mary Nichols. But given her high profile and close relationship with Brown, that also seems unlikely.

Ultimately, it’s the voters who must hold the governor and legislators accountable. Which they may do if green-power costs spike energy rates.

In 2004 California voters passed Proposition 63, based on the promise it would tax the rich to help the state’s mentally ill population. But 10 years later, while it’s been successful in taking about $10 billion from top earners, state officials are largely clueless about whether the money has been well spent.

The problem is a “dilapidated, antiquated” data collection and processing system, according to testimony at a recent hearing of the state watchdog agency the Little Hoover Commission.

The proposition known as the Mental Health Services Act increased the tax on personal income over $1 million by 1 percentage point, affecting an estimated 25,000-30,000 people. In the 2007-08 fiscal year, the MHSA tax brought in $1.5 billion; but the Great Recession shrank that to $849 million in 2011-12, the last year closely scrutinized. A total of about $9.5 billion had been allocated to counties through 2013-14.

The problem is that no one knows whether the money has actually helped the mentally ill. Karen Baylor, deputy executive director for the California Department of Health Care Services, which is in charge of collecting the data, isn’t sure.

“I think the question is: Do we know that these dollars that translate into services make people better?” she told the commission. “I think we do have data and know how the money is being spent. Do we know the efficacy of these programs? No, we don’t.”

Lack of data

Earlier in the hearing, several mental health advocates expressed their frustration at the lack of data.

“And we certainly understand the frustration,” said Baylor. “The act has been around for 10 years and we don’t have any evaluation, and we understand that. We just became involved with this in the last year. So I can’t explain to you what the former Department of Mental Health did because we weren’t there.”

(Under Assembly Bill 102, a reorganization  passed in 2011, the DMH was replaced by the Mental Health Services Division of the California Department of Health Care Services.)

Her testimony came more than a year after an Aug. 2013 state audit criticized the lack of oversight of county mental health programs by the DMH and by the Mental Health Services Oversight and Accountability Commission.

“We found no evidence that Mental Health performed on-site reviews to ensure that county assertions about their compliance with MHSA [Prop. 63] requirements and use of funds were accurate and proper,” the audit said. “None of the entities charged with evaluating the effectiveness of MHSA programs – Mental Health, the Accountability Commission, or a third entity – have undertaken serious efforts to do so.

“Mental Health either did not always obtain certain data or did not ensure counties reported the required data. The Accountability Commission did not adopt a framework for evaluation until recently – more than eight years after the passage of the MHSA.

“Each of the four county departments we reviewed used different and inconsistent approaches in assessing and reporting on their MHSA programs, and the county departments rarely developed specific objectives to assess the effectiveness of the programs.”

Mentally ill

The U.S. Department of Health estimated in 2009 that 4.8 percent of adults in the country are seriously mentally ill, according to the audit. That equates to more than 1.8 million seriously mentally ill Californians, who may – or may not – be benefiting from the $10 billion taken from California’s top earners.

“[S]ome counties could not effectively demonstrate through their processes that their MHSA programs are achieving the stated intent,” the audit said. “[They] rarely developed specific objectives to assess the effectiveness of program services. Media reports have reflected skepticism about counties’ Innovation programs, some of which include acupuncture and yoga.”

Acupuncture and yoga are just the tip of the spending-waste iceberg, according to mental health advocate Mary Ann Bernard. In a California Progress Report article, “Legislative Fix Needed To Stop Waste of Millions Earmarked For Severe Mental Illness,” she wrote MHSA funds have been spent on:

“[E]lementary school programs about bullying, therapeutic gardening for unhappy Hmong refugees, horse therapy for troubled teens who are not mentally ill, a support group for gay and lesbian teens, parenting skills programs, a support program for unwed mothers, a hip hop car wash, homework help programs for non-mentally ill students, yoga and ‘Soul Chi’ for the stressed, among other things.

“These may be fine programs, but they are hardly ‘effective’ and ‘successful’ at preventing or shortening the duration of ‘severe mental illness,’ as required by law.”

Mental health funds also have been spent on sweat lodges for Native Americans and massage chairs for students, according to the Associated Press.

Prop. 63 has created “a cottage industry of consultants earning up to $200 an hour, as well as a host of new programs that in many cases are only loosely linked to prevention, treatment and recovery,” reported a Bay Area News Group examination of the spending.

The article quoted Prop. 63 co-author Rose King, “The state of California clearly did not comply with the law, and they did not keep and honor the contract with the voters. It’s a corruption of purpose, and it’s a boondoggle for consultants and entrepreneurs at the expense of core services.”

Helped

But amid the waste of tax dollars there also are people being helped. A Mental Health Services Oversight and Accountability Commission press release summarized a July 2014 study by the UCLA Center for Healthier Children, Families and Communities:

“Hundreds of thousands of Californians at risk of or with early symptoms of mental illness are being helped by Proposition 63’s Prevention and Early Intervention (PEI) programs …. [C]hildren, youth, young adults and the elderly are experiencing reduced homelessness, school dropout rates and unemployment through PEI programs.”

MHSOAC Chairman Richard Van Horn asked the Little Hoover Commission to help obtain more funding from the Legislature to provide better oversight of county mental health spending.

“The issue is that we have not had a data system that is modern,” he said. “We have legacy systems. Legacy systems can drive you to the ground because you can’t get the information out once you put it in. We need to have a system statewide in which counties, agencies can talk to each and all can talk to the state. The state can talk back to them. This needs to be a fully interactive system.

“That is an expensive proposition. The fact that you have got 0.1 percent [of MHSA expenditures] going to evaluation at the state level in a $6 billion system is sheer craziness. But that’s what we’re stuck with at the moment. You guys have a different kind of political clout than we do. And we need your help in making this happen.

“This is a learning process. We are way ahead of other states. Everybody is looking at California because we had the brass to pass this thing 10 years ago. Now we have to put the proper infrastructure in so that not only will we know the results [of mental health programs], but be able to communicate those results.”

Little Hoover Commissioner David Beier agreed it’s up to the state Legislature to fix the oversight problem.

“The person who has the money is going to dictate whether there’s going to be compliance,” he said. “With an initiative it defaults to the Legislature. In this, legislative oversight is the key component to driving change. They need to be a key participant. They have the purse strings. I would hope that one of the things that would come out of this [hearing] is a sense of urging the Legislature to do a focused job of oversight.”

In its recently released report, “An Agenda for Veterans: The State’s Turn to Serve,” the bi-partisan Little Hoover Commission critiques the California Department of Veterans Affairs for its “inconsistent leadership” and inability to fully take advantage of funds set aside for veterans.

The dysfunction becomes more pressing every day. California’s population of veterans — already at 1.8 million, the largest of any state — will see annual growth of about 35,000 in the coming years.

CalVet and its flaws

CalVet’s vision is simple. Its Website promises, “CalVet will be the state’s leading advocate and resource so veterans can achieve the highest quality of life.” The department employs 2,600 workers and has an annual budget of $405 million. The CalVet Veterans Homes Division, which provides long-term care for homeless, disabled and retired veterans, consumes nearly 80 percent of the department’s budget.

The Farm and Home Loan Program consumes $66 million a year. Yet the results are low. According to the report, “The program issued 81 loans totaling $8.8 million in the 2012-13 fiscal year. The program also has collaborated with Habitat for Humanity to build, through a sweat equity program, homes for veterans.”

But a weak Veterans Services Division, charged with outreach and educating veterans about their access to certain federal benefits, is undermining the department’s ambitious goals—and hurting the state in the process.

“The overriding problem for California is that many California veterans are eligible for federal benefits that they need, but they are not enrolled to receive them,” the report says.

The Texas population of veterans, comparable in size to California’s, drew down an average of 30 percent more in veterans' benefits than California’s. Florida’s drew down 16 percent more.

“Texas and Florida each have a very aggressive outreach program. They also have a fairly good veterans service representative core,” J.P. Tremblay, deputy secretary for communications and legislation, said in an interview. (He added that Florida’s large retiree population and Texas’ many military bases are also natural advantages.)

In fact, CalVet has based one of its marquee efforts — the implementation of a 36-person strike team to lessen the backlog of soldiers waiting for benefits — on a Texas program.

According to the report, encouraging veterans to seek benefits may actually be fiscally responsible (bold emphasis added):

“Some who do not draw down their federal veterans benefits instead turn to public aid programs. Veterans experts told the Commission that California leaves between $500 million and $1 billion a  year in federal money untapped because California veterans are not  signed up for benefits and services to which they are entitled and have  earned. Getting more California veterans signed up for their federal Veterans Administration benefits could improve their lives, bring more money into the state economy and reduce demand on state services.”

The chair of the state Senate Veterans Affairs Committee is Sen. Ben Hueso, D-San Diego. He told U-T San Diego that the report contained “important insight on how we can improve our veteran services and invest in ways that will allow us to effectively leverage federal dollars to benefit California veterans.”

The report also notes that CalVet has “suffered through long stretches of turnover at the secretary level, often when strong leadership was needed to implement needed change.”

This has made the department slow to adapt to changes, according to the report, and has prevented CalVet from harnessing “the potential of the state’s many non-profit partners, including the main veterans organizations.”

Said CalVet Secretary Peter J. Gravett in a written statement, “[T]he department now has a new strategic imperative to refocus its efforts on the needs of our state’s veterans and the continuum of services available to them.” Gravett and CalVet did not contest any of the report’s findings.

Practical solutions

The commission also spells out several concrete recommendations for CalVet.

Since the Legislature has already provided $6 million in one-time funds to review and clean up benefits claims, the report says, it “should monitor the department’s results to determine whether additional funding is warranted.”

Also, the report suggests sending operational savings to a litany of services that help veterans file benefit claims and pursue referrals for services. (Currently, savings from operational efficiency are sent to California’s general fund.) The report also suggests several strategies — such as investing more heavily in social media marketing — as a means of engaging the community of veterans.

The commission also suggests that the Legislature and governor “review and update the Military and Veterans Code” of the state, which was described in a Little Hoover Commission press release as “confusing, contradictory and misaligned with current CalVet practices and veterans’ needs.”

Most salient, though, was the commission’s recommendation that California’s state and federal representatives “work with and press federal agencies to obtain up-to-date information from veterans and relay it to appropriate state agencies through electronic means.”

Such a program would enable California to develop a database of veterans and to reach veterans sooner after their departure from the military, helping veterans file faster and more accurately.

Tremblay said that CalVet has already begun to use the Defense Personnel Records Information System. According to its Web site, DPRIS “provides a conduit for the secure electronic retrieval of document images” from military personnel records. (Access to these records is often necessary for veterans applying for benefits.)

But in a frustratingly complex bureaucracy, the state often works against itself while trying to help.

“There’s a paradox here,” Little Hoover Commission Executive Director Stuart Drown said in an interview. “The more people the state gets to file claims, the greater the backlog becomes.”

Federal backlog

The system for claiming benefits is simple, at least in theory.

Local agencies help a veteran prepare his/her claim, then forward it to the state; which reviews and then submits the claim to the federal Department of Veterans Affairs, which approves or denies the benefits.

Naturally, the process is muddled and lengthened at each step by structural inefficiency, understaffing and confusion.

Earlier this year, the Center for Investigative Reporting, in a report about the federal Department of Veterans Affairs, said “the agency’s ability to quickly provide service-related benefits has virtually collapsed under President Barack Obama.”

The Obama administration attempted to improve the backlog by computerizing processing and hiring more staff. But as the CIR showed, those initiatives “have fallen apart in the implementation.”

In fact, the national average wait-time for benefits is 349.6 days. Meaning the average veteran waits nearly a year before receiving benefits that are considered a right. The average wait times in Los Angeles and Oakland are significantly worse than the national average, at 619.4 days and 617.8 days, respectively.

Many of the delays are caused by veterans who simply fail to fill out the forms correctly. To its credit, CalVet is already working to alleviate the problem.

According to Tremblay, the department will send out strike teams by the end of September or the beginning of October to ensure that all forms are “fully developed,” or correctly filled-out.

Tremblay says the temporary strike teams — 36 people set to work for three years — have “more than enough time to take care of it and deal with the backlog.”

After all, the commission argued that, despite the federal government’s failings, California could still greatly improve its wait times.

The report concluded, “California can do better, and to honor those who have sacrificed for the many, it must do better.”