BILL ANALYSIS Ó
SENATE COMMITTEE ON HUMAN SERVICES
Senator McGuire, Chair
2015 - 2016 Regular
Bill No: AB 211
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|Author: |Gomez |
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|Version: |February 2, 2015 |Hearing |June 23, 2015 |
| | |Date: | |
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|Urgency: |No |Fiscal: |Yes |
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|Consultant|Mareva Brown |
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Subject: In-home supportive services
SUMMARY
This bill de-links the establishment of a statewide public
authority for the In-Home Supportive Services (IHSS) program,
and its associated bargaining functions, from other provisions
and timelines of the Coordinated Care Initiative (CCI).
ABSTRACT
Existing law:
1)Establishes in state law a program of public Medi-Cal benefits
to provide health care for people who lack sufficient annual
income to meet the costs of health care, and whose other
assets are so limited that their application toward the costs
of such care would jeopardize the person or family's future
minimum self-maintenance and security. (WIC 14000 et seq.)
2)Establishes the In-Home Supportive Services program to provide
domestic supportive and personal care services for aged, blind
or disabled individuals living at or below the poverty level
for the purpose of enabling consumers to avoid
institutionalization and remain safely in their homes. (WIC
12300 et seq.)
3)Requires each county to establish a public authority or
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nonprofit consortium for providers of IHSS to establish a
registry to help consumers find workers, conduct background
checks of prospective workers, provide training and serve as
the employer of record for collective bargaining. Establishes
that recipients of IHSS shall retain the right to choose the
individuals that provide their care and to recruit, select,
train, reject, or change any provider under the contract mode
or to hire, fire, train, and supervise any provider under any
other mode of service. (WIC 12302.25 et seq.)
4)Establishes the CCI, subject to federal approval, which
establishes in eight counties an integrated health and
long-term managed care plan for individuals and seniors and
persons with disabilities who receive both Medi-Cal and
Medicare benefits, and includes IHSS within the managed care
plans. (WIC 14182.16, WIC 14186.35)
5)Predicates establishment of a statewide bargaining authority,
the California In-Home Supportive Services Authority, upon the
completed enrollment of each demonstration county's CCI
participants and notification by the state that such
enrollment has been completed. Sets this date as no sooner
than March 1, 2013. (WIC 12300.7 (a))
6)Deems inoperable the establishment of the statewide bargaining
authority and related authority to obtain information about
IHSS providers established in the CCI if the CCI becomes
inoperative. (GOV 6253.2)
7)Establishes that a statewide employee organization may be
established after a county's CCI implementation date and makes
related references in statute. (GOV 110003, et seq.) (GOV
110011 (e)) (WIC 12300.5)
8)Creates an IHSS Maintenance Of Effort (MOE) requirement for
each county and provides that this MOE shall be counted in
lieu of the county's share of nonfederal costs of the county
services block grant and IHSS administration requirements, but
provides that this MOE shall become inoperative if the CCI is
inoperative. (WIC 12306.15, 10101.1 (d), 12306 (f))
9)Establishes state rates for IHSS providers and permits
counties to set wages based on their collective bargaining
agreements. Provides specific conditions under which the state
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may participate in increased wages and benefits, as specified.
(WIC 12306.1 (a))
10)Provides that each county's share of the costs of negotiated
wage and benefit increases will remain during the period in
which a county's MOE exists, however the MOE share will be in
lieu of that share. Establishes that this section be
inoperative if the CCI becomes inoperative. (WIC 12306.1 (g)
and (h))
11)Requires that participating managed health care plans enter
into a memorandum of understanding (MOU) with a county's
public authority or related organization when a demonstration
county has enrolled its eligible beneficiaries into the CCI.
The MOU must include an agreement to continue to perform
specific activities including assessing, authorizing and
approving each recipient's initial and continuing need for
services, conducting criminal background checks on all
potential providers, providing assistance to IHSS recipients
in finding eligible providers, referring all providers to the
statewide bargaining agency, and other specified tasks. (WIC
14186.35)
12)Requires the state's Director of Finance to estimate the
amount of net General Fund Savings gained from implementing
the CCI and to suspend the CCI immediately if it is determined
that no savings will be generated, as specified. Specifies
which sections of statute shall be deleted if the CCI is
deemed inoperative and requires that the statewide public
authority cease to be the employer of record and the counties
resume that role. (Section 34, Chapter 37, statutes of 2013)
This bill:
1)Sets January 1, 2016, as the date that the California In-Home
Supportive Services Authority assumes responsibility for
statewide collective bargaining.
2)Deletes the state's ability to eliminate the statewide
authority, including language identifying associated duties,
and to return the role of employer of record to the counties
should the CCI become inoperative.
3)Deletes the requirement to link the establishment of the
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statewide authority to a county's implementation of the CCI,
and makes related language changes in numerous places in the
statute.
4)Deletes the requirement that the establishment of the
California In-Home Supportive Services Authority be tied to
the completed enrollment of beneficiaries into the CCI and the
notification of such by the director of the Department of
Health Care Services (DHCS).
5)Deletes redundant sections (WIC 12302.25, 12306.1) that have
been replaced in statute.
6)De-links from the CCI the requirement that a county's IHSS MOE
can be counted in lieu of a county's share of cost of
negotiated wage and benefit increases.
7)Eliminates the requirement to revert a county's MOE share of
cost to the original cost-sharing formula if the CCI is
inoperative.
8)Changes the required date for plans to establish an MOU with
county public authorities that transfers bargaining
responsibility to the statewide authority from the
implementation of the CCI in each county to January 1, 2016.
9)Eliminates from the list of codes that shall be deleted if the
CCI becomes inoperative those codes that establish the In-Home
Supportive Services Employer-Employee Relations Act, establish
and define the duties of the statewide authority, establish
the IHSS Fund, which is used to fund the statewide authority,
require all counties to have a County IHSS MOE, as specified.
FISCAL IMPACT
An Assembly Appropriations Committee analysis identified ongoing
costs in the tens of millions of dollars (GF) 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 will
result in an adjustment to the County IHSS MOE. Thus, any
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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.
The Appropriations analysis also identified 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.
BACKGROUND AND DISCUSSION
Purpose of the bill:
According to the author, the 2012 statute that established the
CCI also created a statewide authority to transfer employer
bargaining responsibility for the IHSS program from the counties
to the state. Under statute, only the eight identified counties
implementing the pilot project would be included in the
statewide authority, and only upon full implementation of the
CCI.
The author states that at the time the CCI statute was enacted,
the Administration intended the CCI to become operative in all
58 counties by 2015, however, due to the unprecedented and
complex nature of the CCI, it has experienced numerous
implementation delays. The author states this bill is needed
because there is no plan to transition collective bargaining
responsibilities to the statewide authority in any of the
remaining 51 counties.
The Coordinated Care Initiative
The CCI was established in the 2012 Budget Act (SB 1036,
Committee on Budget and Fiscal Review, Chapter 45, Statutes of
2012) to integrate long-term services and supports, including
IHSS, into managed care. The intent of the CCI was to bring dual
eligible beneficiaries -- people who qualify for both Medicare
and Medi-Cal - into the same plan. In California, as many as
seven in ten dual eligible beneficiaries are age 65 and older,
and most are women. Approximately one in three are younger
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people with disabilities. California has about 1.1 million of
these beneficiaries.
Initially, the integration into managed care was anticipated to
begin in eight specified demonstration counties as early as
March 2013, with the intent to ultimately expand statewide. But
there have been delays in the implementation of the CCI, due in
part to delayed approval from the federal Centers for Medicaid
and Medicare Services (CMS). Currently, seven counties remain in
the pilot program. San Mateo County transitioned to the
Statewide Authority in February 2015, and will be followed by
Los Angeles, Riverside, San Bernardino and San Diego counties in
July 2015. Santa Clara County is anticipated to transition
January 2016 and finally Orange County in August 2016. Alameda
is not longer participating due to concerns about one of its
plans.
Continued implementation of the CCI is statutorily dependent
upon an annual determination by the Department of Finance (DOF)
that there are net General Fund savings for CCI. If CCI is not
cost-effective, all components of CCI would cease operation.
According to DOF, several factors are threatening the solvency
of the CCI, and it could cease operations, effective January
2017.<1>
More than 100,000 participants were exempted, including
Medicare Special Needs Plans and certain categories of
Medi-Cal beneficiaries based on age or health condition.
Medicare and Medicaid savings were intended to be shared
50:50 with the federal government; however, the federal
government reduced the amount of savings California was
allowed to retain to approximately 25 to 30 percent.
The federal government allowed a 3.975 percent tax on
managed care organizations through June 30, 2016 which is
attributable to the state's participation in the CCI
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<1> Senate Budget and Fiscal Review agenda, March 25, 2015
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demonstration. However, recent federal guidance indicates
that this tax will not be allowed to continue in its
current form.
As of November 1, 2014 approximately 69 percent of
eligible participants opted out of Cal MediConnect compared
to initial projections of approximately 33 percent. Of the
69 percent that have opted-out, about 80 percent of these
individuals are In-Home Supportive Services.
IHSS
The IHSS program is a county-administered Medi-Cal benefit which
provides low-income individuals who are aged, blind or disabled
with specified personal care and domestic services that allow
them to remain safely in their own homes and to avoid
institutionalization.
IHSS services include tasks like feeding, bathing, bowel and
bladder care, meal preparation and clean-up, laundry, and
paramedical care. According to the Governor's budget, the
average monthly caseload for IHSS in 2015-16 will be 462,648
recipients and approximately 470,000 IHSS providers. Nearly
three-fourths of the providers are family members of care
recipients and half live in the home with the recipient for whom
they provide services.
Eligibility for IHSS services is determined by county social
workers who conduct a standardized in-home assessment, and
periodic reassessments, of an individual's ability to perform
specific activities of daily living. Recipients are responsible
for hiring, firing, directing and supervising their own IHSS
provider or providers. The counties or public authorities must
conduct a criminal background check and provide an orientation
before a provider can receive payment. In most counties, local
public authorities are designated as "employers of record" for
collective bargaining purposes, while the state administers
payroll, workers' compensation, and benefits. IHSS is funded
through a combination of federal, state, and county money. The
state historically has paid 65 percent and counties have paid 35
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percent of the non-federal share of IHSS funding. The average
annual cost of services per IHSS client is estimated to be
around $14,217 ($1,185 per client per month) for 2015-16.
Role of the Public Authority
In-home care was first provided in California in the 1950s
through grants to eligible consumers who hired and paid their
own providers. Over time, as the eligible population grew along
with the desire to keep individuals in the most home-like
setting, the IHSS program was developed and has grown to the
nation's largest program of its type. Initially, care was
provided by family members who received pay for a few hours of
service. In the late 1980s state law established a county's
responsibility to create a local public authority or non-profit
consortium and to create a registry for consumers find
providers, to conduct background checks and to train workers. It
also served as the employer of record for bargaining purposes.
The requirement to form a public authority or similar entity
became mandatory in 1999.
Under the CCI, county public authorities will relinquish their
employer of record status to the statewide IHSS bargaining
authority, but will retain other duties, such as performing
background checks and creating a registry for consumers to find
appropriate caregivers. This bill would broaden the statewide
authority that currently exists within the CCI pilot counties to
encompass all 58 counties.
Related legislation:
AB 485 (Gomez, 2013) was nearly identical to this bill,
attempting to de-link the statewide bargaining authority from
the CCI. It died on concurrence on the Assembly floor.
SB 94 (Committee on Budget and Fiscal Review) Chapter 37,
Statutes of 2013, delinks the mandatory enrollment of Medi-Cal
and Medicare beneficiaries, into Medi-Cal managed care from
other elements of the CCI, including the integration of
long-term supports and services into managed care plans, and the
commencement of the In-Home Supportive Services (IHSS) Statewide
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Public Authority. Makes technical changes related to the
statewide public authority's ability to conduct closed meetings.
SB 1036 (Committee on Budget and Fiscal Review) Chapter 45,
Statutes of 2012, provided for the integration of long-term
services and supports, including IHSS, into managed care through
the CCI.
AB 1682 (Peace) Chapter 90, Statutes of 1999, established that
the state and county share costs of any increase in IHSS wages
and benefits negotiated by a public authority or private
consortium and required each county to act as, or establish, an
employer for IHSS personnel for purposes of collective
bargaining.
PRIOR VOTES
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|Assembly Floor: |58 - |
| |20 |
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|Assembly Appropriations Committee: |13 - |
| |3 |
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|Assembly Human Services Committee: |6 - |
| |0 |
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POSITIONS
Support:
AFSCME
Oppose:
None received.
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