BILL ANALYSIS                                                                                                                                                                                                    



          SENATE COMMITTEE ON APPROPRIATIONS
                             Senator Ricardo Lara, Chair
                                2015 - 2016  Regular 

          SB 199 (Hall) - IHSS:  reading and document completion services   

          
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          |Version: April 7, 2015          |Policy Vote: HUMAN S. 5 - 0     |
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          |Urgency: No                     |Mandate: Yes                    |
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          |Hearing Date: April 20, 2015    |Consultant: Jolie Onodera       |
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          This bill meets the criteria for referral to the Suspense File. 

          

          Bill  
          Summary:  SB 199 would expand the scope of services available  
          under the In-Home Supportive Services (IHSS) program to include  
          assistance in reading and completing financial and other  
          documents, for up to two hours per month, for a recipient who is  
          blind, when that assistance is necessary for the recipient to  
          remain in his or her home, as specified. This bill provides that  
          provision of the service would be implemented on January 1,  
          2017, only to the extent that federal financial participation is  
          available and any necessary federal approvals have been  
          obtained.  


          Fiscal  
          Impact:  
               IHSS services to blind  : Potential first-year costs (6  
              months) of up to $2.1 million (General Fund/Federal Fund),  
              and $3.9 million annually to fund additional authorized IHSS  
              provider hours for services to IHSS recipients who are  







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              blind. This estimate assumes approximately two percent of  
              the IHSS caseload, or 12,000 individuals, are legally blind  
              and would be authorized for an additional two hours per  
              month. Estimated costs do not reflect the potential impact  
              of the Fair Labor Standards Act (FLSA) overtime regulations  
              recently vacated by the court.   
               IHSS services to visually impaired or otherwise qualified  :  
              Potential ongoing costs of about $14 million (General  
              Fund/Federal Fund) annually to fund additional authorized  
              IHSS provider hours to visually impaired or other qualified  
              individuals eligible for the service. This estimate assumes  
              approximately 30,000 additional IHSS recipients may qualify  
              for the service authorized for an additional three hours per  
              month. 
               IHSS Administration  : Near-term potentially significant  
              county administrative costs (General Fund/Federal Fund) to  
              assess current IHSS recipients who are visually impaired or  
              otherwise eligible for this new service. Future ongoing  
              costs are estimated to decline once the existing caseload is  
              assessed.
               Automation  : Unknown but potentially significant one-time  
              costs (General Fund/Federal Fund) for necessary automation  
              changes to CMIPS II.
              Minor one-time costs to DHCS to submit the request for  
              federal approval of this service. 


          Background:  Existing law provides for the IHSS program, administered by  
          the Department of Social Services (DSS), through which qualified  
          aged, blind, or disabled individuals receive supportive services  
          enabling them to remain in their own homes. Existing law defines  
          the scope of supportive services under the IHSS program to  
          include heavy cleaning, personal care services, accompaniment by  
          a provider when needed during necessary travel to health-related  
          appointments or to alternative resource sites, yard hazard  
          abatement, protective supervision, teaching and demonstration  
          directed at reducing the need for other supportive services, and  
          paramedical services which make it possible for the recipient to  
          establish and maintain an independent living arrangement.

          Under existing law, county welfare departments are required to  
          provide visually impaired applicants and recipients with  
          information on, and referral services to, entities that provide  
          reading services to visually impaired persons.








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          Proposed  
          Law:  This bill would expand the scope of services available under  
          the IHSS program to include assistance in reading and completing  
          financial and other documents, limited to up to two hours per  
          month for a recipient who is blind, when that assistance is  
          necessary for the recipient to remain in his or her home, or  
          abode of his or her own choosing, as defined by the DSS.  
          Additionally, this bill:
                 By January 1, 2017, requires the DHCS to seek all  
               federal approvals necessary to ensure that Medicaid funds  
               may be used in implementing the provisions of this measure.
                 Provides that the authorization to provide the specified  
               service becomes operative on January 1, 2017.
                 Specifies that provision of the service shall be  
               implemented only if, and to the extent that, federal  
               financial participation is available, and any necessary  
               federal approvals have been obtained.
                 Provides that the state and counties shall be immune  
               from any liability, including negligence or intentional  
               torts of providers, associated with the delivery of the  
               service, as specified.
                 Authorizes the DSS to implement the bill's provisions  
               through all-county letters until emergency regulations are  
               filed, as specified.
                 Requires the DSS to adopt emergency regulations on or  
               before January 1, 2018, and to adopt final regulations by  
               January 1, 2019.


          Related  
          Legislation:  AB 1703 (Hall) 2014 was substantially similar to this measure.  
          AB 1703 would have provided assistance in reading and completing  
          financial and other documents to an IHSS recipient who is blind  
          or visually impaired, or who has another disability that  
          significantly impairs his or her ability to read. This bill was  
          held on the Suspense File of this Committee.

          AB 238 (Beall) 2007 was substantially similar to AB 1703 (Hall)  
          and was vetoed by the Governor with the following message:

          I strongly support the In-Home Supportive Services program which  








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          provides services to low-income aged, blind or disabled persons  
          so they can remain safely in homes. My Administration has worked  
          hard to secure more than 1.7 billion in federal funds to protect  
          these important services. However, I cannot support expanding  
          the program's scope to include reading services. This expansion  
          would add more than one million dollars in new costs at a time  
          of ongoing budget challenges. We must balance our need for  
          important program services with our fiscal reality. For these  
          reasons, I am returning AB 238 without my signature.


          Staff  
          Comments:  By expanding the scope of authorized IHSS program services to  
          include assistance in reading and completing financial and other  
          documents, this bill will result in an ongoing increase in  
          authorized IHSS hours and costs for IHSS provider wages. SB 1036  
          (Chapter 45/2012) altered the historical county contribution of  
          IHSS funding by enacting a county IHSS maintenance of effort  
          (MOE), which replaced the county contribution of 17.5 percent  
          with a requirement that counties generally maintain their FY  
          2011-12 expenditure level for IHSS program costs as of FY  
          2012-13, to be adjusted annually for inflation beginning in FY  
          2014-15. As a result, all increases in the non-federal share of  
          IHSS costs above the county IHSS MOE are now borne by the  
          General Fund. 

          The DSS has indicated two percent of the IHSS caseload is  
          legally blind, or about 12,000 individuals. Assuming the  
          necessary federal approvals have been obtained, costs to provide  
          the new service to 12,000 recipients at two hours per month  
          would result in annual costs of about $2.1 million (General  
          Fund/Federal) in FY 2016-17 and $3.9 million annually ongoing.    
            

          As drafted, this bill could potentially be interpreted to extend  
          eligibility for assistance in reading and completing financial  
          and other documents to all IHSS recipients, with the two-hour  
          limitation applicable only to IHSS recipients who are blind. As  
          a result, IHSS recipients who are visually impaired or assessed  
          to have another disability that significantly impairs their  
          ability to read could potentially be eligible for the new  
          service. It is estimated an additional 30,000 IHSS recipients  
          could qualify for this service under an assessment meeting this  
          standard. Assuming the 30,000 IHSS recipients are authorized for  








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          the new service at three hours per month would result in annual  
          costs of nearly $14 million (General Fund/Federal).

          Staff notes the estimates above do not include the potential  
          impact of the changes to FLSA regulations recently vacated by  
          the court and on appeal by the federal Department of Labor. To  
          the extent the overtime provisions of the regulations are  
          implemented in the future, estimated costs would potentially be  
          greater.

          To the extent a portion of the existing IHSS caseload would  
          request reassessment for potential eligibility for this service  
          upon enactment of this bill would result in a short-term  
          increase in county eligibility worker costs to reassess IHSS  
          recipients for this new service. The addition of this new  
          supportive service will also likely require automation changes  
          to existing systems which could result in potentially  
          significant one-time costs.

          Recommended Amendments: To clarify that the new service may only  
          be provided to blind IHSS recipients, staff recommends the  
          following amendments to WIC  12300(b):

          (b)  (1)  Supportive services shall include domestic services and  
          services related to domestic services, heavy cleaning, personal  
          care services, accompaniment by a provider when needed during  
          necessary travel to health-related appointments or to  
          alternative resource sites, yard hazard abatement, protective  
          supervision, teaching and demonstration directed at reducing the  
          need for other supportive services,  and  paramedical services  
          that make it possible for the recipient to establish and  
          maintain an independent living  arrangement.   arrangement, and  
          assistance in reading and completing financial and other  
          documents, for up to two hours per month, for a recipient who is  
          blind, when that assistance is necessary for the recipient to  
          remain in his or her home, or abode of his or her own choosing,  
          as defined by the department  .
           (2) Supportive services shall also include assistance to a  
          recipient who is blind in reading and completing financial and  
          other documents, for up to two hours per month, when that  
          assistance is necessary for the recipient to remain in his or  
          her home, or abode of his or her choosing, as defined by the  
          department.









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