BILL ANALYSIS
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THIRD READING
Bill No: AB 2274
Author: Beall (D)
Amended: As introduced
Vote: 21
SENATE HUMAN SERVICES COMMITTEE : 3-2, 6/22/10
AYES: Liu, Romero, Yee
NOES: Emmerson, Runner
SENATE APPROPRIATIONS COMMITTEE : Senate Rule 28.8
ASSEMBLY FLOOR : 48-26, 5/6/10 - See last page for vote
SUBJECT : In-Home Supportive Services program
SOURCE : Services Employees International Union
DIGEST : This bill allows an In-Home Supportive Services
recipient who receives services from an entity authorized
by a federal Section 1115 Medicaid waiver, subject to
program requirements, to select any qualified person to
provide the services, and defines "qualified person" to
include an employee of such an entity who is available and
eligible to provide the services.
ANALYSIS : Existing law:
1.Establishes the In-Home Supportive Services (IHSS)
program to provide personal services and home care for
eligible poor, aged, blind and disabled individuals to
CONTINUED
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enable recipients to remain in their own homes and avoid
institutionalization.
2.Provides that IHSS recipients who receive services
through a contract or managed care provider may, subject
to program requirements, select any qualified provider
who is an employee of the contract or managed care
provider.
This bill allows an In-Home Supportive Services recipient
who receives services from an entity authorized by a
federal Section 1115 Medicaid waiver, subject to program
requirements, to select any qualified person to provide the
services, and defines "qualified person" to include an
employee of such an entity who is available and eligible to
provide the services.
Background
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.
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
recipieint nonetheless may, subject to program
requirements, select any qualified person to provide IHSS
services.
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
authority to waive aspects of the law to permit states to
undertake "research and demonstration" projects that
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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, AB 6 4x 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.
FISCAL EFFECT : Appropriation: No Fiscal Com.: Yes
Local: No
SUPPORT : (Verified 7/29/10)
Services Employees International Union (source)
California Association of Public Authorities
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ARGUMENTS IN SUPPORT : Services Employees International
Union states that "major changes to programs made within
short time frames - the 1115 waiver amendments are on a
course for summer 2010 - can result in accidental omissions
that potentially harm people who rely on the programs being
changed." According to the author's office, this bill
simply ensures that the right of recipients to choose their
provider will not be interrupted or interfered with through
any new program model that may be authorized under
California's new Section 1115 waiver.
ASSEMBLY FLOOR :
AYES: Ammiano, Arambula, Beall, Blakeslee, Blumenfield,
Bradford, Brownley, Buchanan, Caballero, Charles
Calderon, Carter, Chesbro, Coto, Davis, De La Torre, De
Leon, Eng, Evans, Feuer, Fong, Fuentes, Furutani,
Galgiani, Hall, Hayashi, Hernandez, Hill, Huber, Huffman,
Jones, Lieu, Bonnie Lowenthal, Ma, Monning, Nava, V.
Manuel Perez, Portantino, Ruskin, Salas, Saldana,
Skinner, Solorio, Swanson, Torlakson, Torres, Torrico,
Yamada, John A. Perez
NOES: Adams, Anderson, Bill Berryhill, Tom Berryhill,
Conway, DeVore, Emmerson, Fletcher, Fuller, Gaines,
Garrick, Hagman, Harkey, Jeffries, Knight, Logue, Miller,
Nestande, Niello, Nielsen, Norby, Silva, Smyth, Audra
Strickland, Tran, Villines
NO VOTE RECORDED: Bass, Block, Cook, Gilmore, Mendoza,
Vacancy
CTW:nl 7/29/10 Senate Floor Analyses
SUPPORT/OPPOSITION: SEE ABOVE
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