BILL ANALYSIS Ó
AB 784
Page 1
Date of Hearing: April 30, 2013
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Mark Stone, Chair
AB 784 (Weber) - As Amended: April 10, 2013
SUBJECT : In-Home Supportive Services: provider health care
benefits.
SUMMARY : Establishes an advisory committee to assess the impact
of the federal Patient Protection and Affordable Care Act (ACA)
on health care benefits for in-home supportive services (IHSS)
providers and provide a report to the Legislature by March 1,
2014. Specifically, this bill :
1)Establishes a 13-member advisory committee to evaluate and
assess the impact of the ACA on health care benefits for IHSS
providers.
2)Requires the Governor, the Speaker of the Assembly, and the
Senate Committee on Rules to consult with labor organizations
that advocate for seniors and persons with disabilities (SPDs)
regarding appointing designated representatives of IHSS
providers from labor organizations.
3)Requires the Governor to appoint seven members to the
committee, the Speaker of the Assembly to appoint three
members, and the Senate Committee on Rules to appoint three
members.
4)Requires at least fifty percent of the committee's membership
to be individuals who are current or past providers of
personal assistance services paid for through IHSS.
5)Requires that at least two members of the committee be current
or former providers of IHSS.
6)Allows individuals who represent an organization that
advocates for SPDs to be appointed to the committee.
7)Requires the advisory committee to provide a report to the
Assembly Committee on Human Services, the Senate Committee on
Human Services, the Assembly Committee on Health, and the
Senate Committee on Health on or before March 1, 2014, on the
appropriate employer under the IHSS program to provide health
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care benefits to IHSS providers under ACA.
EXISTING LAW
1)Establishes the IHSS program, administered at the state level
by DSS, to provide personal care and domestic services to
eligible low-income aged and disabled individuals.
2)Establishes the Medi-Cal Program, administered by DHCS, to
provide comprehensive health care services and long-term care
to pregnant women, children, and people who are aged, blind,
and disabled.
3)Establishes a list of covered benefits under the Medi-Cal
program, which includes hospital services, prescription drugs,
physician services, skilled nursing facility (SNF) care, and
personal care services.
4)Establishes, within the federal ACA, the Federal Coordinated
Health Care Office and the Center for Medicare and Medicaid
Innovation, to better integrate care for individuals who are
eligible for Medicare and Medicaid, and to test innovative
payment and delivery models to lower costs and improve quality
of care for enrollees who are dually-eligible for Medicare and
Medicaid, respectively.
5)Establishes the Coordinated Care Initiative, which requires
the California Department of Health Care Services (DHCS) to
seek federal approval to establish demonstration sites in up
to eight counties to provide coordinated Medi-Cal and Medicare
benefits to dual-eligibles, authorizes DHCS to require SPDs
who are eligible for Medi-Cal only (not Medicare) to
mandatorily enroll in Medi-Cal managed care plans, and
requires consultation with stakeholders in implementing these
provisions.
FISCAL EFFECT : Unknown.
COMMENTS :
In-Home Supportive Services
IHSS is a county operated service, in coordination with DSS,
which provides in-home care to low-income elderly and disabled
persons. IHSS provides support services and some "paramedical
services" but often not extensive, skilled nursing-level medical
services in the home. The focus of IHSS is to provide services
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that make it possible for a patient (or recipient) to live
independently at home while receiving personal care services and
assistance from an IHSS provider, in addition to help with
administering medications, assistance with prosthetic devices,
and bowel, bladder and menstrual care.
Affordable Care Act (ACA)
The ACA refers to two separate pieces of legislation - the
Patient Protection and Affordable Care Act (P.L. 111-148) and
the Health Care and Education Reconciliation Act of 2010 (P.L.
111-152) - that, together expand Medicaid coverage to millions
of low-income Americans and make numerous changes to both
Medicaid and the Children's Health Insurance Program (CHIP).
Signed into law on March 23, 2010 and upheld by the United
States Supreme Court on June 8, 2012, the ACA mandates
requirements on people and employers to acquire and provide
health care coverage, respectively.
Among its many provisions, beginning in 2014, individuals will
be required to maintain health insurance or pay a penalty, with
exceptions for financial hardship (if health insurance premiums
exceed 8% of household adjusted gross income), religion,
incarceration, and immigration status. Additionally, by 2014
either a state will establish separate exchanges to offer
individual and small-group coverage or the federal government
will establish one. Exchanges will not be insurers but will
provide eligible individuals and small businesses access to
private plans in a comparable way. In 2014 some individuals
with income below 400% of the federal poverty level (FPL) will
qualify for tax credits toward their premium costs and subsidies
toward their cost-sharing for insurance purchased through an
exchange. California has established Covered California, as a
state-based exchange that is operating as an independent
government entity.
Employer mandated health care coverage and IHSS
Under the ACA, larger businesses that employ over 50 employees
will be generally required to provide health care for their
employees or pay a fee into Covered California. The fee will
help to cover the costs associated with the provision of
California's health benefits exchange.
For purposes of IHSS providers, it has not yet been determined
"who" is the employer responsible for providing health care
coverage for IHSS providers. Under SB 1036 (Budget and Fiscal
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Review), Chapter 45, Statutes of 2012, substantial changes were
made to the IHSS program with regard to how provider wages and
benefits are determined. Since its inception, IHSS providers
have collectively bargained their wages and benefits with their
employer; the county public authority. This results in varying
wages by county throughout the state. However, with the
adoption of SB 1036, according to the LAO, collective bargaining
over IHSS provider wages and benefits will transition from the
local level to an entity known as the California IHSS Authority,
or Statewide Authority.
In beginning the transition from county-by-county operated
public authorities, SB 1036 opted to begin by implementing as a
pilot program with the eight counties (Alameda, Los Angeles,
Orange, Riverside, San Bernardino, San Diego, San Mateo, and
Santa Clara) participating in the Coordinate Care Initiative
(CCI). The purpose of the CCI is to integrate the delivery of
medical, behavioral, and long-term care services and also to
provide a road map to integrate services for individuals who are
dually eligible for Medicare and Medi-Cal, i.e., "dual eligible"
beneficiaries.
SB 1036 also fundamentally shifts how counties contribute to
their share of cost for the IHSS program, and how the
non-federal share will be covered by the state's general fund.
For purposes of this measure, with the shift from county public
authorities to a statewide authority it is unclear who IHSS
providers should look to as their employer as the state also
implements Covered California in alignment with the ACA.
Need for the bill
According to this author, this measure is needed to help resolve
who is the employer of IHSS providers for purposes of health
care coverage under the ACA. Through the establishment of a
stakeholders work group, the author intends to help formulate a
process by which recommendations can be made to the Legislature
to identify who is the proper employer for IHSS providers in a
timely manner.
Writing in support of this measure, the American Federation of
State, County and Municipal Employees (AFSCME) writes:
Workers who provide these (IHSS) supportive services are a
crucial part of California's exceptional network of care
for the elderly and disabled. With the implementation of
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the ACA, it is critical that we allow proper access to
health coverage so that those who help others for a living
are able to help themselves as well. This bill ensures
that In-Home Supportive Services providers are able to
continue helping the members of our communities who rely on
them for care and assistance.
SUGGESTED AMENDMENTS
According to the Assembly Health Committee's analysis of AB 784:
Since the purpose of this advisory committee is to develop
recommendations on employer of record for purposes of
health coverage, it may be helpful to have an expert on
health benefits and the ACA included on the advisory
committee. In addition, the author may wish to clarify two
provisions: one requires a majority of the advisory
committee to be made up of current or past providers and
the other requires at least two members of the advisory
committee to be current or past providers.
Committee staff agrees with this assessment, and suggests the
following amendment:
On page two, delete lines 11 and 12 and replace with the
following language:
(1) At least two members of the advisory committee shall be
experts on health benefits and the Patient Protection and
Affordable Care Act.
REGISTERED SUPPORT / OPPOSITION :
Support
American Federation of State, County & Municipal employees
(AFSCME) - co-sponsors
Opposition
None on file
Analysis Prepared by : Chris Reefe / HUM. S. / (916) 319-2089
AB 784
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