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California’s 2011-12 state budget, signed by Governor Jerry Brown (D) on June 30, contains a provision that could automatically trigger a $100 million cut to the In-Home Supportive Services (IHSS) program at the start of 2012.

The final $86 billion budget projects that the state will receive an additional $4 billion in revenue by mid-December. If the anticipated revenue falls short — only $2 billion to $3 billion is realized — then the IHSS program cuts will take effect, according to the Sacramento Bee.

“IHSS advocates fear the revenue projections will not be met and that the likely impact on consumers will be severe,” said Donna Calame, executive director of the San Francisco IHSS Public Authority and PHI board member.

“Consumers have already sustained cuts in Medi-Cal and an increase in co-pays. About 85 percent have seen their Supplemental Security Income/State Supplementary Payment cut from $904 to $830 a month,” Calame said.

Services and Wages Would Be Cut

Services provided by IHSS would be reduced by 20 percent should the cuts be triggered, reports the Associated Press.

“Workers could experience up to a 20 percent pay cut,” Calame said, “and with a drop in work hours, lose their health care coverage.”

The IHSS program was already scaled back last February with a 3.6 percent cut in hours.

If there is a revenue shortfall at the end of the year, budgets will also be slashed at several other state-funded programs and services, including the California Department of Developmental Services, the state university and college system, and child care assistance.

California’s adult day health care program has already been slated for elimination by September 1.

– by Deane Beebe

Calif. state legislators at a demonstration against proposed IHSS cuts

California would face legal risks if proposed cuts to its In-Home Supportive Services (IHSS) program are enacted, according to a January 25 report (pdf) issued by the state’s nonpartisan Legislative Analyst’s Office (LAO).

The 2011-12 budget plan introduced by California Governor Jerry Brown (D) includes a 43 percent cut to the IHSS program to help close the state’s $25 billion budget gap.

Brown’s proposed cuts to IHSS would:

• reduce the hours of care for all consumers by about 8 percent;
• eliminate all domestic service hours — such as cooking, cleaning, and laundry — for consumers who live with another person; and
• require consumers to obtain a physician’s certificate stating that if they were to lose home care, they would require care in an institution.

Consumers who do not get a physician’s certificate would be dropped from the program.

The IHSS program provides home care, personal care, and/or transportation accompaniment to 456,000 low-income consumers who are elderly, blind, or living with a disability to help them remain safely in their homes instead of an institutional setting.

“Any time services are reduced or limited, we have to think about whether this puts recipients at risk of being institutionalized,” said Ginni Bella Navarre, an LAO analyst, in reference to the U.S. Supreme Court’s Olmstead decision. Federal law requires states to provide care in less-restrictive community settings rather than institutions when possible.

Advocates for the elderly and disabled rallied outside the California State Capitol on January 27 to oppose the proposed budget cuts, which would also eliminate state-funded Adult Day Health Care and Multipurpose Senior Services Programs.

“The state of the state is not just about balancing a budget. It means balancing priorities and lives fairly. The governor’s proposed cuts to In-Home Supportive Services and other health human services is not fair,” said Marty Omoto, director, California Disability Community Action Network.

State legislators from both sides of the aisle held a press conference in support of IHSS, emphasizing how IHSS is more cost-effective for the state than institutional care.

Public Services Are Crucial Link, Report Finds

To document how budget cuts would affect low-income elderly consumers who depend on these services to remain in their homes, the UCLA Center for Health Policy Research released a policy note in late January entitled “Holding On: Older Californians with Disabilities Rely on Public Services to Remain Independent.”

After a year of tracking 33 elderly consumers who have both Medicare and Medi-Cal and receive IHSS and other community care, the researchers found that these consumers

• depend on a variety of public programs
• have “fragile arrangements” of paid and unpaid help
• “barely manage to live safely in their homes” but want to maintain their independence and remain at home

The researchers report that public services are a “crucial link” in the support networks of these consumers.

They further point out that service cuts would undermine the ability of many older adults who depend on community-based services to remain safely at home.

The policy note was supported with a grant from The Scan Foundation.

More information on California’s direct-care workforce is available in PHI State Facts (pdf).

– by Deane Beebe

California state capitol building

One hundred days after California’s new fiscal year started, Governor Arnold Schwarzenegger signed the state budget containing cuts to the In-Home Supportive Services (IHSS) program on October 8.

While the cuts were not nearly as severe as the governor proposed earlier this year, the final budget includes a 3.6 percent across-the-board reduction to the number of hours that IHSS clients were assessed for being eligible for services.

This cut translates into IHSS direct-care workers receiving “15 minutes less work and pay each day,” according to the Sacramento Bee.

California’s 2010-2011 budget actually specifies reducing the IHSS program by $300 million but due to other calculations, the budget cut to IHSS is about $35 million.

The actual reduced cut is based on the state using “IHSS provider-generated revenue to draw down additional federal funds and offset General Fund expenditures in the program [by] $190 million,” according to the budget.

The $35 million figure also reflects an additional $75 million in savings to the state because the budget purports an “updated caseload estimate based on an actual decline in recipients as compared to the previous caseload projection.”

Any Cut Hurts Consumers

“The reduction in hours many not seem like a lot, but they are significant for our clients,” said Personal Assistance Services Council Executive Director Greg Thompson.

“The cuts could mean the difference between getting help bathing or out of bed and ready for work. Already our clients feel like they are getting by with minimum care. Every cut means a lot to the quality of these consumers’ lives.”

The budget also changes the law on background checks for IHSS workers, adding additional disqualifying convictions and crimes.

IHSS currently employs about 370,000 home care workers who provide services and supports to 400,000 low-income people aged 65 and over, and Californians who are blind or living with a disability, including children.

Line-item vetoes that Schwarzenegger made to the budget include $256 million for child-care subsidies for working parents, $132 million in mental health services for children, and $80 million for child welfare services.

– by Deane Beebe

In a recent New York Times blog post, Nancy Folbre, an economics professor at the University of Massachusetts Amherst, argues for creating more jobs by providing increased federal support for home care services.

These are services, she suggests, that America’s families need and would support.

Folbre refers to two recent studies that support greater investment in home care services as a strategy improving the economy.

One of the papers, a policy brief by economists at the Levi Economics Institute of Bard College, argues that a federal investment of $50 billion into home and child care services would especially benefit low-income familieshurt by the recession.

The other paper is by the New America Foundation, a Washington D.C.-based think tank. They propose the introduction of a nationwide voucher system to help elderly consumers secure home care. By using their vouchers, elders would create more demand for home care services, and would enjoy the benefits of consumer direction.

Dr. Candace Howes

PHI, along with the Institute for Women and Policy Research (IWPR), released a report this week by Dr. Candace Howes, examining why California’s proposal to cut 444,000 elders and people with disabilities from the In-Home Supportive Services progam is short-sighted and fiscally irresponsible. Read the full story

A policy brief about proposals to close California’s $20 billion budget gap cautions that “all options for closing the budget gap are not equal.” Read the full story