The In-Home Supportive Services (IHSS) program—administered at the state level by the Department of Social Services (DSS)—provides support for in-home care for over 460,000 low income seniors and persons with disabilities who cannot safely remain in their own homes without such assistance. IHSS is a lifeline program that promotes independence, freedom of choice and well-being for its recipients, and without it, many of these individuals could end up in more costly nursing home placement.
Lawyers representing IHSS consumers, unions and the State of California have reached a settlement that will prevent the implementation of devastating cuts to In-Home Supportive Services (IHSS). The settlement resolves a federal lawsuit, David Oster et al. v. Lightbourne (formerly V.L. v. Wagner). The settlement also resolves a second lawsuit challenging wage reductions for IHSS providers.
In the Oster lawsuit, IHSS recipients and their caregivers had won temporary court orders over the past 4 years that stopped the State from implementing cuts to IHSS. These cuts would have meant a significant reduction in hours, or complete disqualification from IHSS, for hundreds of thousands of current IHSS recipients. The State had appealed the earlier favorable court decisions, which meant that a higher court could allow the deep cuts in IHSS to go into effect. Finally, the settlement provides a pathway to stabilize the IHSS program with new revenue and the possibility of restoring all cuts in IHSS hours (including the 3.6% cut that went into effect in 2009) over the next two years.
In the settlement, the State has agreed to repeal and eliminate two major cuts to IHSS: (1) the 20% across-the-board reduction in IHSS hours from 2011, and (2) the termination or reduction in IHSS for many recipients based on their functional index score from 2009.
Instead, the settlement:
• Replaces the permanent 20% cut in IHSS hours with a temporary 8% cut in July 2013. (This is an additional 4.4% on top of the 3.6% current cut.)
• Reduces the cut to 7% (3.4% on top of the 3.6% current cut) in July 2014.
• Restores the hours lost from the 7% cut as early as the spring of 2015 if the State obtains federal approval of a provider fee which could bring significant new federal revenue to California.
• Commits any savings from retroactive federal approval of the new provider fee to fund a program to benefit IHSS recipients, such as the SSI Special Circumstances program, which was used to pay for refrigerators and stoves, rent to avoid eviction and other emergency needs but has not been funded in the budget for many years.
David Oster, lead plaintiff in the lawsuit said: “The uncertainty of the IHSS cuts was always in the back of my mind. If the cuts had gone into effect, I was worried that I would lose all my hours and not be able to stay in my home. The temporary cuts will be hard, but I know I will be able to remain at home and that is a relief.”
Melinda Bird, Co-Litigation Director for DRC and lead counsel for Mr. Oster and other IHSS recipients in the case, said: “Although we won two court orders stopping the cuts temporarily, we faced a risk that these could be reversed in the next year and both the 20% cut and the functional index cuts could go into effect at the same time. That would have been unthinkable. The settlement was the best compromise to achieve long-term stability of the IHSS program and remove the uncertainty for our Class Members.”
The proposed 2012-13 budget reflected a $15.7 deficit. The enacted budget includes spending reductions, tax increases and other solutions to make up that deficit.
An in-depth summary of enacted budget
Proposals affecting seniors and people with disabilities
Eliminate Domestic and Related Services
The Governor's proposal to eliminate domestic and related services for IHSS recipient was rejected by the legislature and not included in the 2012-13 budget. This proposal would have meant IHSS recipients who live in shared living arrangements would not be eligible to receive IHSS hours for domestic and related services including housework, grocery shopping, meal preparation and cleanup, laundry, and other shopping and errands. Other members of the household would be expected to do it for no pay.
7% Across-The-Board Reduction in Hours
The budget proposal to impose a seven percent across-the-board reduction in authorized IHSS hours was rejected by the Legislature, and instead the 2012-13 budget maintains the existing 3.6 percent across-the-board reduction in IHSS hours through June 2013.
20% Across-The-Board Reduction in IHSS Hours
A 20% across-the-board reduction in IHSS hours that would have been triggered by lower than expected 2011- 12 revenues has been temporarily halted by a federal court decision in response to litigation filed against the state. As a result, the state currently is prevented from implementing this reduction. However, the Governor’s January budget assumed success in litigation such that the reduction can take effect at a later date, following resolution of Oster v. Lightbourne in the U.S. District Court, California Northern District. Therefore, the enacted 2012-13 budget will not include this proposed cut.
In an effort to achieve budget reductions and improve the delivery of long-term care services, the Governor's proposal to integrate IHSS and other long-term care services into managed care plans was enacted. Through the Coordinated Care Initiative the state is authorizing the development of "Dual Eligibles Integrated Demonstration" projects in eight counties. Medicare and Medi-Cal recipients (dual eligibles) will be enrolled into plans no sooner than March 1, 2013. Marin County is NOT one of the demonstration counties. Managed care will begin in all counties by 2015. Among other things, this means the great majority of IHSS recipients will be put in managed care programs.
It is unclear how these managed care plans will work. Private home care agencies, county health plans, and other groups are submitting proposals to the State, which will select the agency in each county to coordinate and deliver an array of managed long-term care services. The intent of the proposal is to integrate various long-term services with a focus on home and community-based services AND to reduce costs. Services will have a capitated limit. Advocates fear that the policies of choice and self-determination in IHSS could be undermined. Of particular concern is that the independent provider social model could be lost and replaced by a medical model. IHSS consumers need to protect their right to set their health care schedules, select, manage and dismiss their providers.
A "Keep IHSS out of Managed Care" petition can be found on the following link:
You may learn more and join the IHSS consumers Union on Facebook at Facebook
For more information on these state issues, see reports at:
CALL OR E-MAIL THE GOVERNOR AND YOUR LEGISLATORS
Gov. Jerry Brown
Sacramento, CA 9
Marin County Representatives
Assemblyman Jerod Huffman
Senator Mark Leno
Marin Voice: Cutting in-home support for disabled and elderly is penny smart and pound foolish By Madeline Kellner Guest op-ed column
GOV. JERRY BROWN has taken the state fiscal crisis head on with his proposed budget for next year. No more smoke and mirrors. No more pushing forward the hard decisions to future leaders. However, there is one set of proposed cuts that will cost the state and its taxpayers more in the long run and leave a wake of human suffering: cutting In-Home Supportive Services. More than 400,000 disabled and elderly Californians receive services through the In-Home Supportive Services (IHSS) program, allowing them to stay safely and independently in their homes. Bringing it closer to Marin, the governor's proposal to reduce IHSS services will have a serious impact on the 1,600 Marin residents who rely on this program. The 30 percent reduction in hours of care will put them at risk for more ER visits, hospital stays, and potential institutionalization in higher cost settings. IHSS caregivers who care for them will lose wages, resulting in a $500,000 hit to the local economy in purchasing power. In addition, almost 50 percent of the IHSS caregivers will lose health-care benefits, putting more pressure on an already strained local health care safety net and increasing the rate of uncompensated care. These cuts are focused on the near term and are shortsighted. Reducing In-Home Supportive Services causes more harm than good, in both economic and human terms. It would be far wiser for the governor and Legislature to focus on reducing the financial burden of nursing home care by shifting care for the disabled and elderly out of institutions and into the community.
Nursing home care costs five times as much as community-based care. Two programs that the state should implement or expand that will shift care out of costly nursing homes into the community include California Community Transitions Program ("money follows the person") and the Community First Choice Program. The latter is new program included in the Health Care Reform legislation that funds in-home care for disabled and elderly Medi-Cal recipients and brings with it an enhanced federal match of 6 percent. Both programs provide the resources and incentives to divert individuals from nursing homes into the community by helping them locate accessible housing and lining up in-home care and other services that keep them safely at home. It is estimated that almost 30 percent of the 99,000 nursing home patients in California, if given the opportunity, would transition into home, generating more than $1.4 billion in savings. In effect, IHSS is not a cost creating program but a cost savings program. While IHSS was cut back in February of this fiscal year and is slated for even more serious cuts next year, recent budget decisions by the state have favored nursing homes, granting them rate increases and providing financial support for their quality improvement programs. We urge our legislators, Assemblyman Jared Huffman and state Sen. Mark Leno, to take the high road and to approve a budget that emphasizes community-based care over nursing home care. This means preserving In-Home Supportive Services as the backbone of this system of care bolstered by the new Community First Choice and the California Community Transitions Programs. By so doing, we will save much more in the long run and provide a more dignified quality of life for disabled and elderly Californians. Madeline Kellner is executive director of the In-Home Supportive Services Public Authority of Marin. She is the mayor of Novato.
We have found that California Disability Community Action Network (CDCAN) provides the most thorough, up-to-date information on all aspects of disability legislation in California. They are an invaluable resource and can be found at www.cdcan.us.
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