Citation
Newcomer, R. (2004, April 15). IHSS Budget Changes & the Population Affected. Presented at the California Program on Access to Care, Policy Briefing .
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Summary
IHSS Budget Changes and the Population Affected
Preliminary Findings Not for citation
Authors:
Robert Newcomer, PhD, Charlene Harrington, PhD, Taewoon Kang, PhD, Debi Waterstone, MPP University of California, San Francisco; Candace Howes, PhD, Connecticut College.
Date: April 15, 2004
Description of Project:
Reported are findings from an analysis examining several proposed budget reductions in the In-Home Support Services (IHSS) program. IHSS is California's major publicly-funded home and community-based services program. It provides personal assistance services to people with physical, sensory, memory, or cognitive disabilities. Program expenditures are over $2 billion per year, financed by a combination of federal Medicaid, state, and county funds. IHSS employs over 280,000 direct service providers and serves about 320,000 aged, disabled, and children recipients per month (about 370,000 annually). Due to multiple causes such as population growth, enrollment increases, and wage rate increases, IHSS expenditures have more than doubled from $1.4 billion in 1998-99, to $3.4 billion in 2003-04. Data are from administrative records compiled by the Department of Social Services.
IHSS is composed of the Residual Program (a component that pays for spouse and parents of minors as direct care workers, as well as providing funds for protective supervision and "domestic care-only" recipients), and the Personal Care Services Program (PCSP) ( a Medicaid Optional Program that provides care to all qualified recipients eligible for Medicaid). Funding for PCSP is 50% federal, 33% state, and 17% county. Funding for the Residual Program is 65% state and 35% county dollars (no federal money). Individuals may be "split," receiving services from both PCSP and Residual programs.
Governor's Budget includes three major cutbacks to the IHSS program:
* Elimination of the Residual Program, potentially affecting 68,000 recipients &about; 3.3 million IHSS service hours monthly,
* A $6.75 maximum wage rate for state payments, affecting 90% or recipients
* Elimination of domestic and related services for recipients living with relatives, affecting about 228,000 recipients
Who is Served?
* Children under age 18 in the program (n=14,072) largely received Residual services
* Most adult-disabled and elderly were either in PCSP or received split services
* Among Residual & Split program recipients 45.$% qualify for Domestic Care, 22% for Protective Supervision, 30.4% for parent/spouse providers
Levels of Need
* Over 70% of recipients in all groups need significant amount of assistance in two or more instrumental activities of daily living (e.g., shopping, meal preparation, housecleaning).
* At least half of those with parent providers or in protective supervision meet minimum criteria for nursing home admission (e.g., requiring substantial assistance in at least two of the following bathing, dressing, eating, toileting, and transferring).
* Fewer than 30% of the identified needs for assistance are authorized for payment in the current Residual program
* Among the most impaired recipient group (i.e., those in protective supervision), the proposed program reduce total authorized hours to 11% of their total needed hours, placing this group a higher risk for institutionalization
Residual Program Transfers
* It is likely that the transfer of recipients from the Residual to PCSP program could be more than double Governor's estimate, reducing state savings
* Assumed savings from Residual program termination seem to assume current wages, not proposed wages, and thus over estimate savings.
Wage Rate Reductions
* Whether there is an adequate labor supply at minimum wage was not directly tested by the analysis, but there was no consistent difference in the % of unmet need (defined as the proportion of total need relative to authorized hours or dollars of service) relative to wages
* Similarly program outcomes, such as nursing home placement & rates of ineligibility were not consistently related to wage levels.
Conclusions & Recommendations
* Potential for cost shifts to other state-funded services were not included in program savings estimates, and these could be substantial
* Attainment of wage reductions assumes that wages can be rolled back as union and other contracts expire, ignoring the differential labor supply in California's regions
* Nursing homes utilization has remained stable in California, and below the national nursing home rates over the past decade as the population has grown
* Proposed changes could result in increased nursing home or out of home placements
* Prudent policy in the short term may be to refine needs assessment and quality assurance processes for the IHSS program rather than the structural changes.
Contact Person:
Robert Newcomer, PhD, Personal Assistance Services Center, University of California, 3333 California Street, Suite 455, San Francisco, CA 94118. Phone 415 476-1408, rjn@itsa.ucsf.edu
Funding for this analysis was provided by the California Healthcare Foundation.
