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CAIC Update
TERMINATING HOMECARE
The Administrations Attack on In-Home Support Services
In November 2003 and January 2004, Governor Schwarzenegger proposed
extreme cuts to California’s In-Home Support Services (IHSS) program
(see detailed discussion below. IHSS provides personal care and domestic
services to persons who are aged, blind or disabled and who live in
their own homes. IHSS is provided to those who otherwise might be placed
in an out-of-home care facility but who can safely remain in their own
home if IHSS services are received.
In April and May, the Governor withdrew his proposals to eliminate the
California’s original (“residual”) homecare program and certain domestic
services. In July, the Schwarzenegger Administration secured a federal
waiver to include the residual program under Medicaid, bringing in a
projected $1.7 billion over five years to support IHSS.
Governor Schwarzenegger’s remaining cut proposals would have pushed
wages of home care workers down towards minimum wage and dismantled the
IHSS Public Authority structure. The result would have been to throw the
IHSS system into turmoil, making home care inaccessible to tens of
thousands of people struggling to remain in their homes. These proposals
would also have violate the U.S. Supreme Court’s Olmstead decision
because it would have lead to the unnecessary institutionalization of
thousands of individuals at an incalculable personal cost to them and
their families.
These remaining proposals failed to gain legislative support, and they
died in budget negotiations with the Legislature. A proposed "quality
assurance" initiative was amended and passed into law.
Discussion of the Governor’s IHSS proposals and their
status.
(1) Eliminate the state-funded IHSS Program
(Savings of $485.4 million FY 04/05 - $365.8 million General Fund).
STATUS: ADMINISTRATION WITHDREW THIS PROPOSAL.
California’s original IHSS program is a state-only program, also known
as the “residual” program. This program includes protective supervision,
authorizes advance pay for people with the most severe disabilities, and
authorizes parents of minors to provide IHSS services under the
restrictive parent/spouse provider provisions. These provisions ensure
that people with developmental disabilities receive the critical
services that enable them to live in their own or family home. For
instance, for a parent to be the paid provider, he or she must show
there is no alternative childcare and is thus prevented from working
full time because of the child's disability related care needs.
Virtually all individuals served under the state funded IHSS program
qualify for institutional long-term care. Therefore, reducing or
eliminating in-home services to these individuals would likely lead to
thousands, if not tens of thousands of individuals to be forced into
institutions at an incalculable cost to them and their families. IHSS
has enabled California to reduce its usage of costly nursing facilities
and other out-of-home settings, resulting in lower per capita Medicaid
costs than other states.
(2) Eliminate State Participation in IHSS Provider Wages Above the $6.75
Minimum Wage Rate (Savings of $301.6 million - $98 million General
Fund). STATUS: LEGISLATURE REJECTED THIS PROPOSAL.
The Governor sought to pay for the rollback of the Vehicle License fee
in part by lowering the hourly wage of already low paid home care
workers (wages vary between $7.50 and $10.50/hr.). The Governor’s
proposal not only sought to drive 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 minimum wage. This would also have
forced people with disabilities back to the old practice of
supplementing IHSS wages from their fixed SSI grant in order to keep a
provider.
(3) Repeal Requirement for IHSS Public Authorities, Advisory Committees,
and Employer of Record (Savings of $7.6 million - $2.2 million General
Fund). STATUS: LEGISLATURE REJECTED THIS PROPOSAL.
The Public Authorities system is responsible for an unprecedented
improvement in the quality and availability of home care to individuals
and families coping with the demands of significant disability. The
model has given consumers a policy level voice, enabling them to
influence the delivery of services, since a majority of their governing
boards are required to be consumers of service. The Public Authority
model also protects the consumers’ rights to hire, train, and terminate
their workers. This would be eliminated under the Administration’s
proposal, damaging a person’s control over their services and their
lives.
The employer of record for IHSS providers enables home care workers to
organize themselves for purposes of collective bargaining, which has
lead to an increase in wages and benefits for workers who had generally
been paid minimum wage with no benefits. Improved compensation has lead
to a substantial increase in the availability of workers and reduced
turnover. This has resulted in improved stability of the care system and
a corresponding decrease in the use of costly nursing homes, group
homes, and other institutional settings.
Public Authorities have also been able to supply services above and
beyond what counties have traditionally offered IHSS consumers, as
documented in a June 2000 report to the Legislature by the California
Department of Social Services:
· Improved and expanded caregiver registry and referral system.
· Prioritizing high risk consumers.
· Active caregiver recruitment.
· Detailed screening for new caregivers.
· Tracking abuse by caregivers.
· Tracking consumer complaints and resolutions.
· Training of caregivers and consumers (for example, consumers can
receive training in how to manage and supervise their caregiver
employee, just as their employee can receive training in transferring
someone from a bed to a wheelchair).
· Tracking and improving quality of care.
Furthermore, a San Francisco study found increased quality of care
based, in part, on the improved ethnic and language match between
consumer and caregiver and “extraordinary constancy in measures of
workforce stability, including turnover and length of match between
consumer and provider.”
(3) Quality Assurance Initiative to promote standard application of how
hours are awarded. STATUS: Approved by the Legislature and signed into
law. The assumption of this proposal is that poor training of County
staff leads to over-utilization of hours by IHSS recipients. The quality
assurance measures are designed to ensure that recipients receive only
those hours to which they are entitled under regulation. The measures
will include training, more frequent needs assessments, a mandatory
county level review function, and data analysis to identify variations
in recipients' usage. Advocates worked with the Legislature and
Administration to craft budget trailer bill language that will
accomplish the quality assurance goals of the program without limiting
hours for those who are eligible.
(4) Selective Elimination of Domestic Services (Savings of $80.9 million
- $26.3 million General Fund). NOTE: THIS PROPOSAL HAS BEEN TEMPORARILY
WITHDRAWN. Federal regulation prevents the Administration from moving
forward with this cut. The Administration may apply for a federal waiver
to allow them to make this cut potentially in the following budget year.
Even with a federal waiver, the Legislature would have to approve any
such cut.
Would eliminate domestic and related services when a recipient such as
an adult child is living with his family or where the recipient is in a
shared living arrangement. The proposal would eliminate laundry services
including laundry that requires separate handling in accord with
universal precautions due to soiling by bodily fluid or feces. Also
eliminated would be changing bed linens (often daily, or more, for
recipients without bowel or bladder control), meal preparation (special
diets, cutting up food) and clean up, errands such as getting
prescriptions or purchasing food and storing those items, picking up
dropped items and other cleaning. This proposal will reduce the
authorized IHSS service hours of 90,000 persons and may conflict with
Medicaid comparability requirements because it results in disparate
treatment for similarly situated beneficiaries. |
