On July 28th, 2009, Governor Schwarzenegger signed into law a group of trailer bills passed by the state legislature to close a projected $26 billion budget shortfall for fiscal year 2009-2010. The bills will implement several cuts and changes to state programs that serve children, seniors, and persons with disabilities, including In-Home Supportive Services (IHSS). Below is a summary of the cuts/changes that will directly impact the IHSS community.
In-Home Supportive Services
Change in Eligibility Requirements (effective date unknown*) – When being assessed for IHSS, applicants are given a functional index score, which is an average measure of their relative dependence on human assistance for performance of basic program tasks. Scores rank from 1 to 6, with 1 representing the least functional limitation and 6 representing the greatest functional limitation. If this cut were to be implemented, consumers who have a functional index score of less than 2 will no longer be eligible to receive services under the IHSS Program. The exact number of consumers who will lose their eligibility for services is unknown, but it is estimated to be around 10% of the IHSS population. Consumers who receive either paramedical services or protective supervision will be exempt from this program change.
Reductions in Hours for Domestic and Related Services (effective date unknown*) – When being assessed for IHSS, applicants are given a functional ranking for each category of service, based on their ability to complete that particular task on their own or with assistance. If this cut were to be implemented, consumers will lose hours for any domestic and related service (i.e., cleaning, laundry, shopping, etc.) for which they are given a ranking of less than 4. This includes consumers with rankings of 3 (can perform the function with some human assistance, including, but not limited to, direct physical assistance from a provider), 2 (able to perform a function, but needs verbal assistance, such as reminding, guidance, or encouragement), and 1 (able to perform the function without human assistance, difficulties completing task do not pose a substantial risk to his or her safety). The exact number of consumers who will see a reduction in hours related to this measure is not yet known, but it is estimated to be around 25% of the IHSS population. Consumers who receive either paramedical services or protective supervision will be exempt from this program change.
*Note: On October 19th, Federal District Court Judge Claudia Wilken issued a preliminary injunction blocking the above changes to IHSS. The changes were scheduled to be implemented on November 1st.
If these program changes are implemented, affected consumers will receive a Notice of Action from the state at least 10 days before the effective date. Consumers will have the right to appeal their termination from the program or reduction in services if they believe that their functional index scores and/or functional rankings have been determined incorrectly. Click here for more information on filing an appeal.
The Elimination of the Share of Cost (SOC) Buyout Program (effective October 1, 2009) – The buyout program reduces the total SOC for certain consumers by paying for the difference between their IHSS SOC and their Medi-Cal SOC. This measure will eliminate the buyout subsidy and result in a increase in SOC for approximately 10,000 consumers. It is estimated that the average increase will be $300-$400 per month. For more information on how this will impact certain consumers, click here.
Mandatory Background Checks for IHSS Providers (effective November 1, 2009) – Beginning November 1st, all providers will have to submit fingerprints and clear criminal background investigations before being eligible to be paid as an IHSS homecare worker. Providers enrolling prior to that date will have to complete the background check by June 30, 2010 as a condition of continued employment. It is not yet certain what crimes/convictions would exclude a provider from being eligible to provide IHSS, or what exemptions (if any) will be granted. The providers will be responsible for paying for the background checks.
Mandatory Orientation for IHSS Providers (effective November 1, 2009) – Beginning November 1st, all providers will have to complete a provider orientation meeting before being eligible to be paid as an IHSS homecare worker. The orientation will cover the requirements to be an IHSS provider, a description of IHSS, rules and procedures for providers, submitting timesheets, the consequences of IHSS fraud, and how to report fraud and abuse. Providers enrolled prior to November 1st will have to attend an orientation before June 30, 2010 as a condition of continued employment. In addition, at the orientation providers will have to sign a written agreement that states they understand and will adhere to the program’s rules and procedures, will provide recipients with authorized serves, etc.
Fingerprinting of Consumers and Providers (effective April 2010) – All consumers, along with their providers, will have to submit fingerprints to the county at the time of their assessment/reassessment. Exemptions will be granted for minors and individuals who are physically unable to provide fingerprints. The fingerprints will be used for identification purposes.
Changes to Timesheet Submission Policies (effective July 2011) – Both consumers and providers will have to place an index fingerprint on each timesheet submitted. In addition, a civil penalty has been established for IHSS provider timesheet fraud.
Authorized Tasks Lists for Providers (effective December 2011) – The county will give providers a list of authorized tasks for each consumer they work for, and providers will be required to sign an acknowledgment of eligible services.
Provider Identification (effective July 28, 2009) – Provider identification must now be verified in-person by a county worker.
Unannounced Home Visits (effective July 28, 2009) – Social workers are required to conduct unannounced home visits.
Changes to Policies Regarding Provider Paychecks (effective July 28, 2009) – If a provider wishes to receive his/her paycheck a at P.O. box, they must now obtain county approval by submitting a request that explains the circumstances that make the use of a P.O. box necessary.
Reduction in State Funding for Public Authorities – Public authorities, such as PASC, are funded by a combination of state, federal, and county monies. The state portion of funding for public authorities will be reduced by approximately 57% or $13.5 million. How this will impact the services provided by public authorities throughout the state is unknown at this time.
No Reductions in Provider Wages or Health Benefits – As part of the budget passed in February, state participation in IHSS wages was reduced to $9.50/hour. However, an injunction issued by a US District Court judge has suspended this reduction until further notice. No additional reductions have been made. (Wages in L.A. County are currently $9/hour.)
In addition, no direct cuts were made to funding for provider health benefits. However, cuts to services for consumers (see above) could cause many providers to lose their health coverage in L.A. County. For instance, if a provider who is working 85 IHSS hours per month sees a six-hour reduction in his/her consumer’s authorized IHSS hours, the provider would be dropped from the healthcare plan unless they begin to work for another consumer.
Cuts to Other Services
Reductions in SSI/SSP Benefit Levels (effective October 1st) – Recipients of SSI/SSP will see a reduction in benefit amounts to $845 per month for an individual and $1,407 per month for couples. In addition, the statutory cost of living adjustments set to be implemented in January 2011 have been eliminated. This will be the 4th reduction in SSI/SSP payments within the last year.
Reductions in Benefits for the Cash Assistance Program for Immigrants (effective October 1st) – Payments to CAPI recipients will be reduced to $835 per month for an individual and $1,392 per month for couples.
Reductions in Medi-Cal Services – The bills signed by the governor will reduce funding for adult day health centers and community clinics, will reduce payment rates for hospitals and prescription drugs covered by Medi-Cal, and will allow the state to centralize the eligibility function for the Medi-Cal, CalWORKs and food stamp programs. In addition, the bills will implement an unallocated reduction of $323.2 million in state funding for the Medi-Cal program. At this time, it is unknown how the state will achieve these savings.
Several other programs, including regional centers, the Multipurpose Senior Services Program, Linkages, CalWORKs, and the Healthy Families Program will also see significant reductions as a result of the new budget revisions.
All of the cuts mentioned above have been signed into law. However, there are still many questions looming regarding the implementation of many of them. Additional information will be forthcoming in the next edition of PASC E-News. To subscribe to PASC E-News, click here.