BILL ANALYSIS
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Date of Hearing: May 11, 2010
ASSEMBLY COMMITTEE ON HUMAN SERVICES
Jim Beall Jr., Chair
ACR 151 (Ma) - As Introduced: April 7, 2010
AS PROPOSED TO BE AMENDED
SUBJECT : In-Home Supportive Services
SUMMARY : Declares the intent of the Legislature to ensure the
preservation of home care and personal services to seniors and
people with disabilities through the In-Home Supportive Services
(IHSS) program. Specifically, this resolution makes the
following legislative findings:
1)For over a quarter century, California has provided home care
and personal assistance services to qualifying residents
through a unique, consumer-directed fiscally sound program
called IHSS.
2)The IHSS program was signed into law by Governor Ronald Reagan
in 1973 to avoid their unnecessary institutionalization and
assist IHSS recipients to live independently in the community.
3)California's IHSS program has become nationally recognized as
the preferred way to provide long-term care assistance and is
being replicated in other states.
4)IHSS is a prime example of the home-based, long-term care
solutions that were the focus of President George W. Bush's
2001 "New Freedom Initiative."
5)February 2010 data from the California IHSS Management
Statistics Summary show that the IHSS program serves nearly
450,000 residents who qualify for services because of
functional limitations and financial need.
6)The average per capita cost of IHSS is one-fifth of the
average per capita cost to taxpayers of nursing homes.
7)The IHSS program is acknowledged as the reason California has
a relatively low number of people in nursing homes and other
institutions.
8)The IHSS program is key to fulfilling the civil rights of
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Californians with disabilities to live in the most integrated
settings, as affirmed by the Americans with Disabilities Act
and the 1999 Supreme Court decision in Olmstead .
9)Nearly 370,000 IHSS providers deliver the home care services
and support to make it possible for California seniors and
people with disabilities to remain living independently in
their homes.
10)Numerous national organizations join together annually to
declare the month of November as National Home Care Month to
recognize, honor, and support the valuable contributions of
home care workers.
11)The work of IHSS providers is essential to the independence
of seniors and people with disabilities and deserves the
respect and appreciation of all Californians.
FISCAL EFFECT : None
COMMENTS :
Proposed amendments : The summary and description of the
resolution above reflect the resolution as proposed to be
amended by the author. The amendments are largely
non-substantive and clarifying.
The IHSS Program helps pay for services so that the elderly,
disabled, or blind individuals can remain in their own homes and
avoid institutionalization. IHSS services include, but are not
limited to, housecleaning, meal preparation, laundry, grocery
shopping, personal care services (such as bowel and bladder
care, bathing, grooming and paramedical services), accompaniment
to medical appointments, and protective supervision for people
with mental impairments. A portion of the costs for IHSS
services are paid by federal funding. More than 370,000
caregivers provide services under the IHSS program to a
projected 450,000 recipients.
In 1999, the United States Supreme Court, in Olmstead v. L.C.
(1999) 527 U.S. 581, held that, under the federal Americans with
Disabilities Act (ADA), unnecessary institutionalization is a
form of discrimination based on disability. The IHSS program is
a critical component of California's efforts to comply with the
"integration mandate" of the ADA.
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The IHSS program is the fastest growing major social program in
California. According to the Legislative Analyst's Office
(LAO), between 1998-99 and 2008-09, IHSS General Fund
expenditures grew at an average annual rate of about 13%.
Increased costs are due to a combination of increases in
provider wages, significant growth in the caseload, and an
increase in the average number of authorized hours per case.
These changes reflect both the increasing population in the
State of seniors and people with disabilities, and the success
of the IHSS program in enabling even people with significant
disabilities to remain in their homes as an alternative to
costly institutionalization.
The growth--that is, the success--of the IHSS program has led to
budget actions and budget proposals to control costs by cutting
provider wages, limiting access to services within the program,
narrowing eligibility for the program, and even elimination of
the entire program. Recent budget actions have reduced the
state's participation in provider wages and benefits, denied all
services based on Functional Index (FI) scores, and reduced
services based on Functional Ranks. These actions have been
enjoined as a result of litigation.
The Governor's budget proposal for Fiscal Year 2010-11 would
eliminate IHSS eligibility for all but the most severely
impaired individuals, resulting in an 87% reduction in the
caseload. The LAO has noted that reducing the IHSS caseload by
87% would have other impacts, including the loss of over 310,000
jobs, thereby increasing the state's unemployment from a
projected 12% to as high as 13.2%, and further stressing the
state's unemployment insurance fund.
The Governor's proposed budget also includes a trigger provision
that would eliminate the entire IHSS program effective October
1, 2010 if the state does not receive $6.9 billion in additional
federal funds for a range of programs. The United Domestic
Workers of America (UDW), sponsor of this resolution, points out
that eliminating the IHSS program "would have the effect of
shifting care to other sectors of the government including the
developmental disability system, aging programs, long-term care
and emergency rooms."
In a January 2010 report, entitled Considering the State Costs
and Benefits: In-Home Supporive Services Program , the LAO
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considered the net fiscal impact of eliminating the IHSS program
and concluded that elimination of the program would result in a
net cost to the state General Fund if more than 32% of
recipients entered a skilled nursing facility as a result. A
subsequentlly conducted analysis suggests that the breakeven
point may be even lower, resulting in net costs to the state if
only 22% of IHSS recipients moved to nursing homes in the
absence of IHSS services. Howes, C., Costs and Benefits of
In-Home Supportive Services for the Elderly and Persons with
Disabilities: A California Case Study , Institute for Women's
Policy Research and PHI (May 3, 2010),
http://www.iwpr.org/pdf/E512HowesCBA.pdf . Moreover, the LAO's
analysis did not address the human costs of eliminating or
drastically cutting the IHSS program on recipients' quality of
life, regardless of the percentage who would be insitutionalized
as a result.
This resolution recognizes the value of the IHSS program, not
only in terms of its cost effectiveness but also in its
importance in human terms to the lives of hundreds of thousands
of California's seniors and people with disabilities. UDW
concludes that "California cannot afford the costs that would be
associated with undermining this critical program. This
resolution acknowledges and supports the mainentance and
preservation of home care servcies for the elderly, blind and
disabled."
REGISTERED SUPPORT / OPPOSITION :
Support
California Association of Public Authorities for IHSS (CAPA)
(sponsor)
United Domestic Providers of America/AFSCME (sponsor)
AARP
American Federation of State, County and Municipal Employees
(AFSCME), AFL-CIO
Gray Panthers (Sacramento)
San Francisco IHSS Public Authority
Opposition
None on file.
Analysis Prepared by : Eric Gelber / HUM. S. / (916) 319-2089
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