BILL ANALYSIS
SENATE HUMAN
SERVICES COMMITTEE
Senator Carol Liu, Chair
BILL NO: AB 2274
A
AUTHOR: Beall
B
VERSION: As introduced
HEARING DATE: June 10, 2010
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FISCAL: Appropriations
2
7
CONSULTANT:
4
Hailey
SUBJECT
In-home supportive services program
SUMMARY
Provides that persons receiving in-home supportive services
(IHSS) from an organization authorized through a federal
waiver has the right to select any qualified person to
provide care.
ABSTRACT
Current law
1) Establishes the IHSS program under which qualified
aged, blind, or disabled persons receive services that
permit them to remain safely in their own homes.
2) Allows a person who receives IHSS services through
either a contract or a managed care provider to select any
qualified person to provide care.
3) Establishes the federal Medicaid program to pay for a
range of health and ancillary services for qualifying
persons - primarily persons who are aged, blind, or
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disabled and of low income.
4) Allows states to apply for and receive waivers to
certain Medicaid requirements in order to provide health
and ancillary services in different ways, including
providing home and community-based services provided in
lieu of services in more institutional settings.
This bill
1) Allows a person who receives IHSS services from an
organization authorized through a federal waiver to Section
1115 of the Medicaid program to select any qualified person
to provide care.
FISCAL IMPACT
According to the Assembly Appropriations Committee, this
bill has minor, absorbable costs.
BACKGROUND AND DISCUSSION
The in-home supportive services program (IHSS)
The IHSS program helps pay for services that enable
elderly, disabled, or blind individuals can remain safely
in their own homes. 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.
IHSS recipients have the right to choose their personal
workers. Most IHSS recipients receive care services from
an individual provider. Some recipients, however, receive
services through contract or managed care providers.
Current law provides that, in those instances, the
recipient nonetheless may, subject to program requirements,
select any qualified person to provide IHSS services.
Medicaid waivers
The Kaiser Commission on Medicaid and the Uninsured
provides a primer on Section 1115 of the Social Security
Act. According to the commission, Section 1115 gives the
Secretary of the Department of Health and Human Services
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authority to waive aspects of the law to permit states to
undertake "research and demonstration" projects that
further the purposes of Medicaid and the State Child Health
Insurance Program (SCHIP).
These waivers allow states to use federal Medicaid and
SCHIP funds in ways that are not otherwise allowed under
federal law. Section 1115 waivers are not new to Medicaid
and SCHIP. However, in August 2001, the Administration
released new waiver guidelines, called the Health Insurance
Flexibility and Accountability Initiative, encouraging
states to submit waivers. The commission notes that this
new initiative, combined with state fiscal pressures, has
led to an increase in the number of states seeking or
expanding a Section 1115 waiver.
This summer, California is renewing its Section 1115
Medicaid waiver, which is due to expire on July 31, 2010.
As part of the 2009-10 Budget, ABx4 6 was enacted to slow
the long-term Medi-Cal expenditure growth rate through
significant restructuring of the Medi-Cal program. This
legislation commits the Department of Health Care Services
to pursuing a Section 1115 waiver that will restructure the
organization and delivery of health care for populations
that include the most medically vulnerable, high cost
Medi-Cal beneficiaries with complex chronic conditions,
co-morbidities, and the highest needs for on-going health
care.
The specifics of California's new Section 1115 waiver have
yet to be determined. It is likely, however, that IHSS
will be included as a component of any coordinated systems
of care included under the new waiver. This bill extends
the right of recipients to choose their provider to any
IHSS program that might be authorized under California's
new Section 1115 waiver.
Assembly votes
Human Services Committee 4-1
Appropriations Committee 10-5
Floor 48-16
POSITIONS
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Support: Service Employees International Union,
California State Council
(sponsor)
California Association of Public Authorities
Oppose: None received
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