BILL ANALYSIS Ó
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|SENATE RULES COMMITTEE | AB 211|
|Office of Senate Floor Analyses | |
|(916) 651-1520 Fax: (916) | |
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THIRD READING
Bill No: AB 211
Author: Gomez (D), et al.
Introduced:2/2/15
Vote: 21
SENATE HUMAN SERVICES COMMITTEE: 3-1, 6/23/15
AYES: McGuire, Hancock, Liu
NOES: Nguyen
NO VOTE RECORDED: Berryhill
SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/27/15
AYES: Lara, Beall, Hill, Leyva, Mendoza
NOES: Bates, Nielsen
ASSEMBLY FLOOR: 58-20, 6/2/15 - See last page for vote
SUBJECT: In-home supportive services
SOURCE: UDW/AFSCME Local 3930
DIGEST: 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).
ANALYSIS:
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
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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
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 IHSS recipients shall retain the right to
choose the individuals that provide their care and to hire,
fire, recruit, select, train, or reject any provider, as
specified. (WIC 12302.25 et seq.)
4) Establishes the CCI 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 establishes
this may happen no sooner than March 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) 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
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requirements. Requires that the MOE becomes inoperative if
the CCI is inoperative. (WIC 12306.15, 10101.1 (d), 12306
(f))
8) 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 becomes
inoperative if the CCI becomes inoperative. (WIC 12306.1 (g)
and (h))
9) Requires that participating managed health care plans
enter into an 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 assessments
and other specific activities. (WIC 14186.35)
10) 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
statewide authority to a county's implementation of the CCI,
and makes related language changes in numerous places in the
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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), and deletes redundant
sections (WIC 12302.25, 12306.1) that have been replaced in
statute.
5) 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.
6) Eliminates the requirement to revert a county's MOE share
of cost to the original cost-sharing formula if the CCI is
inoperative.
7) 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.
8) 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.
Background
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, there are about 1.1 million dual-eligible
beneficiaries; as many as seven in ten are age 65 and older, and
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most are women. About one-third are younger people with
disabilities.
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). Seven counties remain in the pilot
program. San Mateo County transitioned to the Statewide
Authority in February 2015, followed by Los Angeles, Riverside,
San Bernardino and San Diego counties. Santa Clara County is
anticipated to transition January 2016 and finally Orange County
in August 2016. Alameda is no 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.
2)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.
3)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 demonstration.
However, recent federal guidance indicates that this tax will
not be allowed to continue in its current form, and a special
Legislative session has been convened to address methods to
fix the MCO tax.
4)As of November, approximately 69 percent of eligible
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participants opted out of Cal MediConnect but initial
projections suggested just a 33 percent opt-out rate. Of those
that opted-out, about 80 percent are in the IHSS program.
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. In an average month, about 462,000 recipients
received care from approximately 470,000 IHSS providers,
according to the Governor's budget. Nearly three-fourths of the
providers are family members and half live with the recipient.
Eligibility for IHSS is determined by county social workers who
conduct an 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
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
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county's responsibility to create a local public authority or
non-profit consortium, which became a 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 broadens the statewide authority that currently exists
within the CCI pilot counties to encompass all 58 counties.
FISCAL EFFECT: Appropriation: No Fiscal
Com.:YesLocal: No
According to a Senate Appropriations Committee analysis, this
bill results in potential costs (General Fund) in the high tens
to hundreds of millions of dollars annually to the extent this
measure results in an increase in IHSS provider wages and health
benefits with the implementation of the Statewide Authority in
all 58 counties effective January 1, 2016. It projected annual
costs of about $6.9 million (50 percent General Fund, 50 percent
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,
and additional significant one-time General Fund costs to CalHR
for limited-term staff and overtime required to support the
workload imposed under the accelerated implementation date
mandated in this measure.
The analysis noted that to the extent the CCI would have
otherwise become inoperative at some future date due to an
estimate by the Director of Finance that the CCI would not
generate net General Fund savings, as specified; the annual
costs noted above would continue to be incurred. The counties'
share of cost limited by the County IHSS MOE would not revert to
the original cost-sharing formula, and CalHR/DSS costs would
continue to support the activities of the Statewide Authority.
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SUPPORT: (Verified 8/28/15)
AFSCME
California Labor Federation
OPPOSITION: (Verified 8/28/15)
Department of Finance
ARGUMENTS IN SUPPORT: 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.
ARGUMENTS IN OPPOSITION: The Department of Finance writes
that it is opposed to this bill because it would require the
state to implement collective bargaining in all 58, even if the
CCI were to become inoperative. The CCI is intended to be a
complete package of reforms designed to improve care
coordination for individuals who are eligible for benefits under
Medicare and Medi-Cal. Allowing statewide bargaining
responsibilities to function separately from the entirety of the
CCI erodes the comprehensive nature of the initiative and places
all fiscal risk of the CCI squarely on the state.
ASSEMBLY FLOOR: 58-20, 6/2/15
AYES: Achadjian, Alejo, Bigelow, Bloom, Bonilla, Bonta, Brown,
Burke, Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley,
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Cooper, Dababneh, Daly, Dodd, Eggman, Frazier, Cristina
Garcia, Eduardo Garcia, Gipson, Gomez, Gonzalez, Gordon, Gray,
Roger Hernández, Holden, Irwin, Jones-Sawyer, Lackey, Levine,
Linder, Lopez, Low, Maienschein, Mayes, McCarty, Medina,
Mullin, Nazarian, O'Donnell, Perea, Quirk, Rendon,
Ridley-Thomas, Rodriguez, Salas, Santiago, Mark Stone,
Thurmond, Ting, Weber, Williams, Wood, Atkins
NOES: Travis Allen, Baker, Brough, Dahle, Beth Gaines,
Gallagher, Gatto, Grove, Hadley, Harper, Jones, Kim, Mathis,
Melendez, Obernolte, Olsen, Patterson, Steinorth, Wagner, Wilk
NO VOTE RECORDED: Chávez, Waldron
Prepared by:Mareva Brown / HUMAN S. / (916) 651-1524
8/30/15 19:11:48
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