BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 485|
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THIRD READING
Bill No: AB 485
Author: Gomez (D)
Amended: 1/17/14 in Senate
Vote: 21
PRIOR ASSEMBLY VOTES NOT RELEVANT
SENATE HUMAN SERVICES COMMITTEE : 4-2, 9/11/13
AYES: Yee, Evans, Liu, Wright
NOES: Berryhill, Emmerson
SENATE HEALTH COMMITTEE : 7-0, 1/15/14
AYES: Hernandez, Beall, De León, DeSaulnier, Monning, Pavley,
Wolk
NO VOTE RECORDED: Anderson, Nielsen
SENATE APPROPRIATIONS COMMITTEE : 5-1, 1/23/14
AYES: De León, Hill, Lara, Padilla, Steinberg
NOES: Gaines
NO VOTE RECORDED: Walters
SUBJECT : In-home supportive services
SOURCE : AFSCME
California United Homecare Workers/AFSCME Local 4034
SEIU
United Domestic Workers Local 4034 AFSCME/SEIU
DIGEST : This bill requires the new statewide California
In-Home Supportive Services Authority (Statewide Authority) to
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assume responsibility for bargaining with recognized employee
organizations representing in-home supportive services (IHSS)
providers effective January 1, 2015, and de-links the Statewide
Authority from implementation of the Coordinated Care Initiative
(CCI) so that the Statewide Authority is permanent regardless of
what happens with the CCI.
ANALYSIS :
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 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 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.
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
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this requirement.
5. Establishes the 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 (DSS), 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, 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.
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, 2015, 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
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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.
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.
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. Prior to July 1, 2012,
county public authorities or nonprofit consortia were designated
as "employers of record" for collective bargaining purposes on a
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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.
Background on the CCI
The Budget Act of 2012 enacted the CCI (also called Cal
MediConnect), a 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. Approximately 65%
of IHSS recipients reside in the demonstration counties.
Related to CCI, a 2012-13 Budget trailer bill SB 1036 (Senate
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. The bill also
created an IHSS MOE funding requirements for counties, which
replaced the previously existing county share of non-federal
funding of 35%. Further, the bill 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.
Prior Legislation
SB 1008 (Senate Budget and Fiscal Review Committee, Chapter 33,
Statutes of 2012), implements the Duals Demonstration Pilot
Projects, including integration of long-term services and
supports.
SB 1036 (Senate 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
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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.
SB 94 (Senate Budget and Fiscal Review Committee, Chapter 37,
Statutes of 2013), enacts 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
According to the Senate Appropriations Committee:
Potentially major ongoing costs (General Fund) in the tens to
low hundreds of millions of dollars to the extent the
provisions of this bill result in an increase in IHSS provider
wages and health benefits with the implementation of the
Statewide Authority in all 58 counties effective January 1,
2015. As only those wage and benefit increases that are
locally negotiated or imposed before the Statewide Authority
assumes employer responsibility result in an adjustment to the
County IHSS MOE, any increases negotiated by the Statewide
Authority is not require a county share of costs. The
nonfederal share of costs will be fully funded by the state,
resulting in major ongoing costs to the General Fund.
Annual costs in the range of $6.9 million (50% General Fund,
50% federal funds) to the Department of Human Resources
(CalHR) to implement and operate a collective bargaining
platform on behalf of the Statewide Authority expanded to
cover all 58 counties effective January 1, 2015.
Additional one-time significant costs (General Fund) to CalHR
for limited-term staff and overtime required to support the
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workload imposed under the accelerated implementation date
mandated in this bill.
To the extent the CCI will have otherwise become inoperative at
some future date due to an estimate by the Director of Finance
that the CCI will not generate net General Fund savings, as
specified, the annual costs noted above would continue to be
incurred. The counties' share of cost limited by the County
IHSS MOE will not revert to the original cost-sharing formula,
and CalHR/DSS costs will continue to support the activities of
the Statewide Authority.
SUPPORT : (Verified 1/23/14)
AFSCME(co-source)
California United Homecare Workers Local 4034 AFSCME/SEIU
(co-source)
SEIU (co-source)United Domestic Workers/AFSCME Local 3930
(co-source)
ARGUMENTS IN SUPPORT : This bill is co-sponsored by AFSCME,
SEIU, California, the United Domestic Workers/AFSCME Local 3930,
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.
JL:d 1/23/14 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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