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Gov. Jerry Brown

To help fill the $9.2 billion gap in California’s 2012-2013 budget, Governor Jerry Brown’s (D) budget proposal includes cuts of $163.8 million to the In-Home Supportive Services (IHSS) Program by eliminating domestic assistance — such as meal preparation, food shopping, laundry, and housework — for clients who reside in the same home as their caregivers.

The IHSS program provides personal care — including help with bathing, dressing, toileting, and feeding — and domestic services to about 435,000 low-income elders, the blind, and people with disabilities who live in their own homes but are at risk for nursing home placement without the services and supports that the program provides.

About 60 percent of IHSS clients would be affected should the proposed cuts take effect at the start of the new fiscal year on July 1, according to an article in the Sacramento Bee.

The caregivers, many of whom are family members, receive hourly wages and benefits between $8 and $14.78, reports the publication.

Cuts Deemed “Unwise”

Calling the proposed cuts to the IHSS “unwise,” a Los Angeles Times editorial says that “Slashing or ending that care means people in need will have to go to nursing homes, which can also be on the state tab but are more expensive.”

“The general public does not understand how easy it is to end up in a nursing home because it is the only place where care will be provided,” explained San Francisco IHSS Public Authority Executive Director Donna Calame, who is also a PHI board member.

“Sometimes, the simple acts of assisting someone with food shopping and preparation are all that keep a person well nourished and out of a hospital or nursing home. For a very few number of hours per IHSS consumer per month, California will not be saving very much money with these cuts and is risking much higher public expenditures for care in an institution.”

The state’s share of the IHSS Program costs is projected to be about $1.4 billion for 2012-13; the remaining costs are covered by state and county funds, reports the Sacramento Bee.

“There is an institutional bias in public funding of long-term services and supports,” Calame said. “IHSS advocates certainly hope the legislature will reject this proposal from Governor Brown.”

Brown has also proposed closing the budget gap by increasing revenues through a temporary half-cent sales tax increase and imposing higher taxes on the rich. A ballot measure which will be voted on in next November’s election will determine whether these proposals will become effective.

California had planned to cut the IHSS Program services by 20 percent beginning on January 1, as part of automatic, midyear across-the-board cuts enacted to offset tax revenue shortfalls. Disability Rights California filed a suit contending that these cuts violated the Americans with Disabilities Act, and a U.S. District Court judge ruled to temporarily halt them.

– by Deane Beebe

Oregon's state capitol building

Contract negotiations between Oregon and the union representing home care workers there have stalled over a state proposal to substantially raise the eligibility requirements for aides to receive health insurance.

A bargaining team led by Oregon Gov. John Kitzhaber (D) wants to require home care aides that provide Medicaid-covered services to low-income elders and people with disabilities to work 130 hours a month for three consecutive months in order to qualify for health benefits. Currently, aides must work 80 hours for three straight months.

The increase in hours would cause 2,000 of the state’s 12,000 home care aides to lose their benefits, according to the Service Employees International Union (SEIU), which represents the aides.

In late December, negotiations between the state and the union reached an impasse, largely because of the insurance issue. Discussions between the two sides will re-open next month.

On January 18, a group of about 100 home care workers staged a protest against the cuts in Kitzhaber’s office.

The governor said that he respected home care workers and collective bargaining rights in general. “We will try to do all we can,” he said.

Budget Woes Cited

Kitzhaber’s bargaining team says that the cuts to home care workers’ benefits are necessary to help close a $300 million budget gap.

Oregon’s in-home care program has been the target of cuts before. On Jan. 1, home care workers saw their hours reduced by 5 percent, a move that saved the state $4 million.

But the SEIU and AARP Oregon say that the newly proposed benefits cuts go too far. The organizations have launched a media campaign asking Oregonians to speak out against the proposed cuts.

“It is extremely disappointing that Gov. Kitzhaber and his team are attempting to reduce benefits for low-wage workers just to save the state a few million dollars,” said PHI Government Affairs Director Carol Regan.

“Beyond that, this is bad fiscal policy,” Regan added. “Reducing low-wage workers’ access to health care will result in higher Medicaid enrollment and put a greater strain on emergency medical care in Oregon. These cuts will simply shift costs, not lower them.”

– by Matthew Ozga

A December ruling by the Ninth U.S. Circuit Court of Appeals could prevent massive cuts to California’s In-Home Supportive Services (IHSS) program.

The Dec. 16 decision (pdf) by the San Francisco-based U.S. Court of Appeals did not directly address California. Rather, it centered on 12 Washington State Medicaid consumers who sued the state for its decision last February to reduce in-home care hours by 10 percent.

The Ninth Circuit found that the dozen plaintiffs would likely be forced to live in nursing homes as a result of the 10 percent cut — a violation of the federal Americans with Disabilities Act (ADA). The court therefore restored in-home services for the plaintiffs.

The court did not overturn the 10 percent cut, however, since the lawsuit was not presented as a class action on behalf of all 45,000 Washington State in-home care recipients.

Implications for California

The Ninth Circuit’s decision has clear implications for another case involving cuts to the California IHSS program.

On Jan. 19, U.S. District Court Judge Claudia Wilken will preside over a hearing to determine whether the state of California can legally proceed with a proposed 20 percent cut to IHSS, which provides care to 440,000 low-income elders and people with disabilities.

In December, Wilken halted the proposed cuts — which had been scheduled to take effect Jan. 1 — because they potentially violated the ADA and the Social Security Act, among other federal laws.

Wilken will have to take the Ninth Circuit’s recent decision into account during the upcoming hearing.

“The Ninth Circuit’s conclusion that loss of hours of home care services exacerbates people’s risk of involuntary institutionalization is very relevant to the case in California,” attorney Stacey Leyton told the San Francisco Chronicle in December.

– by Matthew Ozga

By the end of August, 35,000 low-income elders and people with disabilities will have received notification that Medi-Cal, California’s Medicaid program, will no longer cover adult day health care (ADHC) beginning December 1.

Adult day health programs provide health, therapeutic, and social services to those at risk of being placed in a nursing home, the California Department of Aging explains.

In California, there are 300 ADHC programs. According to the California Disability Action Network, they employ 7,000 people.

Eliminating the Medi-Cal benefit for ADHC was proposed by Governor Jerry Brown last January to help close the state’s budget gap.

Class Action Suit Filed

Advocates, including the AARP California Foundation, Disability Rights California, National Senior Citizens Law Center, and National Health Law Program, filed a federal class action suit on behalf of the ADHC consumers.

The organizations charge that the elimination of the Medi-Cal ADHC benefit violates federal disability law, and are trying to stop it, “unless the state can provide adequate and appropriate replacement services.”

“Adult day health care has been a cost-effective means to keep thousands of people out of nursing homes and other institutionalized care,” said Barbara Jones, senior attorney, with the AARP Foundation.

“Estimates of the increased annual cost of premature institutionalization to California, if adult day health care is eliminated by year’s end, have topped $50 million. California still has not found alternate services for the thousands of low-income and elderly people dependent on this program,” Jones said.

Managed Care Plans to Coordinate Services

The state’s plan — just released on August 5 — is to mandatorily enroll the ADHC clients in Medi-Cal managed care plans, with an “opt-out option.”

The managed care plans will be responsible for coordinating services for the ADHC clients, including additional in-home supportive services, physical and occupational therapy, and social services, a Los Angeles Times article explains.

“State health care officials know they have 35,000 medically needy elderly and disabled patients whose lives clearly depend on what they do in finding coordinated care for these patients’ complex medical needs in a matter of weeks or face disastrous legal consequences in court,” said California Association for Adult Day Services Executive Director Lydia Missaelides, in a media statement (pdf).

“Pressed for time, they had to produce something, and the result is now a plan and strategy that is nothing more than a list of existing health care services for ADHC patients to be plugged into like widgets or lumped together in managed care plans that the patient may not accept or that may not be able to provide for the patient’s specific needs because the services simply don’t exist,” Missaelides said.

Strong Attachments

California’s required ratio of direct-care workers to clients in ADHC programs is 1:16, but many programs have higher worker staffing, Missaelides told PHI.

“Despite their strong attachments to clients, some of the ADHC staff is starting to look elsewhere for employment because of the uncertainty of the program’s future. It’s a very emotional time: the workers are attached to clients but they have their own families to feed,” Missaelides added.

A hearing is scheduled for November 1 to determine if California’s scheduled elimination of ADHC is in compliance with federal disability law.

– by Deane Beebe

Several dozen Tennesseans with disabilities sued the state’s Department of Intellectual and Developmental Disabilities (DIDD) for eliminating funding for critical home care and personal assistance services.

The lawsuit was filed in a Nashville federal court on July 11. It alleges that DIDD’s budget cuts violate the Supreme Court’s Olmstead decision, which requires states to place people with mental disabilities in home- and community-based settings whenever appropriate.

The plaintiffs, who range in age from 7 to 52 years old, say that the cuts would require them to move into group care homes.

They are joined in the lawsuit by People First, a nonprofit group that advocates for people with disabilities, and by the Legal Aid Society.

DIDD Cuts Reduce Hours

In June, the DIDD, tasked with trimming millions of dollars in spending as part of statewide budget cuts, imposed a cap on the number of hours that individuals with disabilities can receive certain types of in-home care.

One-on-one nursing services are now limited to 12 hours a day under the DIDD’s new plan, while personal assistance services are capped at 215 hours a month, or approximately 7 hours a day.

These cuts affect an estimated 680 Tennesseans, many of whom say that their disabilities are so severe they essentially require round-the-clock services.

For example, Christopher Hughes, a 34-year-old Campbell County resident with cerebral palsy, had for years relied on the care of two personal assistants, who provide more than 300 hours of care a month.

Because of the cuts, his mother says, Christopher will be forced to move into a group home, an hour’s drive from his family.

Lenny Croce, a Legal Aid attorney, told The Tennessean that the cuts will be responsible for “segregating individuals” with disabilities by removing them from their communities and placing them in group homes.

– by Matthew Ozga

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