005-2006_ IHSS Quality Assurance Raises Concerns by Advocates.htm

CDCAN
CALIFORNIA DISABILITY COMMUNITY ACTION NETWORK
DISABILITY RIGHTS NEWS REPORT
#005-2006 January 12, 2006 Thursday
Connecting people with disabilities & seniors to rights and unified action
1225 8th Street Suite 480 - Sacramento, CA 95814 916/446-0013 Fax: 916/446-0026
Marty Omoto - director email: martyomoto@rcip.com    website: www.cdcan.us

IN-HOME SUPPORTIVE SERVICES
* CONTINUED REDUCTIONS DUE TO QUALITY ASSURANCE PROJECTED
* STATE SAYS AMOUNT WILL BE REVISED WITH NEW FIELD SURVEY
* ADVOCATES FEAR LOSS OF HOURS FOR PEOPLE WHO NEED SERVICES
* NO CUTS TO STATE'S CONTRIBUTION TO IHSS WORKER WAGES

SACRAMENTO - The Governor's proposed budget released Tuesday (January 10) has raised major concerns among advocates about the ongoing impact of a In-Home Supportive Services (IHSS) statewide quality assurance program on low income children and adults with disabilities and seniors that could result in loss of needed hours for services and hundreds of millions of dollars of growing funding reductions to the overall IHSS program.   However, continuing the mixture of both good and bad news in the proposed state budget, as previously reported, the Governor, unlike in 2003 and 2004, does not call for any cuts to the State's contribution to In-Home Supportive Services worker wages and benefits and nor does he reduce funding to the IHSS Public Authorities or Advisory Committees that oversee the program in most of California's counties. [Note: CDCAN is holding a Disability Rights Townhall Telemeeting today at 1 PM, and also in the coming weeks that will focus on this and other budget issues impacting people with disabilities and seniors. ]

Schwarzenegger Administration officials said earlier this week that the actual IHSS program spending reductions (or savings to the State general fund) resulting from a decrease in the number of hours for IHSS services by persons with disabilities and seniors will be revised after a new field survey is completed that will provide more up to date information. That information should be, they say, reflected when the Governor releases revisions in May to his proposed budget. The officials said that the quality assurance program within IHSS is not meant to deny people eligibility or needed hours for services. Many advocates however remain skeptical and concerned about possible denial of needed services for recipients and the growing program spending reductions as a result of quality assurance.

Longtime disability rights advocate Maggie Dee Dowling, a resident of Contra Costa county worried that "... those of us who do not know what changes are in the [[IHSS quality assurance] plan and can not advocate for themselves...and who lose significant number of hours as a result of the policy changes, [could] end up entering a nursing facility because they can not manage with fewer [IHSS] hours."

Program Savings/Reductions Approved or Reviewed in Previous Budgets
* What Is Being Proposed or Estimated Now: The Governor's budget released Tuesday estimates that the July 2005-June 2006 budget year - the budget the State is currently operating under, will save (or reduce) spending for the IHSS program as a result of various quality assurance measures by $201 .6 million federal and state money of which $65.5 million is state funds.   The Governor's proposed July 2006-June 2007 budget estimates that savings (or reductions) to the IHSS program will increase to $352.2 million federal and state funds, of which $114.5 million is state money.
* What the Legislature Approved In July 2005: The July 2005-June 2006 budget approved by the Legislature included savings or spending reductions to the overall IHSS program due to IHSS quality assurance of $173.9 million (of which $55.4 million was state funds), so the estimates made Tuesday in the Governor's proposed budget are higher.
* What the Legislature Approved or Reviewed In May 2004: the Schwarzenegger Administration estimated to the legislative budget committees in May 2004 that savings to the state general fund (or reductions to spending) as a result of IHSS quality assurance in 2006-2007 would be approximately $92 million in state funds, which is lower then the estimate in the proposed budget released on Tuesday by the Governor..

About 380,000 low income children and adults with developmental and other disabilities. including persons with traumatic brain and other injuries, and seniors receive IHSS services. According to Department of Social Services, the state agency that oversees the county-run program, just over 50% of those receiving services are children and adults with disabilities, with just under 50% who are seniors. More than 12% of the total number of people receiving services are children and adults with developmental disabilities - disabilities that include autism, cerebral palsy, mental retardation and other cognitive disabilities.

How IHSS Quality Assurance Will Achieve Savings (or Spending Reduction) and Impact On People With Disabilities and Seniors
According to the state Department of Social Services budget information, the IHSS quality assurance program will achieve significant savings (or spending reductions) to the overall IHSS program by the following steps, which first began in December 2004:
* Counties hired IHSS quality assurance staff and additional IHSS workers in budget years that began July 2004-05 and July 2005-06.
* Pilot training for those county workers began in July 2005.
* Beginning in the state budget year that began July 2005-06, the state Department of Social Services estimates that approximately 2,500 county workers will receive training every year.
Those steps of implementing IHSS Quality Assurance - a program that the Legislature approved as part of the July 2004-June 2005 state budget, will result - the Schwarzenegger Administration says, in the following spending reductions to the overall IHSS program (or cost savings to the state general fund). These measures were part of on-going meetings of work groups composed of Schwarzenegger Administration representatives, county agencies, IHSS workers and advocacy organizations and individuals that have occurred over the past 12 months, with several still meeting. Larger meetings of these representatives have been held periodically since the fall of 2004. Some advocates however have raised on-going concerns about the outreach of including more people with disabilities and seniors who are receive IHSS services in these meetings.
ASSESSMENTS/HOURS: The average number of hours for IHSS services needed by eligible low income children and adults with disabilities and seniors whose cases are reassessed will be reduced by 10% after the IHSS county workers have completed the training. which the Schwarzenegger Administration says will be the result of improved and uniform assessments processes and the use of uniform assessment guidelines. Those new guidelines and processes and tools have been discussed over the past year by the State with stakeholders, including advocates for persons with disabilities and seniors. However advocates have raised major concerns about how this will be implemented, especially in light of the estimated budget savings (or spending reductions) to the overall IHSS program.
Cost savings/spending reductions to the overall IHSS program:
2005-2006 Budget: $152.1 million ($49.4 million state funds)    2006-2007 Budget: $298.8 million ($97.1 million state funds)
EARLIER REASSESSMENTS/HOURS: The proposed budget for July 2006 - June 2007 estimates that 12% of children and adults with disabilities or seniors will have conditions which will be expected to improve and, under IHSS quality assurance, will be flagged for earlier reassessments prior to the annual review of each case. The State estimates for the budget year that begins July 2006 and ends June 30, 2007 that there will be an average of 3% reduction in hours for IHSS services for children and adults with disabilities and seniors whose cases are reassessed.
Cost savings/spending reductions to the overall IHSS program:
2005-2006 Budget: $13.1 million ($4.3 million state funds)    2006-2007 Budget: $14.1 million ($4.6 million state funds)
CASELOADS: The Schwarzenegger Administration says that the hiring of additional IHSS workers will reduce workers caseloads. The proposed budget estimates that reduced workloads, which the Schwarzenegger Administration says will result in a 1% reduction of costs statewide cue to improved assessments, better documentation and explanation of case decisions. [see below for savings/spending reductions]
COUNTY ANTI-FRAUD/ACTIONS: The proposed budget for July 2006 - June 2007 estimates that there will also be a 1% reduction in costs as a result of actions taken by county IHSS quality assurance workers and a 1% reduction in costs due to new anti-fraud activities. Similar amounts of savings (or spending reductions) as a result of those measures are estimated to occur in the current state budget year that ends on June 30 this year.
Cost savings/spending reductions to the overall IHSS program (for caseload and county anti-fraud and other actions):
2005-2006 Budget: $36.4 million ($11.8 million state funds)   2006-2007 Budget: $39.3 million ($12.8 million state funds)

Background of the IHSS Quality Assurance Program
* The IHSS Quality Assurance program, passed as part of the July 2004 - June 2005 budget, is an effort proposed by the Schwarzenegger Administration in June 2004, to increase statewide standardization in authorizing IHSS services control costs through uniform assessments, training, new efforts to prevent fraud and overpayments to IHSS recipients by the counties.The legislature approved the Governor's proposal and the language authorizing the program is in SB 1104, passed in 2004.
* Advocates however representing IHSS workers and people with disabilities and seniors who receive services, raised on-going concerns about establishing uniform statewide standards that will ignore or not address individual needs that differ from person to person, and vary due to location and other factors. They also raised on-going concerns about the State's anti fraud and other efforts that does not address problems when low income children and adults with disabilities and seniors are denied services they are eligible to receive.
* The development of statewide quality assurance standards is similar in concept and purpose to previous attempts by both the Davis and Schwarzenegger Administrations to impose uniform standards for the regional center budgets that fund community-based services for children and adults with developmental disabilities. Both the IHSS quality assurance program and the previous unsuccessful attempts to impose a similar program in the regional center budget that funds community-based services were accompanied by significant funding reductions (or cost savings to the State).
* The Department of Social Services have held a series of on-going statewide community meetings with interested groups and individuals, along with work groups to develop the IHSS Quality Assurance program. Some advocates have praised the work groups and stakeholder meetings as positive first steps while others have criticized the Schwarzenegger Administration for the outreach to people with disabilities and seniors who receive IHSS services.

Budget Also Impacts Poorest of State's Poor Who Have Disabilities, Blind or Elderly
As previously reported, the biggest spending cuts proposed would impact the poorest of the State's low income residents who depend on cash grants from the state and federal government called SSI/SSP (Supplemental Security Income/State Supplemental Payment). Many of these recipients also receive needed In-Home Supportive Services,and also other community-based services including regional center funded services. The Governor proposes that the federal increase due in January 2007 but delayed until April 2007 by the budget passed last year be delayed further, by another year and three months - until July 1, 2008. The delay would result in a reduction (or savings to the state) to the SSI/SSP program budget of $48 million in the July 2006 - June 2007 budget, and another $185 million in the July 2007 - June 2008 budget. Last year's budget suspended for two years (January 2006 and January 2007) the state cost of living increase to the SSP portion of the grant, and delayed passing the federal increase to recipients until April of both years. That reduction to the program was the largest single budget cut impacting people with disabilities and seniors in the 2005-2006 budget.

NEXT STEPS
* The IHSS Quality Assurance program - though not the specific details of how it would be implemented - was previously approved by the Legislature as part of the July 2004-June 2005 state budget. The cost savings (or spending reductions) estimated as a result of IHSS Quality Assurance, was approved or included as part of the budgets that were passed in 2004 and last year. Some of those estimates however have increased.
* The state Department of Social Services headed by new director Cliff Allenby, formerly the head of the Department of Developmental Services (both under the California Health and Human Services Agency) will continue meeting with advocates and other stakeholders in on-going work groups and meetings dealing with IHSS Quality Assurance. The Schwarzenegger Administration says that new field surveys to look at the new IHSS assessment tools and processes have just been released and will likely result in a change in the cost savings (or spending reductions) when the Governor releases his revisions to his proposed budget in May.
* The Assembly and State Senate Budget Committees will look at the proposed budget and issue by the end of the week a quick general analysis. Both committees have subcommittees dealing with health and human services, another with transportation and housing, another with education, employment and education and by late February or early March begin to hold the first hearings at the State Capitol .
* The Governor's budget requires 2/3rds approval of both houses in order to pass. The new budget year begins July 1.
*CDCAN Disability Rights Townhall Telemeeting scheduled for January 12, Thursday (today) between 1 PM and 2:45 PM. The Townhall Telemeeting will feature at 1 PM an update from California Health and Human Services Agency Secretary Kim Belshe. Legislative budget consultants on health and human service issues, including Michael Dimmitt of the Assembly Budget Committee, will later participate and provide updates and answer questions on budget issues impacting people with disabilities.

How To Receive CDCAN Capitol News Reports and Alerts
The California Disability Community Action Network is a non-partisan link to thousands of Californians with developmental and other disabilities, people with traumatic brain and other injures, seniors and their families, community organizations and providers, direct care and other workers, and other advocates. These action alerts and news reports is for all of them.   If you would like to get on this distribution (and conversely, get off of it) please send an email with that request to: martyomoto@rcip.com OR sign up via the NEW CDCAN website at www.cdcan.us Sharing information is part of our organizing effort. Please feel free to forward or copy this (attribution is nice). We're all in this together!