Content about In-Home Supportive Services

Two important budget subcommittees are scheduled this week that will focus on important community-based services including:

• In-Home Supportive Services (IHSS) and the Multipurpose Senior Services Program (MSSP) on Wednesday at 1:30 PM at the State Capitol in Room 437 by the Assembly Budget Subcommittee on Health and Human Services, with likely action by the subcommittee to reject the Governor’s proposal to eliminate domestic and related services for IHSS recipients who live in certain “shared living arrangements”
• The reorganization of mental health community-based services and a likely action regarding Caregiver Resource Centers, on Thursday at 10:30 AM at the State Capitol in Room 4203 by the Senate Budget Subcommittee on Health and Human Services.

The Senate subcommittee will focus on several issues under the Department of Mental Health including the Governor’s proposal that would have the impact of eliminating the Caregiver Resource Centers, and the Governor’s proposals to implement the realignment or transfer to the counties from the State of Medi-Cal Specialty Mental Health services and the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) Program during the 2012-2013 State Budget year.

The Assembly Budget Subcommittee on Health and Human Services released a 24 page agenda, with subcommittee staff recommendations, for the scheduled March 28th hearing focusing on developmental services budget issues.  This hearing is similar to the hearing held yesterday by its counterpart in the Senate, the Senate Budget Subcommittee #3 on Health and Human Services.  Like that hearing yesterday – and nearly all the hearings held to date by all the subcommittees, with one exception on the Governor’s proposal impacting CalWORKS, no action will be taken on any major budget item until May, after the release of the Governor’s proposed budget revisions, when also more up to date spending and revenues figures will be available.

Health and human services budget, policy and legal issues will come to center stage this coming week, not only in Sacramento with budget and policy committee hearings and meetings – but in a critically important federal court hearing in San Francisco on Adult Day Health Care and in an historic hearing in Washington DC before the US Supreme Court on whether or not provisions in the federal health care reform act are constitutional.  The outcome of many of those issues in the coming months could have sweeping impact in California particularly for hundreds of thousands of children and adults with disabilities, mental health needs, the blind, seniors, their families, low income families and workers.

The Legislative Analyst Office released a brief 12 page update on the In-Home Supportive Services program and finds the Governor’s proposed reductions “…presents significant legal and implementation challenges” and instead recommends that the Legislature consider two other ways alternatives to save State general funding, including extension of the existing 3.6% across-the-board reduction in service hours that is set to expire at the end of the current year, and consider re-enacting a reduction in state participation in IHSS provider wages to a level, determined by a study, that does not impact recipient access to services.

The Senate Budget Subcommittee #3 on Health and Human Services released the hearing agenda for March 15th, Thursday that will focus on the Governor’s proposals impacting the Multipurpose Senior Services Program (MSSP), the In-Home Supportive Services (IHSS) program, the Department of Rehabilitation and CalWORKS program.

Urged by virtually all advocates on the various stakeholder panels that the State should “slow down” on new proposals to expand efforts to shift people with disabilities and seniors eligible for both Medicare and Medi-Cal – referred to as “dual eligibles” - the Assembly Budget Subcommittee #1 on Health and Human Services and the Assembly Aging and Long Term Care Committee adjourned a nearly 6 hour informational hearing on the Governor’s controversial proposal to expand from 4 to 10 counties in 2013 and all counties by the end of 2015, an existing demonstration project proposal to shift those “dual eligible” from Medi-Cal “fee-for-service” to Medi-Cal managed care type plans.  No action was taken at the joint hearing.

Several regular legislative session policy bills impacting the In-Home Supportive Services program were introduced by the February 24th bill introduction deadline.  Two bills – and possibly a third – deal with IHSS providers that would propose changes to existing State law that currently prohibit an individual from working as an IHSS provider if he or she was convicted of certain crimes.  Current State law allows the IHSS recipient to hire such an individual by submitting to the county a signed waiver document.

In a narrow 5 to 4 decision, the US Supreme Court sent the three Medi-Cal cases back to the US 9th Circuit Court of Appeals for further review, keeping those lawsuits alive – and for now, the lower court orders from those cases that continue to block the State from implementing Medi-Cal provider reductions. Linked to those three Medi-Cal cases are several other Medi-Cal related cases, including a 2009 lawsuit that blocked the State from rolling back State funding for In-Home Supportive Services (IHSS) worker wages. [CDCAN will issue a more detailed report later this morning on the US Supreme Court ruling]

The Department of Health Care Services will hold a teleconference briefing open to the public on the Brown Administration's proposal to expand an existing demonstration project proposal to shift people with disabilities and seniors eligible for both Medicare and Medi-Cal from Medi-Cal “fee-for-service” to Medi-Cal managed care type plans from 4 counties to up to 10 counties in 2013 and statewide by 2015. The Governor is also proposing, as part of the proposal to expand the “dual eligible” demonstration project from 4 to 10 counties in 2013 and statewide by 2015, the In-Home Supportive Services (IHSS) program will become a Medi-Cal managed care benefit for persons in the demonstration project counties.

The Department of Health Care Services, the state agency that oversees California's Medicaid program (called "Medi-Cal)" released a document called a "Request for Solutions" (RFS), that will be used to select sites to be included in a demonstration project proposal that the Brown Administration will submit for approval to the federal government to shift possibly hundreds of thousands of people with disabilities and seniors who are eligible for both Medicare and Medi-Cal - known as "dual eligibles" into managed care types of healthcare delivery.  The deadline for applicants to respond to the "Request for Solutions" is February 24, 2012.

The Senate Budget and Fiscal Review Committee will hold three informational hearings in February and March, including a February 23rd hearing focusing on the Governor's controversial proposals that include shifting persons with disabilities and seniors eligible for both Medicare and Medi-Cal into Medi-Cal managed care plans. That hearing will also hear the impact of the Governor's proposal to make In-Home Supportive Services, a Medi-Cal managed care benefit for those persons beginning next January, and also the impact on the Multi-Purpose Senior Services (MSSP) programs. Senate budget staff said there will be time for public comment.

Governor Jerry Brown released his proposed 2012-2013 State Budget plan which calls for a staggering $4 billion in additional spending cuts and nearly $7 billion in new revenues from temporary tax increases on the state's wealthiest taxpayers and a one-half percent increase in the state's sales tax. The revenues would help close what the Governor said is a projected $9.2 billion budget deficit.