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.
