CALIFORNIA BUDGET CHANGES AND THEIR EFFECTS ON THE MEDICAID PERSONAL CARE PROGRAM.

This paper examines possible consequences of proposed changes in California’s In-Home Supportive Service (IHSS) Program. IHSS employs over 280,000 direct service providers and serves about 350,000 aged and disabled recipients monthly. Proposed changes include eliminating a component of the program that pays family members as direct care workers; cutting the maximum wage rate for workers to $6.75 state-wide (an approximately 30% hourly pay cut in many counties); eliminating authorized hours for domestic services when the recipient lives with family members. Data come from IHSS 2003 administrative records. These include recipient assessments, provider eligibility, and payment. Analyses describe and compare the recipients in both standard program and the state/county only funded program, differences between authorized and paid hours, and the outcomes among participants, the amount of hours of assistance and reasons for leaving the program (i.e., nursing home placement, residential care placement, death, recipient request, ineligibility). Variations among counties in wage rates, provider supply, and recipient characteristics permit the development of cross sectional multivariate models. These models are the basis for simulating the effects on IHSS worker supply and turnover; the levels and type of services authorized, the level of services received, and unmet need; shifts in patterns of assistance provision among family members; changes in nursing home placement, residential care placement, and death rates. Project was funded by a grant from the California Healthcare Foundation.

Entire paper available on the Center for PAS website.