En español |Would cut assessed hours by 8.4 percent, eliminate domestic and related services for consumers living with their providers, and require a physician’s written certification for IHSS services. UDW’s detailed response to the governor’s proposal will be available shortly.
Below are details from the Governor’s Budget Summary. It is also available online at http://www.ebudget.ca.gov/pdf/BudgetSummary/HealthandHumanServices.pdf
The In Home Supportive Services (IHSS) program provides support services, such as house cleaning, transportation, personal care services, and respite care to eligiblelow-income aged, blind, and disabled persons. These services are provided in an effort to allow individuals to remain safely in their homes and prevent institutionalization.
The Governor’s Budget proposes $1.1 billion General Fund for the IHSS program in 2011‑12. Absent the program changes described below, the average monthly caseload inthis program is estimated to be 456,400 recipients in 2011‑12, a 3.4‑percent increase overthe 2010‑11 projected level.
IHSS services in general exceed similar services provided in other states and serve amuch wider population. Major cost drivers for IHSS include caseload, cost per hour,and hours per case. Over the last ten years, caseload has increased from 249,000 in 2000‑01 to 429,000 recipients in 2009‑10. This accounts for more than 50 percent ofthe increase in total costs over this period. Also over this period, state law triggered a series of increases in the hourly amount up to which the state participates in IHSS worker wages and health benefits. This accounts for more than 35 percent of the increase in total costs. Hours per case account for approximately 10 percent of the increase in costs from 2000‑01 to 2009‑10.
To contain costs, several reductions are proposed for 2011‑12. Each IHSS reduction proposal assumes enacting state legislation by March 1 and implementation of eachproposal July 1, 2011. Each reduction is described in detail below.
Across-the-Board Reduction to Service Hours.
This proposal would implement an 8.4‑percent reduction to assessed hours for all IHSS recipients for General Fund savings of $127.5 million in 2011‑12. This proposal, combined with the 3.6‑percent reduction enacted in 2010‑11, would bring the total across-the-board reduction in assessed hours for IHSS recipients to 12 percent. Under this proposal, qualified recipients at risk of out‑of-home care placement because of the reduction could apply for supplemental hours. As such, it is estimated that approximately 21,000 recipients will ultimately receive full restoration of their assessed hours, and this impact is reflected inthe savings assumed in the budget.
Eliminate Domestic and Related Services for Certain Recipients.
This proposal would eliminate domestic and related services (which include housework, shopping forfood, meal preparation and cleanup, and laundry) for consumers living with their provider. Approximately 48 percent of IHSS providers live with the consumers for whom they care.In addition, this proposal would eliminate domestic and related service hours for recipients under eighteen years of age who live with a parent who is able and available to provide the domestic and related services.
Currently, when an IHSS applicant/recipient resides in a shared living arrangement and his/her need for any domestic or related service is met in common with other household members, the authorized hours are pro‑rated by county social workers based on the number of household members. Under this proposal, IHSS applicants/recipients livingin any type of shared living arrangement would not be eligible for domestic and related services that can be met in common with other household members. IHSS applicants/recipients who have a need for domestic and/or related services that cannot be met in common due to a medically verified condition of other members of the shared living arrangement could be authorized hours for any of these services that meet the need-assessment metrics. Similarly, when minor recipients are living with their parent(s),the need is being met in common; hence, the need for domestic and related service hours would no longer be allowed. Since minors would not be expected to be able to perform these services independently, the parent would be presumed available to perform these tasks unless the parent could provide medical verification of his/her inability to do so.
Eliminating domestic and related services for recipients in shared living arrangements and minor recipients living with an able and available parent is estimated to impact more than 300,000 recipients. The proposal will provide General Fund savings of $236.6 million in 2011‑12.
Eliminate IHSS Services for Recipients Without Physician Certification.
This proposal would require the provision of IHSS services to be conditioned upon a physician’s written certification that personal care services are necessary to prevent out‑of‑home care. Under current law, upon Medicaid eligibility determination, IHSS applicants are required to be assessed by an authorized county social worker to determine the types of services needed and the number of hours required for each service category. Current IHSS recipients must also be reassessed by county social workers every 12 months (18 months if certain exemption criteria are met). Lacking in the current assessment/reassessment process is a medical evaluation, which would provide an increased level of certainty that IHSS services are being provided to those most at‑risk of institutionalization. This proposal would require a medical level of review for all IHSS applicants/recipients to ensure services are needed to avert out‑of‑home placement.
Eliminating IHSS services for recipients without physician certification would result in the loss of services for approximately 43,000 recipients, providing General Fund savings of $120.5 million in 2011‑12.
Eliminate State Funding for IHSS Advisory Committees.
This proposal would eliminate the mandate for counties to establish advisory committees, for General Fundsavings of $1.6 million in 2011‑12. Chapter 90, Statutes of 1999 mandated that counties act as or establish an employer‑of‑record for IHSS providers and establish advisory committees for IHSS purposes. Advisory committees submit recommendations to their respective county boards of supervisors on the preferred mode of IHSS service to be utilized in their counties. Although this proposal would eliminate state funding for advisory committees, counties would have the option to continue advisory committees attheir own expense. Those counties that choose to do so would be eligible for matching federal funds.