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.
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 seought
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.
