CAIC UPDATE
Budget Act of 2005 Signed into Law
Major Items from Schwarzenegger 2005-2006 Budget Proposal
Affecting People with Developmental Disabilities
SSI/SSP - Stinging Defeat for People with
Disabilities
The January 2006 and January 2007 State COLA ELIMINATED - The
Governor proposed eliminating the January 1, 2006 state COLA (4.6%) and
to absorb the January 1, 2006 federal COLA (2.3%) into the General Fund.
The Legislature compromised with the Governor, agreeing to delay the
Federal COLA by three months in both 2006 and 2007, and ELIMINATE the
state COLA in BOTH 2006 and 2007. The January 2006 and January 2007
state COLA's would not be re-instated at any point. They are simply
eliminated. On April 1, 2006 the Federal COLA will raise the individual
grant from $812 to $827/month, and raise the couple's grant from $1,437
to $1459/month.
In Home Supportive Services (IHSS) - Major Victory
IHSS Wages Holding Firm - The Governor proposed lowering the
hourly wage of already low paid home care workers (wages vary between
$6.75 and $10.50/hr.). This would have driven these members of the
working poor further into poverty, it would have returned California to
the time when people with disabilities were forced into institutions or
left to cope in dangerous or degrading situations because they were
unable to find home care workers willing to work for near minimum wage.
Democrats in the Legislature held firm in protecting IHSS wages. The
budget contains no decreases, and the maximum wage for IHSS workers that
the state will contribute towards was increased from $10.10 to
$11.10/hour.
Background - IHSS wages are split between the federal government
(50%), the state (35%), and the county (15%), up until $11.10/hour
(above that level the state will not pay their 35%, and the county has
to share the cost with the feds 50/50).. Workers negotiate with the
county for wages and benefits, but the county only pays 15% of any
increase they agree to. Under the Governor's proposal, the state would
have continued to contribute their 35% up to California's minimum wage
($6.75/hour), but would not contribute to wages beyond the minimum wage.
Therefore counties would have had to pay 50% of any wages above
$6.75/hour, over a three fold increase. Cash strapped counties would
likely have respond by rolling back wages.
Developmental Services
Holding Our Ground on Budget and Self-Direction Moves Forward
Temporary Budget Cuts from 2004-2005 Continued – Temporary budget
cuts from the last two years have created enormous stresses on the
provider community and reduced the availability of services to people.
The following cuts will remain in place: (1) Rate freezes for Day
Program, contract services, and Community Care Facilities. (2)
Elimination of the SSI/SSP pass-through. (3) Delay in intake and
assessment from 60 to 120 days. (4) Elimination of start-up funds
(except for people exiting developmental centers). (5) Unallocated
reduction in Regional Center Operations of $6.5 million. (6) Unallocated
reduction in the Purchase of Services budget of $7 million.
Legislature Gives Authority for the Self Directed Services Waiver
- Regulations will be developed with community input - Earliest date of
implementation July 2006 - Will be available statewide for up to 9,000
people. DDS is applying for a federal waiver for self-directed services.
This would authorized regional centers to give families and consumers
individual budgets over which they will have substantial control for
purchasing services and supports. A person's individual budget will be
calculated as 90% of their historic purchase of service (POS) costs or
90% of the average cost of people with similar disabilities and living
situation, whichever is larger. The other 10% will be allocated by
putting 5% to a risk pool and 5% savings for the state.
This program will be available in ALL regional Centers when implemented
and serve as many as 9,000 people after three years. It is fully
voluntary. People will decide to enroll in self-direction based on the
size of their individual budget and personal preference for gaining
greater control over their services and supports. This proposal was
controversial with many advocates supporting and many opposing the
proposal. Advocates will continue to weigh in as regulations are
developed during the next six to nine months. A separate report on
self-direction will be posted later.
Legislature Authorizes Funds for 2005/2006 Closure Costs of Agnews
Developmental Center - The Schwarzenegger Administration has
submitted to the Legislature a plan to close Agnews Developmental Center
by July of 2007. The state plans to move 80% of Agnews' 350 residents to
community living arrangements. In order to ensure quality of community
services the state will:
• Establish a permanent stock of housing dedicated to serve individuals
with developmental disabilities.
• Establish new residential models by expanding the Adult Family Home
Agency to include the ‘Family Teaching Model’ and by establishing a
residential pilot project for adults with special health care and
intensive support needs.
• Utilize Agnews’ employees on a transitional basis (up to 4 years) in
community settings to augment and enhance services including health
care, clinical services and quality assurance.
• Implement a Quality Management system under a federal grant that
focuses on assuring that quality services and supports are available
prior to, during, and after transition of each person leaving Agnews.
Long Term "Common Sense" Cost Containment Strategies -
Defeated -
The Administration recognizes that rate freezes
and suspension of start-up funding cannot be made permanent. They are
therefore looking for long-term strategies to reduce the growth in the
community services budget. The last three years, the Davis and
Schwarzenegger Administrations proposed Statewide Purchase of Service
Standards, and they were defeated each year. This year the
Schwarzenegger Administration has apparently abandoned the POS
Standards, but they introduced legislation (trailer bill language) to
codify some of the cost savings ideas from the old POS Standards
proposal. ALL of the following cost containment proposals were DEFEATED:
(1) Require regional centers to use the least costly vendor who can meet
the consumer's needs, as identified in the IPP. When choosing a day
program the regional center shall consider the combined cost of
transportation and program.
(2) For consumers age 0-17 years, regional centers shall consider the
family's responsibility for purchasing services for a non-disabled
child.
(3) Regional centers shall give preference to purchasing services using
a group modality in lieu of an individual intervention, if the consumers
needs can be met by the group modality. This appears to apply to
behavioral supports, social/recreational activities, and non-medical
therapies.
(4) Regional centers shall provide annual reports to consumers/families
listing the type, amount and cost of services purchased on their behalf
in that year. The idea is that consumers will be able to check to make
sure they have received all the services regional center has been billed
for.
(5) Internal regional center procedures to ensure that purchases comply
with laws and regulations, such as the requirement to first use generic
(non-regional center funded) services.
(6) Review by a regional center clinician for all requests to purchase
(a) supplemental program staffing, (b) assistive technology and
environmental adaptation, (c) behavioral services, (d) specialized
medical or dental services, and (e) therapeutic services. The review
shall ensure that the proposed purchase is clinically appropriate with
respect to the type, amount, durations and scope needed to meet the
individual's IPP or IFSP.
Medi-Cal Redesign - Proposals Affecting People With
Disabilities Largely Rejected
Managed Care Expansion - Proposal Scaled Back - The Governor
proposed that participants in Medi-Cal who are aged, blind, or disabled,
will be required to enroll in managed care plans, where those plans are
available (mostly urban and suburban areas), and would have required the
expansion of managed care to new counties. The Legislature authorized
expansion of managed care to up to 13 new counties, but only at the
consent of the county; and would involve aged, bind, or disabled in up
to seven additional counties (Marin, Mendocino, San Benito, San Louis
Obispo, Sonoma, Ventura, and possibly Lake, but only with consent of
county and stakeholders.
Dental Benefit Limit - Compromise - The Governor proposed a
yearly benefit limit of $1,000 for dental services for adults, excluding
federally mandated emergency services. The Legislature authorized a
limit of $1,800/year.
Benefit Cost Sharing - Defeated - The Governor proposed a Medi-Cal
monthly premiums of $10 for an adult, $4 for a child, with a maximum
premium of $27/family per month. This would have applied to roughly
90,000 seniors and people with disabilities and families with incomes
above the SSI/SSP level ($1,006/mo. for an individual and $1,339 for a
couple) and 460,000 children and family members above the Federal
Poverty Level ($1,306/mo. for a family of three).
Acute and Long-Term Care Integration Plans - Defeated for Now -
As a way to encourage care delivery in the least restrictive setting
possible, Medi-Cal will create Acute and Long-Term Care Integration
plans in three counties to provide integrated Medi-Cal and Medicare
services to seniors and people with disabilities. This was an attempt,
among other things, to privatize and bypass IHSS Public Authorities,
possibly becoming a back door way to reduce IHSS worker wages. This will
be re-introduced by the Administration as legislation.
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