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A Pragmatic Approach to Medicaid Reform: Increasing Sustainability, Flexibility, and Value for Medical Spending

April 16, 2017

A series of proposals at the federal level have focused on Medicaid, the healthcare coverage program for low-income people that goes by the name "Medi-Cal" in California. There has been an intense focus, in particular, on the budgetary cost of coverage through this program. Therefore, whether one believes enrollment in the program needs to be expanded or curtailed, it is essential to increase the affordability of the care that the program finances. This brief lays out some key statistics and considerations—particularly related to the impact of Medi-Cal on the state economy—that policymakers should take into account. It also advances a series of policy recommendations aimed at increasing both the quality of the care Medicaid finances, as well as the fiscal sustainability of the program.

"Positive Youth Justice Initiative Phase I Implementation Evaluation"

January 1, 2016

Sierra Health Foundation launched the Positive Youth Justice Initiative (PYJI) in 2012 with the goal of supporting California counties to change the way they approach and work with justice-involved youth. Through an integrated model that invests in youth, treats trauma, provides wraparound service delivery, and strengthens local infrastructure, PYJI seeks to reduce barriers to crossover youths' successful transition to adulthood, including structural biases that exacerbate the over-representation of youth of color in the juvenile justice system. The two-year external evaluation of the implementation of systems change reforms in Phase I of PYJI— which included interviews, focus groups, and surveys with staff, youth, and caregivers in participating counties—explored the successes and challenges of the four counties (Alameda, San Diego, San Joaquin, and Solano) who have been implementing this far-reaching and ambitious initiative. This brief summarizes the key areas of progress and areas of challenge in PYJI implementation; facilitators of and hurdles to successful implementation; notable impacts of PYJI thus far; and areas for consideration as counties move forward in their efforts to achieve reforms that are both impactful and sustainable.

Large Recovery of Fish Biomass in a No-Take Marine Reserve

August 12, 2011

No-take marine reserves are effective management tools used to restore fish biomass and community structure in areas depleted by overfishing. Cabo Pulmo National Park (CPNP) was created in 1995 and is the only well enforced no-take area in the Gulf of California, Mexico, mostly because of widespread support from the local community. In 1999, four years after the establishment of the reserve, there were no significant differences in fish biomass between CPNP (0.75 t ha−1 on average) and other marine protected areas or open access areas in the Gulf of California. By 2009, total fish biomass at CPNP had increased to 4.24 t ha−1 (absolute biomass increase of 3.49 t ha−1, or 463%), and the biomass of top predators and carnivores increased by 11 and 4 times, respectively. However, fish biomass did not change significantly in other marine protected areas or open access areas over the same time period. The absolute increase in fish biomass at CPNP within a decade is the largest measured in a marine reserve worldwide, and it is likely due to a combination of social (strong community leadership, social cohesion, effective enforcement) and ecological factors. The recovery of fish biomass inside CPNP has resulted in significant economic benefits, indicating that community-managed marine reserves are a viable solution to unsustainable coastal development and fisheries collapse in the Gulf of California and elsewhere.