Following is a detailed description of some of the Governor's proposed cuts, as well as information on how they could impact the care and quality of life of hundreds of thousands of individuals throughout the State.
Proposed Cuts to the In-Home Supportive Services (IHSS) Program
The Governor's revised budget proposal includes four drastic cuts to the IHSS program:
- The elimination of domestic and related services for IHSS consumers with a functional ranking of less than four,
- The reduction of the State's share of cost buyout program,
- The reduction of the State's participation in provider wages above $8 per hour, and
- The reduction by 10% of funds used for county administration of the IHSS Program
All of these proposed cuts would have a significant impact on the IHSS program because they would reduce the hours of services that many IHSS consumers receive and their overall quality of care. Regrettably, if these proposed cuts are signed into law, many consumers may be forced to seek assistance in an institutional setting in order to receive the care that they need.
1. Domestic and Related Services: In his initial budget proposal released in January, the Governor sought to cut domestic and related services for all IHSS consumers by 18%, resulting in a loss of approximately 6 hours of service per month. Services that fall under this category include cleaning, taking out garbage, making the bed, changing sheets, meal preparation/cleanup, laundry, food shopping and errands.
The Governor's May 14 revised budget proposal now seeks the permanent elimination of each domestic and related service for which a consumer is given a functional ranking of less than four during the social worker's needs assessment. This proposal would cause nearly 83,000 IHSS consumers to lose an estimated average of 21.6 hours of domestic and related services per month.
What is the Functional Ranking? The functional ranking scale is a tool used by IHSS social workers to determine eligibility and hourly allotment for IHSS-related tasks. During the assessment process, the social worker ranks the consumer's ability to perform certain tasks as follows (taken from Welfare & Institutions Code 12309):
Rank 1 - Independent and able to perform the function without human assistance. Client may have difficulty, however completion of the task, poses no substantial risk to his or her safety.
Rank 2 - Able to perform a function, but needs verbal assistance, such as reminding, guidance, or encouragement.
Rank 3 - Can perform the function with some human assistance, including, but not limited to, direct physical assistance from a provider.
Rank 4 - Can perform a function, but only with substantial human assistance.
Rank 5 - Cannot perform the function at all, with or without human assistance.
Rank 6 - Paramedical Services Needed.
Under the Governor's proposal, IHSS consumers would lose all of their hours for those authorized services where they (the consumers) are given a ranking below four. For example, Christie is an IHSS consumer who receives the following domestic and related services:
- Domestic services - 3 hours per month
- Meal preparation - 28 hours per month
- Meal clean-up - 10 hours per month
- Routine laundry - 0 hours per month
- Shopping for food - 4 hours per month
- Other shopping errands - 2 hours per month
Total hours for domestic and related services = 47 hours per month
During her IHSS assessment, Christie's social worker gave her the following functional rankings for each task:
- Domestic services - functional ranking: 3
- Meal preparation - functional ranking: 4
- Meal clean-up - functional ranking: 3
- Routine laundry - functional ranking: 1
- Shopping for food - functional ranking: 2
- Other shopping/errands - functional ranking: 2
Under the Governor's proposal, Christie's hours for domestic and related services would be reduced as follows beginning on October 1st:
- Domestic services - 0 hours per month
- Meal preparation - 28 hours per month
- Meal clean-up - 0 hours per month
- Routine laundry - 0 hours per month
- Shopping for food - 0 hours per month
- Other shopping/errands - 0 hours per month
Total hours for domestic and related services = 28 hours per month
Current Status - Budget sub-committees in both the State Assembly and Senate have rejected the proposed reduction in hours for domestic and related services. It is not known if these cuts will be reintroduced as part of the State's final budget.
2. Share of Cost Buyout Program: The Governor's revised budget also proposes to cut the state's share of cost (SOC) buyout program for certain IHSS consumers whose Medi-Cal share of cost is higher than their IHSS share of cost and whose functional index is less than four. The consumer's functional index is different than functional rankings and is calculated based on his/her overall need for care.
The SOC buyout program was originally implemented to protect consumers who would have to pay a greater SOC under Medi-Cal rules than they would have to under IHSS eligibility requirements. Although the majority of IHSS recipients do not have a SOC, this would affect approximately 7,100 individuals who will have to pay a new monthly SOC at an estimated average of $427 per month. As IHSS consumers, these individuals already have very little disposable income and would probably lose their IHSS benefits if they are unable to pay the new SOC.
Current Status - Budget sub-committees in both the State Assembly and Senate have rejected the proposed cuts to the SOC buyout program. It is not known if these cuts will be reintroduced as part of the State's final budget.
3. Provider Wages: The Governor's revised budget additionally proposes to reduce the cost of the IHSS program by lowering the State's participation in provider wages to $8 per hour. If passed, this would affect provider wages across the state and in L.A. County would reduce wages from the current level of $9 per hour to minimum wage unless the County is able to pay the difference out of local funds.
A decrease in wages for IHSS homecare workers could have a devastating impact on both IHSS providers and consumers as many workers may be forced to seek employment in higher-paying jobs, thus weakening the stability of the IHSS workforce as well as diminishing the quality of care that the consumers receive.
Provider health benefits in L.A. County would not be directly affected under this proposal. However, the Governor's proposed cuts to hours for domestic and related services under IHSS could cause many providers to lose their health benefits. For instance, if a provider who is working 85 IHSS hours per month sees a six-hour cut in his/her consumer's authorized IHSS hours, the provider would be dropped from the healthcare plan in L.A. County unless he/she begins to work for another consumer and gets back up to 80 or more hours of work per month. This too would affect the stability of the IHSS workforce and the quality of care that the consumers receive.
Current Status - Budget sub-committees in both the State Assembly and Senate have rejected the proposed reduction in the State's participation in IHSS wages. It is not known if this proposal will be reintroduced as part of the State's final budget.
4. County Administration of the IHSS Program: The current state budget provides counties with State funding for the administration of the IHSS program based on the assumption that it takes roughly 11 ½ hours of administrative services for each consumer on a yearly basis. This includes time for consumer eligibility determination and enrollment, yearly assessments, enrolling new providers, and processing timesheets. Despite the rapid growth of IHSS, counties have not received an increase in funding for the administration of the program for the past seven years and it is estimated that the program will be under-funded by $78.2 million over the next year. The Governor's proposed budget would reduce the current funding levels by 10%, thus worsening this budget shortfall.
Current Status - At this time it is not known if these cuts will be implemented as part of the State's final budget.
Proposed Cuts to the Medi-Cal Program
In addition to IHSS, the Governor's revised budget proposes two other cuts to the Medi-Cal Program, which could affect the quality of care for thousands of seniors and persons with disabilities. First, the governor proposes to cut by 10% the reimbursement payments that doctors and medical providers who accept Medi-Cal receive from the State. A possible outcome would be that many providers could stop accepting Medi-Cal.
Second, the Governor is proposing to eliminate what is called "Optional Benefits" under Medi-Cal. These include coverage for dental care, acupuncture, audiology, optometry, chiropractic care, podiatry, psychological treatment, speech therapy, and incontinence creams and washes. If these services are cut, Medi-Cal recipients will either have to pay for them out of their own pockets or go without care. This would severely impact the health and safety of thousands of seniors and persons with disabilities.
Current Status - Budget sub-committees in both the State Assembly and Senate have rejected the proposed 10% reduction in reimbursement payments for Medi-Cal providers and have voted to implement a 5% reduction as an alternative. Committees in both houses have also voted to reject the elimination of optional benefits under Medi-Cal. It is not known if these cuts will be reintroduced as part of the State's final budget.
SSI/SSP Cost Of Living Adjustments (COLA)
The Governor's revised budget further proposes to suspend the SSI/SSP Cost of Living Adjustments (COLAs) that are set to be implemented in October 2008 and June 2009. Many IHSS consumers depend on their SSI/SSP payments to pay rent and obtain the basic necessities that they need to live. Over the last several years, SSI/SSP COLAs have been suspended several times. As prices for goods such as food and gas continue to rise, the COLAs are becoming more critical for many IHSS consumers who wish to continue to live independently in their own homes.
Current Status - At this time it is not known if these cuts will be implemented as part of the State's final budget.
Cash Assistance Program for Immigrants (CAPI)
The Cash Assistance Program for Immigrants (CAPI) provides assistance to certain legal immigrants who are seniors or persons with disabilities who have been denied SSI benefits because of their immigration status (i.e., those who have been in the U.S. for five years or less). The Governor's revised budget proposes to eliminate this program, leaving an estimated 10,000 seniors and persons with disabilities without the financial assistance that others receive through SSI/SSP.
Current Status - Budget sub-committees in both the State Assembly and Senate have refused to hear and approve the proposed elimination of the CAPI program. It is not known if this proposal will be reintroduced as part of the State's final budget.
Additional Information
