BILL ANALYSIS Ó
AB 211
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Date of Hearing: April 15, 2015
ASSEMBLY COMMITTEE ON APPROPRIATIONS
Jimmy Gomez, Chair
AB
211 (Gomez) - As Introduced February 2, 2015
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Urgency: No State Mandated Local Program: NoReimbursable: No
SUMMARY: This bill delinks implementation of statewide
collective bargaining authority for the In-Home Support Services
(IHSS) program from the state's Coordinated Care Initiative
(CCI) and implements it separately under the new statewide
California IHSS Authority (Statewide Authority) beginning
January 1, 2016. Specifically, this bill:
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1)Requires the Statewide Authority to assume collective
bargaining responsibility for IHSS providers in all 58
counties beginning January 1, 2016, rather than in the eight
counties participating in the CCI demonstration project.
2)Makes the Statewide Authority permanent by deleting the
statute making statewide collective bargaining conditional
upon implementation of the CCI.
3)Deletes the authority of the Director of Finance to halt
implementation of the CCI, and therefore statewide collective
bargaining by the Statewide Authority, if the director
determines that the CCI will not generate anticipated General
Fund (GF) savings.
4)Makes permanent, through the separation of statewide
collective bargaining authority for IHSS, 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
of negotiated wage and benefit increases.
FISCAL EFFECT:
1)Potentially major ongoing costs (GF) in the tens 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. Only those wage and benefit increases that are
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locally negotiated or imposed before the Statewide Authority
assumes employer responsibility result in an adjustment to the
County IHSS MOE. Thus, any increases negotiated by the
Statewide Authority do not require a county share of costs.
The nonfederal share of the increase will be fully funded by
the state, resulting in ongoing costs to the GF.
2)Annual costs in the range of $7 million (50% GF, 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.
COMMENTS:
1)Purpose. While the statute creating the CCI anticipated a
fairly seamless roll-out within the eight demonstration
counties, there have been numerous implementation delays. As a
result, five counties are still in the enrollment process, one
county has not yet begun, and one county withdrew from the
demonstration. Thus far, San Mateo is the only county to have
completed enrollment and transitioned to collective bargaining
under the Statewide Authority. According to the author, this
bill is necessary to shift to statewide collective bargaining
for IHSS providers despite delays in the implementation of the
CCI. The bill makes this shift for all 58 counties, not just
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the demonstration counties.
The bill's co-sponsor, the American Federation of State and
County Municipal Employees, notes that the implementation
delays have delayed the transfer of collective bargaining to
the state in all counties, and as a result, collective
bargaining at the county level has either been delayed or met
with reluctance to engage in bargaining when the transfer of
responsibility is expected to be imminent. The sponsor writes
that several counties have proposed one-year contract
extensions, while others have opposed increases in IHSS
spending because it would permanently increase the county's
IHSS MOE.
2)Background. 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 was originally limited to 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.
As part of the CCI, budget trailer bill language (SB 1036,
Chapter 45, Statutes of 2012) shifted collective bargaining
responsibilities in the demonstration counties from the county
level to the new Statewide Authority. 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. However, due to the unprecedented and
complex nature of the CCI, it has experienced numerous
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implementation delays. Enrollment of the recipients into the
CCI in six of the eight pilot counties will now be completed
by July 2015. Enrollment has not yet begun in Orange County,
and Alameda County withdrew from the CCI demonstration project
in 2014.
According to the author, in 2012, the Administration intended
for the CCI to become operative in all 58 counties by 2015.
However, there is no plan to transition collective bargaining
responsibilities to the state level in any of the remaining 51
counties.
3)In-Home Supportive Services (IHSS). The IHSS program is a
Medi-Cal benefit, which provides services that enable the
recipient to remain in his or her home. The IHSS program
provides personal care and domestic 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. IHSS is funded with
federal, state, and county resources, and prior to
implementation of the CCI demonstration project, (July 1,
2012) county public authorities or nonprofit consortia were
designated as "employers of record" for collective bargaining
purposes, while the state administered payroll and benefits.
4)Prior legislation.
a) AB 485 (Gomez), 2014, was nearly identical to this bill.
AB 485 died on the Assembly Floor, concurrence pending.
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b) 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.
c) 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.
d) 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.
e) SB 208 (Steinberg), Chapter 714, Statutes of 2010:
Implemented several changes to the Medi-Cal Program as
proposed in the state's application to renew the state's
Section 1115 Medicaid Waiver. Also gave DHCS the authority
to establish the dual eligible beneficiary demonstration
project to give those eligible for Medicare and Medi-Cal a
continuum of services and maximize coordination of
benefits.
AB 211
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Analysis Prepared by:Jennifer Swenson / APPR. / (916)
319-2081