BILL ANALYSIS Ó
SENATE COMMITTEE ON HEALTH
Senator Ed Hernandez, O.D., Chair
BILL NO: AB 485
AUTHOR: Gomez
AMENDED: September 6, 2013
HEARING DATE: January 15, 2014
CONSULTANT: Marchand
SUBJECT : In-home supportive services.
SUMMARY : Requires the new statewide California In-Home
Supportive Services Authority to assume responsibility for
bargaining with recognized employee organizations representing
in-home supportive services providers effective January 1, 2014,
and de-links this Statewide Authority from implementation of the
Coordinated Care Initiative so that the Statewide Authority is
permanent regardless of what happens with the Coordinated Care
Initiative.
Existing law:
1.Establishes the Medi-Cal program, administered by the
Department of Health Care Services (DHCS), under which
qualified low-income individuals receive health care services.
Establishes a schedule of benefits for Medi-Cal beneficiaries,
which includes in-home supportive services (IHSS). IHSS
services include housecleaning, meal preparation, laundry,
grocery shopping, personal care services (including bathing,
bowel and bladder care, and grooming), accompaniment to
medical appointments, and protective supervision for the
mentally impaired.
2.Establishes a demonstration project, subject to federal
approval, in up to eight counties, known as the Coordinated
Care Initiative (CCI). The CCI is intended to better serve
the state's low-income seniors and persons with disabilities
by integrating delivery of medical, behavioral, and long-term
care services.
3.Requires dual eligible beneficiaries (those eligible for both
Medicare and Medi-Cal), as one of the components of the CCI,
to be assigned as mandatory enrollees in Medi-Cal managed care
health plans for their Medi-Cal and Medicare benefits in
counties participating in the CCI demonstration project, with
specified exceptions. This component of the CCI is known as
Cal MediConnect.
Continued---
AB 485 | Page 2
4.Requires, as an additional component of the CCI, that all
Medi-Cal long-term services and supports, which include IHSS,
be services that are covered under managed care health plan
contracts and be available only through managed care health
plans to beneficiaries residing in counties participating in
the CCI demonstration project, with specified exceptions.
Requires the director of DHCS to consult with the Legislature,
the Center for Medicare and Medicaid Services, and
stakeholders when determining the implementation date of this
requirement.
5.Establishes the California IHSS Authority (Statewide
Authority) as a joint powers authority, composed of two county
officials who serve at the pleasure of the Governor, and the
directors of DHCS, the Department of Social Services, and the
Department of Finance.
6.Requires the Statewide Authority to be the entity authorized
to meet and confer regarding wages and benefits with
recognized employee organizations for IHSS providers
commencing after the "county implementation date." The
"county implementation date" occurs when a county that is one
of the CCI demonstration counties is notified by the Director
of DHCS that the enrollment of eligible Medi-Cal
beneficiaries, as specified, has been completed in that
county.
7.Requires the Director of Finance, at least 30 days prior to
enrollment of beneficiaries into the CCI, to estimate the
amount of net General Fund savings obtained from the CCI.
Requires the CCI to be suspended immediately if the Director
of Finance estimates the CCI will not generate net General
Fund savings, and specifies that various statutes become
inoperative if the CCI is suspended, including provisions
creating the Statewide Authority.
8.Requires, beginning July 1, 2012, all counties to have a
County IHSS Maintenance of Effort (MOE), as specified, which
the counties pay in lieu of paying the non-federal share of
IHSS costs, as specified. Also requires the MOE to be paid in
lieu of a county's share of the costs of negotiated wage and
benefit increases. Makes these MOE provisions inoperative, and
reverts counties back to the otherwise specified share of
cost, if the CCI becomes inoperative.
AB 485 | Page
3
This bill:
1.Requires the Statewide Authority to assume responsibility for
bargaining with the recognized employee organizations
representing IHSS providers, as specified in the IHSS
Employer-Employee Relations Act, in all counties as of January
1, 2014, rather than in a county participating in the CCI
demonstration project upon notification by the director of
DHCS that the enrollment of eligible Medi-Cal beneficiaries
has been completed in that county, as specified.
2.De-links the Statewide Authority and related provisions from
the CCI, thereby making these provisions permanent, by
deleting language that renders these provisions inoperative if
the Director of Finance determines that the CCI will not
generate net General Fund savings and therefore renders the
CCI inoperative.
3.De-links from the CCI, and thereby makes permanent, a
provision establishing an IHSS MOE requirement for all
counties in lieu of their share of non-federal costs, by
deleting language that renders the MOE provision inoperative
if the CCI is rendered inoperative.
4.De-links from the CCI, and thereby makes permanent, a
provision of law requiring each county's IHSS MOE to count
toward its share of cost of negotiated wage and benefit
increases.
5.Conforms various provisions of law to the new January 1, 2014,
implementation date of the Statewide Authority by removing
reference to the county implementation dates.
6.Eliminates from the list of codes that will become
inoperative, if the CCI is rendered inoperative because of a
lack of General Fund savings, various codes relating to the
Statewide Authority, including those that establish the IHSS
Employer-Employee Relations Act, establish and define the
duties of the Statewide Authority, and require all counties to
have a county IHSS MOE.
7.Makes other technical and conforming changes.
FISCAL EFFECT : This bill has not been analyzed by a fiscal
committee.
AB 485 | Page 4
PRIOR VOTES :
Senate Human Services:4 - 2
COMMENTS :
1.Author's statement. According to the author, this bill is
necessary because ongoing delays to the implementation of the
State's CCI have resulted in delays in the creation of the
IHSS Statewide Authority and the transfer of employer
responsibilities in IHSS from the local level to the state
level. This bill would sever the link between the CCI and
collective bargaining in the IHSS program, and would require
the IHSS Statewide Authority to assume the employer
responsibility for collective bargaining in all 58 counties in
California beginning in January.
2.Background on IHSS. The IHSS program is a Medi-Cal benefit,
which provides services that enable the recipient to remain in
their home. The IHSS program provides personal care services
to approximately 420,000 qualified low-income individuals who
are aged, blind, or disabled. Services include tasks like
feeding, bathing, bowel and bladder care, meal preparation and
clean-up, laundry, and paramedical care. These services
frequently help program recipients to avoid or delay more
expensive and less desirable institutional care settings. The
average annual cost of services per IHSS client is estimated
to be $12,000 for 2012-13.
County social workers determine IHSS eligibility and perform
case management after conducting a standardized in-home
assessment of an individual's ability to perform activities of
daily living. Based on authorized hours and services, IHSS
recipients are responsible for hiring, firing, and directing
their IHSS provider(s). In the majority of cases, recipients
choose a relative to provide care. In 2012, there were around
380,000 IHSS providers with hourly wages varying by county and
ranging from $8.00 to $12.20 per hour. Prior to July 1, 2012,
county public authorities or nonprofit consortia were
designated as "employers of record" for collective bargaining
purposes on a statewide basis, while the state administered
payroll and benefits. Pursuant to 2012-13 trailer bill
language, however, collective bargaining responsibilities in
the eight counties participating in the CCI will start to
shift to an IHSS Authority administered by the state.
3.Background on the Coordinated Care Initiative. The Budget Act
of 2012 enacted the CCI (also called Cal MediConnect), a
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framework for integrating delivery of medical, behavioral and
long-term care services through a single health plan for
persons eligible for both Medicare and Medi-Cal. The CCI is
currently limited to the following eight demonstration
counties: Alameda, Los Angeles, Orange, San Diego, San Mateo,
Riverside, San Bernardino, and Santa Clara. As part of the
CCI, persons receiving long-term services and supports, such
as IHSS, are required to be enrolled in a managed care plan to
receive these services. Approximately 65 percent of IHSS
recipients reside in the demonstration counties.
Related to CCI, a 2012-13 budget trailer bill (SB 1036 (Budget
and Fiscal Review Committee), Chapter 45, Statutes of 2012)
shifted collective bargaining responsibilities from local
county public authorities or non-profit consortia in the
demonstration counties to the new Statewide Authority, with
specified members and an advisory committee. SB 1036 also
created an IHSS MOE funding requirements for counties, which
replaced the previously existing county share of non-federal
funding of 35 percent. Further, SB 1036 shifted collective
bargaining responsibilities from local county public
authorities or non-profit consortia in the demonstration
counties to the new Statewide Authority, with specified
members and an advisory committee. Under the trailer bill
language, this shift occurs in each county once enrollment
into managed care pursuant to the CCI has been completed. DHCS
anticipates that this shift will begin in April 2014.
4.Double referral. This bill was heard in the Senate Human
Services Committee on September 11, 2013, and passed with a
4-2 vote.
5.Prior legislation. SB 1008 (Budget and Fiscal Review
Committee), Chapter 33, Statutes of 2012, implement the Duals
Demonstration Pilot Projects, including integration of
long-term services and supports.
SB 1036 (Budget and Fiscal Review Committee), Chapter 45,
Statutes of 2012, was a human services budget trailer bill
that contained the necessary statutory changes to implement
the human services provisions related to the integration of
home and community based and long-term care services,
including IHSS, into Medi-Cal managed care, as specified in
the Budget Act of 2012.
AB 485 | Page 6
SB 94 (Budget and Fiscal Review Committee), Chapter 37, Statutes
of 2013, enacted changes to existing law regarding the CCI and
de-linked CCI components to allow the mandatory enrollment of
Medi-Cal and Medicare beneficiaries (dual eligible) into
Medi-Cal managed care, the integration of long-term services
and supports into managed care plans, and the commencement of
the IHSS Statewide Authority, to proceed separately from the
CCI Duals Demonstration Project.
6.Support. This bill is co-sponsored by the American Federation
of State, County and Municipal Employees (AFSCME), the Service
Employee International Union (SEIU) California, the United
Domestic Workers/AFSCME Local 3930 (UDW), and the California
United Homecare Workers Local 4034 AFSCME/SEIU. The
proponents state that the Budget Act of 2012 planned for CCI
enrollment in eight counties to begin no earlier than March
2013, but that it is now slated to begin no earlier than April
2014, a delay of more than a year. Additionally, there is no
plan in place to expand beyond the eight counties. Proponents
state that this bill effectively de-links the transition to
state level collective bargaining from every other aspect of
the CCI and allows state level bargaining to begin in all 58
counties in a timely manner.
7.Expanding beyond the eight demonstration counties. Under
current law, the Statewide Authority will become the
bargaining entity for IHSS providers only in a county that is
one of the eight CCI demonstration counties, and only when the
director of DHCS determines that enrollment into managed care
plans has been completed for the Medi-Cal beneficiaries in
that county. While the intent may have always been to
eventually have the Statewide Authority become the bargaining
entity to negotiate with providers in all 58 counties, the
current statutory structure only provides a pathway for the
eight CCI demonstration counties. This bill not only speeds
up the effective date of the Statewide Authority in the eight
demonstration counties to January 1, 2015, it also applies it
to the remaining 50 counties.
8.Policy Comment. The previous contents of this bill were
deleted and the current provisions were amended into this bill
on September 6, 2013. The effect of this bill is to change an
agreement reached as part of the 2012 Budget Act, and modified
as part of the 2013 Budget Act. Having the Statewide
Authority assume the bargaining authority across all 58
counties, coupled with making the county MOE in lieu of their
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share of cost permanent, will have the effect of shifting
significant cost pressure from the counties to the state. As
described in comment 7) above, this bill is taking an idea
that is currently scheduled to be demonstrated in eight
counties, and applying it statewide before any of the
demonstration counties are up and running.
9.Amendment to change implementation date. As currently drafted,
this bill takes effect on January 1, 2014. This date should
be changed to January 1, 2015.
SUPPORT AND OPPOSITION :
Support: American Federation of State, County and Municipal
Employees (co-sponsor)
Service Employees International Union (co-sponsor)
United Domestic Workers/AFSCME Local 3930 (co-sponsor)
California United Homecare Workers Local 4034
AFSCME/SEIU (co-sponsor)
Oppose: None received
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