BILL ANALYSIS
SENATE HEALTH AND HUMAN SERVICES
COMMITTEE ANALYSIS
Senator Martha M. Escutia, Chair
BILL NO: AB 16
A
AUTHOR: Honda, et. al.
B
AMENDED: June 17, 1999
HEARING DATE: June 23, 1999
1
FISCAL: Appropriations
6
CONSULTANT:
Umemoto
SUBJECT
In-home Supportive Services
SUMMARY
Removes the restriction regarding the state paying any
share of the nonfederal costs for counties utilizing the
Public Authority or nonprofit consortium mode of
administering IHSS for increasing workers benefits and
wages, under specified circumstances.
ABSTRACT
Current Law:
1.Establishes the IHSS program within the Department of
Social Services (DSS) to provide personal care services
and domestic assistance to eligible aged, blind, and
disabled individuals who would otherwise be unable to
remain safely in their homes. Provides services without
cost to SSI/SSP recipients. Requires those with higher
incomes to pay a share of the cost.
2.Authorizes counties to deliver IHSS through any of the
following modes of service delivery:
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Individual providers (IPs) hired by the recipient;
County contract with a private agencies; or
County social service staff.
1.Authorizes counties to establish a public authority or
nonprofit consortium to administer the IP mode and
requires them to:
Operate a registry of IPs;
Screen potential IPs;
Provide for training of IPs and recipients; and
Perform any other necessary functions.
1.Establishes the public authority or nonprofit consortium
as the employer of record for the purpose of collective
bargaining by individual providers.
2.Requires the state and counties to have a share of cost
for the nonfederal costs at a ratio of 65 percent to 35
percent, respectively, except as provided in (6) for
public authorities.
3.Specifies that any cost due to increased provider wages
or benefits negotiated by a public authority or nonprofit
consortium shall be paid by the county, without any state
share, unless otherwise provided for in the annual Budget
Act.
This Bill:
1.Requires the state to also share in the annual,
nonfederal cost of services on a 63 to 35 ratio for
counties under the public authority or nonprofit
consortium mode of administration at the same rate it
pays for other forms of IHSS administration and mode of
service delivery.
2.Requires the state, beginning in the 1999-2000 fiscal
year and continuing in subsequent fiscal years, to
reimburse counties that have public authorities,
nonprofit consortia, or contracts for the cost of
increased wages and benefits for IHSS workers, provided
the county spends at least the amount it accrues in
savings during that fiscal year due to the receipt of
federal Medicaid Personal Care Option funding for IHSS
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share-of-cost recipients.
FISCAL IMPACT
The budget provides for $90 million General Fund for the
1999-2000 fiscal year for wage and benefit increases by
counties.
BACKGROUND AND DISCUSSION
General Background:
The IHSS program is administered by the State Department of
Social Services (DSS) to provide, through the 58 counties,
personal care services and domestic assistance to eligible
aged, blind, and disabled individuals who would otherwise
be unable to remain safely in their homes and as an
alternative to out-of-home care. Eligible persons are
aged, blind and disabled recipients on public assistance
and similar persons with low income. IHSS is provided
without cost to SSI/SSP recipients. Those with higher
income pay a share of the cost.
IHSS includes domestic services such as meal preparation,
laundry, shopping and errands, nonmedical personal care
services, assistance while traveling to medical
appointments or to other supportive services, teaching and
demonstration directed at reducing the need for supportive
services; and certain paramedical services ordered by a
physician.
Prior Legislation:
Numerous major IHSS policy changes were adopted as part of
the 1991 Budget Act and 1992 Budget Act. Prior to these
budgets, IHSS was supported by Title XX of the federal
Social Security Act and State General Fund. They were:
1) Chapter 91, Statutes of 1991 - State-Local
Realignment - established the current nonfederal share
of cost for IHSS, at 65/35 ratio.
2) Chapter 939, Statutes of 1992 required the state to
include the Medicaid Personal Services Option as a
service in the Medi-Cal Program.
3) Chapter 722, Statutes of 1992 established the
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authority to create a Public Authority or contract
with a nonprofit consortium for the provision of IHSS.
Current law, [Chapter 206, Statutes of 1996 (SB 1780)],
requires that only county funds be used to fund the
nonfederal share of cost for any increase in provider wages
or benefits through a public authority or nonprofit
consortium.
Specific Background:
AB 16 is sponsored by IHSS Agenda '99, a coalition of 38
organizations representing consumers, workers, and
community advocates. The Coalition has met annually for
the last three years in order to identify common goals for
improving the IHSS program. Public authorities have been
established in Alameda, Contra Costa, Los Angeles, San
Francisco, San Mateo, and Santa Clara counties. Monterey
County has recently given approval to establish a public
authority, and Sacramento County is considering the
establishment of a public authority pending funding
considerations. Federal funds pay for only a portion of the
IHSS program because federal law prohibits the use of
Medicaid funds to pay providers who are family members.
The Little Hoover Commission published two reports related
to AB 16, "Unsafe in Their Own Homes: State Programs Fail
to Protect Elderly from Indignity, Abuse, and Neglect" in
1991 and "Long Term Care: Providing Compassion Without
Confusion" in 1996, The 1991 report recommended that
counties be required to provide multiple modes of services
so IHSS recipients who do not want to or cannot act as
employers have options, including care through agencies.
In 1996, the Commission found promise in the concept of
Public Authorities acting as umbrella agencies, where the
caregiver is employed directly by the consumer and the
umbrella agency handles consumer complaints and improves
the availability and training of the caregiver.
Prior to last year, the state did not exercise its option
to include income eligible recipients (share of cost
recipients whose income is above the SSI/SSP level and who
pay a share of cost for their services) for Medicaid funds.
Last year, in the annual Budget Act, the Legislature and
Governor agreed to use Medicaid funds to share in funding
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the income eligible IHSS recipients. Approximately 15,600
IHSS recipients were affected by this policy change,
resulting in savings for both the state and counties. The
bill proposes to take advantage of the savings generated by
folding income eligibles into the Medicaid program.
The sponsor indicates that most IHSS workers earn the
minimum wage and receive no benefits. As a result, they
say that it is hard to recruit and retain workers, causing
a major problem for seniors and people with disabilities
who need home care to stay out of costlier and impersonal
institutions. According to HCFA, the average cost of
nursing care in California is $47,000 a year.
The sponsor seeks parity in the counties share of cost
between Public Authorities and other IHSS service modes, by
requiring the state to pay the same nonfederal share of
cost (65/35 ratio) as other service modes.
The contents of this bill and SB 288 were merged into AB
1682, the budget trailer bill on IHSS. The budget also
provides for $90 million to implement the provisions of
this bill.
PRIOR ACTIONS
Assembly Floor: 62-17 Pass
Assembly Appropriations: 13-7 Do Pass as Amended
Assembly Human Services: 6-2 Do Pass as Amended
POSITIONS
Support: Addus Health Care (Clovis)
Adult and Aging Commission
Alzheimer's Association
American River College (Sacramento)
Bay Area and Western Paralyzed Veterans of
America
Board of Supervisors of Santa Clara County
California Coalition of United Cerebral
Palsy Associations
California Council of the Blind
California Retired Teachers Association
California State Association of Counties
City of Los Angeles
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Congress of California Seniors
Contra Costa County Developmental
Disabilities Council
County of Contra Costa
County of Sacramento Board of Supervisors
County of Santa Clara Board of Supervisors
Family Service Agency of San Mateo County
Foundation of Resources for Equality and
Employment for the
Disabled
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Foundation of Resources for Equality and
Employment of the
Disabled
IHSS Public Authority (San Francisco)
IHSS Recipients & Providers Sharing (IRAPS)
Jay Nolan Community Services
LACES
Little Hoover Commission
Los Angeles Coalition for IHSS Reform
Older Womens League of California
Organization of Area Boards on
Developmental Disabilities
Resources for Independent Living, Inc.
SEIU Local 415
SEIU Local 535
SEIU Local 616 Service Employees
International Union
Senior Gleaners, Inc.
Senior Outreach Services of Contra Costa
TACC Triple-A Council of California
The ARC San Francisco
World Institute on Disability
Oppose: None received
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