BILL ANALYSIS Ó
AB 211
Page 1
Date of Hearing: March 24, 2015
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Chu, Chair
AB
211 (Gomez) - As Introduced February 2, 2015
SUBJECT: In-Home Supportive Services
SUMMARY: Disconnects implementation of the Statewide Authority
for collective bargaining within the In-Home Support Services
(IHSS) program from the state's Coordinated Care Initiative
(CCI) and implements it separately, beginning January 1, 2016.
Specifically, this bill:
1)Requires the In-Home Supportive Services Statewide Authority
to assume collective bargaining responsibility for IHSS
providers in all 58 counties, beginning January 1, 2016.
2)Deletes the requirement that the statewide collective
bargaining activities of the Statewide Authority are
conditioned upon implementation of the CCI and therefore
subject to the timeline and other restrictions within the CCI
demonstration project.
3)Deletes the authority of the Director of Finance to terminate
the Statewide Authority or the collective bargaining
responsibilities of the Statewide Authority if the CCI
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demonstration project is terminated due to not generating
anticipated General Fund savings.
4)Makes permanent the IHSS maintenance of effort (MOE)
requirement for all counties in lieu of their share of
non-federal costs, as well as the inclusion of a county's IHSS
MOE when calculating that county's share of cost for
negotiated wage and benefit increases.
EXISTING LAW:
1)Establishes the IHSS program as a benefit available to
Medi-Cal beneficiaries that provides in-home care and
supportive services to low-income aged, blind, or disabled
persons who are unable to provide or care for themselves and
who cannot live safely in their homes without assistance.
Defines supportive services within the program to include
domestic services, personal care services, protective
supervision, paramedical services, and other services, as
specified. (WIC 12300 et seq.)
2)Establishes the Coordinated Care Initiative demonstration
project in up to eight counties, subject to federal approval,
to better serve the state's low-income seniors and persons
with disabilities by integrating the delivery of medical,
behavioral, and long-term care services. (SB 1008 (Chapter
33, Statutes of 2012) and SB 1036 (Chapter 45, Statutes of
2012))
3)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.
(WIC 14186 et seq.)
4)Establishes the IHSS Statewide Authority as a joint powers
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authority, as specified, that is required 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" within the
CCI, which occurs when a county that is one of the CCI
demonstration counties is notified by the Director of the
Department of Health Care Services (DHCS) that the enrollment
of eligible Medi-Cal beneficiaries, as specified, has been
completed in that county. (GOV 6531.5, WIC 12300.5)
5)Requires, beginning July 1, 2012, all counties to have a
County IHSS 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. (WIC 12306.15)
FISCAL EFFECT: Unknown
COMMENTS:
In-Home Supportive Services (IHSS): The IHSS program provides
personal care and domestic services to approximately 420,000
qualified, low-income individuals who are aged, blind, or
disabled. Through the IHSS program, recipients are cared for
and assisted with activities of daily living, allowing them to
remain safely in their own homes and avoid institutionalization.
IHSS services include: Paramedical services, such as giving
medications and changing a colostomy bag; Non-Medical Personal
Care services, such as toileting, dressing, and transportation;
Domestic services, such as housework, shopping for groceries and
meal preparation; and, Protective supervision for those who, due
to cognitive decline or dementia, cannot be left alone for
extended periods.
County social workers determine eligibility for IHSS and the
authorized hours of care after conducting a standardized in-home
assessment, and periodic reassessments, of an individual's
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ability to perform specified activities of daily living. Once
eligible, recipients are responsible for hiring, firing,
directing and supervising their own IHSS provider or providers.
Prior to receiving payment for services, providers must submit
to a criminal background check and a provider orientation. IHSS
is funded with federal, state, and county resources, and prior
to implementation of the CCI demonstration project, 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.
Coordinated Care Initiative (CCI): The Budget Act of 2012
enacted the CCI, also referred to as 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 was originally
limited to the following eight demonstration counties: Alameda,
Los Angeles, Orange, San Diego, San Mateo, Riverside, San
Bernardino, and Santa Clara, in which approximately 65% of IHSS
recipients reside. Alameda County withdrew from the CCI
demonstration in 2014.
As part of the CCI, collective bargaining responsibilities
shifted, in the demonstration counties, from local county public
authorities or non-profit consortia to the new Statewide
Authority, which is composed of specified members and an
advisory committee. The CCI also created an IHSS MOE funding
requirement for counties, which replaced the previously existing
county share of non-federal funding for IHSS. Under the
demonstration project, the shift to the Statewide Authority is
set to occur in each county once enrollment into managed care
pursuant to the CCI has been completed in that county.
According to the Department of Health Care Services (DHCS), this
shift was scheduled to have occurred in April 2014.
Need for the bill: While the statute creating the CCI
anticipated a fairly seamless roll-out within the eight
demonstration counties, delays have resulted in enrollment still
being underway for five counties, with San Mateo being the only
county that has already completed enrollment and transitioned to
collective bargaining under the Statewide Authority. According
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to the author, this bill is necessary to shift to statewide
collective bargaining for all IHSS providers despite delays in
the implementation of the CCI and despite the lack of a plan to
transition collective bargaining to the state level in the
remaining 51 counties not included in the CCI.
PRIOR LEGISLATION:
AB 485 (Gomez), 2014, was nearly identical to this bill. It
failed to meet the legislative calendar deadline for passage.
SB 94 (Senate 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
eligibles) 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.
SB 1036 (Senate Budget and Fiscal Review Committee), Chapter 45,
Statutes of 2012, was the 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 under the CCI.
SB 1008 (Senate Budget and Fiscal Review Committee), Chapter 33,
Statutes of 2012, implemented the Duals Demonstration Pilot
Project, including integration of long-term services and
supports.
REGISTERED SUPPORT / OPPOSITION:
Support
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UDW/AFSCME Local 3930, co-sponsors
American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO
California Labor Federation
Opposition
None on file.
Analysis Prepared
by: Myesha Jackson/HUM. S./(916) 319-2089