BILL ANALYSIS Ó
AB 211
Page 1
ASSEMBLY THIRD READING
AB
211 (Gomez)
As Introduced February 2, 2015
Majority vote
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|Committee |Votes |Ayes |Noes |
| | | | |
| | | | |
|----------------+------+--------------------+----------------------|
|Human Services |6-0 |Chu, Mayes, | |
| | |Calderon, Lopez, | |
| | |Mark Stone, | |
| | |Thurmond | |
| | | | |
|----------------+------+--------------------+----------------------|
|Appropriations |13-3 |Gomez, Bonta, |Gallagher, Jones, |
| | |Calderon, Chang, |Wagner |
| | |Daly, Eggman, | |
| | |Eduardo Garcia, | |
| | |Gordon, Holden, | |
| | |Quirk, Rendon, | |
| | |Weber, Wood | |
| | | | |
| | | | |
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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)
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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
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. (Welfare and Institutions Code
(WIC) Section 12300 et seq.)
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2)Establishes the CCI 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 (Budget and Fiscal Review Committee),
Chapter 33, Statutes of 2012, and SB 1036 (Budget and Fiscal
Review Committee), 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
Section 14186 et seq.)
4)Establishes the IHSS Statewide Authority as a joint powers
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.
(California Government Code (GOV) Section 6531.5, WIC Section
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 Section 12306.15)
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FISCAL EFFECT: According the Assembly Appropriations Committee:
1)Potentially major ongoing costs (General Fund (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
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:
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
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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 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
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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 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.
Analysis Prepared by:
Myesha Jackson / HUM. S. / (916) 319-2089 FN:
0000599