BILL ANALYSIS Ó SENATE COMMITTEE ON APPROPRIATIONS Senator Ricardo Lara, Chair 2015 - 2016 Regular SB 199 (Hall) - IHSS: reading and document completion services ----------------------------------------------------------------- | | | | | | ----------------------------------------------------------------- |--------------------------------+--------------------------------| | | | |Version: April 7, 2015 |Policy Vote: HUMAN S. 5 - 0 | | | | |--------------------------------+--------------------------------| | | | |Urgency: No |Mandate: Yes | | | | |--------------------------------+--------------------------------| | | | |Hearing Date: May 28, 2015 |Consultant: Jolie Onodera | | | | ----------------------------------------------------------------- SUSPENSE FILE. AS AMENDED. 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 (as approved May 28, 2015): 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 SB 199 (Hall) Page 1 of ? 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. Automation : Unknown but potentially significant one-time costs (General Fund/Federal Fund) for necessary automation changes to CMIPS II. Federal approval : 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. 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. SB 199 (Hall) Page 2 of ? 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 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 SB 199 (Hall) Page 3 of ? 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 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 SB 199 (Hall) Page 4 of ? 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. Author amendments (as adopted May 28, 2015): To clarify that the new service may only be provided to blind IHSS recipients, the following amendments to WIC § 12300(b) were adopted: (b) 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, up to two hours per month of assisting in reading and completing financial and other documents for a recipient who is blind, 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, 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. -- END --