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Since 1997, California expanded public health insurance coverage and increased provider and health plan payments in a fiscally responsible way. The state enacted moderate Medi-Cal expansions for adults, significantly expanded children's coverage through the Healthy Families program, and is planning to expand Healthy Families further to include parents. California addressed consumer concerns about managed care through the creation of the Department of Managed Health Care, where consumers can go for assistance in dealing with their health plan. California decreased fragmentation in long-term care programs and improved quality of services through the establishment of the Long-Term Care Council. The state also achieved wage increases for nursing home staff and home health workers, and reduced patient-to-nurse staffing ratios in nursing homes.