Union helped write California budget changes for in-home care
Published: Saturday, Apr. 16, 2011 - 12:00 am | Page 1A
As they reduced the budget deficit last month, Democrats repeatedly emphasized the ideological sacrifices they made in cutting California's safety net.
But in the fastest-growing social program over the past decade – in-home care – Democrats shelved cuts pushed by Gov. Jerry Brown in favor of alternatives backed by allies in organized labor.
Brown proposed saving $365 million by reducing In-Home Supportive Services across the board and eliminating paid domestic services provided by live-in caregivers, often relatives.
The Legislature instead opted to rely on new federal funds, use a pilot project involving automatic medication dispensers and assume fewer people will use the program than the governor predicted.
Those ideas were floated in a memo titled, "IHSS: Alternatives To Proposed Cuts," that the largest care workers' union, Service Employees International Union, circulated during the budget process.
"What we were able to do was really have a conversation with the Legislature," said Laphonza Butler, president of SEIU-United Long Term Care Workers.
Butler noted that Brown invited stakeholders to offer alternatives to his January budget. "We were being creative, looking at every avenue to find funding," she said.
Sen. Bob Huff, R-Diamond Bar, said Democrats should have agreed to the governor's original cuts.
"I think it's kicking the can down the road that the governor said he wasn't going to do," said Huff, vice chairman of the Senate Budget Committee. "He said he wasn't going to do gimmicks, but the Democrats did some, and he didn't challenge them on it."
IHSS, a $5.8 billion program that relies on county, state and federal funds, provides services to about 440,000 low-income elderly, blind and disabled Californians. Advocates say many enrollees would otherwise use more costly care at nursing facilities, paid by Medi-Cal.
In an effort to trim state costs estimated at $1.3 billion this fiscal year, the Democratic governor proposed slashing services by 8.4 percent across the board. He wanted to stop paying for domestic services provided by caregivers who live with their IHSS clients.
The Legislature made changes in 1999 that enabled IHSS workers to unionize. Service Employees International Union represents an estimated 272,000 IHSS workers. United Domestic Workers, which represents another 65,000 IHSS employees, also backed the changes.
As reliable Democratic contributors, the unions are expected to help finance a campaign for tax measures in a potential special election.
Reshaping the plan
Advocates say Brown's proposals had pitfalls. For instance, courts ruled that Washington state violated Medicaid law by cutting domestic services.
But in the fastest-growing social program over the past decade – in-home care – Democrats shelved cuts pushed by Gov. Jerry Brown in favor of alternatives backed by allies in organized labor.
Brown proposed saving $365 million by reducing In-Home Supportive Services across the board and eliminating paid domestic services provided by live-in caregivers, often relatives.
The Legislature instead opted to rely on new federal funds, use a pilot project involving automatic medication dispensers and assume fewer people will use the program than the governor predicted.
Those ideas were floated in a memo titled, "IHSS: Alternatives To Proposed Cuts," that the largest care workers' union, Service Employees International Union, circulated during the budget process.
"What we were able to do was really have a conversation with the Legislature," said Laphonza Butler, president of SEIU-United Long Term Care Workers.
Butler noted that Brown invited stakeholders to offer alternatives to his January budget. "We were being creative, looking at every avenue to find funding," she said.
Sen. Bob Huff, R-Diamond Bar, said Democrats should have agreed to the governor's original cuts.
"I think it's kicking the can down the road that the governor said he wasn't going to do," said Huff, vice chairman of the Senate Budget Committee. "He said he wasn't going to do gimmicks, but the Democrats did some, and he didn't challenge them on it."
IHSS, a $5.8 billion program that relies on county, state and federal funds, provides services to about 440,000 low-income elderly, blind and disabled Californians. Advocates say many enrollees would otherwise use more costly care at nursing facilities, paid by Medi-Cal.
In an effort to trim state costs estimated at $1.3 billion this fiscal year, the Democratic governor proposed slashing services by 8.4 percent across the board. He wanted to stop paying for domestic services provided by caregivers who live with their IHSS clients.
The Legislature made changes in 1999 that enabled IHSS workers to unionize. Service Employees International Union represents an estimated 272,000 IHSS workers. United Domestic Workers, which represents another 65,000 IHSS employees, also backed the changes.
As reliable Democratic contributors, the unions are expected to help finance a campaign for tax measures in a potential special election.
Reshaping the plan
IHSS supporters testified that Brown's cuts would threaten low-cost care for thousands of individuals. They said IHSS workers often must rely on state wages to care for relatives because they had to quit other jobs.
And they said IHSS had accepted its share of cuts in previous budgets, which include anti-fraud measures and a 3.6 percent reduction that began in February.
One SEIU-backed alternative adopted by the Legislature relies on $128 million from a new federal program whose rules are still being finalized. The "Community First Choice" option is part of the federal health care overhaul approved last year.
Though lawmakers and Brown are counting on the funds, the bill provides only for the state to "assess" whether it would be cost-effective to apply for the new program.
Another idea involves a pilot project to install automated medication dispensers in the homes of patients at risk of hospitalization. Lawmakers assumed $140 million in savings. The program is questionable enough that lawmakers spelled out 2012-13 contingencies in case it does not save that money.
Democrats also assumed the state would have fewer IHSS recipients than Brown's Department of Finance originally estimated, for about $80 million in savings.
Assemblyman Bob Blumenfield, D-Woodland Hills, chairman of the Assembly Budget Committee, said it was appropriate to incorporate suggestions from SEIU.
"Absolutely, they're a major stakeholder," he said. "Who knows that program better than they do? If they're able to propose ways to get to the savings that make sense, of course we're going to listen to them."
Cuts in other areas
Huff said Brown's proposal to eliminate pay for domestic services was reasonable. It would have ended such services for an estimated 300,000 IHSS recipients, according to the legislative analyst.
"It's a little bit problematic when you're hiring relatives that some would argue would be providing this service on the natural, anyway," Huff said.
Butler said that proposal would have put elderly individuals at risk. "You can't just say there's a family member who would just do it anyway. If they're not receiving compensation from the IHSS program, they have to be out of the house working somewhere else. Otherwise, nobody eats."
In the end, lawmakers adopted two IHSS ideas proposed by Brown. One saves $1.4 million by allowing counties to close advisory panels.
The other requires a licensed health professional to certify patients for IHSS; Brown wanted physicians to certify. Advocates raised concerns that restricting certification to doctors could be a problem for patients with limited access to care.
Labor groups have been instrumental in shaping the IHSS portion of the budget in recent years, whether in the Legislature or in the courts.
In 2009, lawmakers and then-Gov. Arnold Schwarzenegger attempted to cut IHSS wages by $2 per hour. But SEIU and other advocates filed suit, saying the state had not considered the potential consequences of reducing care providers, and courts blocked the wage reduction.
To avoid IHSS cuts last year, Democrats approved a maneuver in which IHSS workers "pay" a tax that gets reimbursed when the state draws additional federal funds. It was proposed by SEIU, UDW and other advocates.
The change was expected to save $190 million in the 2010-11 budget, but has yet to be implemented because the state has not received federal approval.
Other social service advocates were less successful. The Legislature softened cuts to welfare-to-work but still reduced grants by 8 percent and cut off parental aid after four years. Lawmakers also cut child-care availability.
Advocates say Brown's proposals had pitfalls. For instance, courts ruled that Washington state violated Medicaid law by cutting domestic services.Huff said Brown's proposal to eliminate pay for domestic services was reasonable. It would have ended such services for an estimated 300,000 IHSS recipients, according to the legislative analyst.
"It's a little bit problematic when you're hiring relatives that some would argue would be providing this service on the natural, anyway," Huff said.
Butler said that proposal would have put elderly individuals at risk. "You can't just say there's a family member who would just do it anyway. If they're not receiving compensation from the IHSS program, they have to be out of the house working somewhere else. Otherwise, nobody eats."
In the end, lawmakers adopted two IHSS ideas proposed by Brown. One saves $1.4 million by allowing counties to close advisory panels.
The other requires a licensed health professional to certify patients for IHSS; Brown wanted physicians to certify. Advocates raised concerns that restricting certification to doctors could be a problem for patients with limited access to care.
Labor groups have been instrumental in shaping the IHSS portion of the budget in recent years, whether in the Legislature or in the courts.
In 2009, lawmakers and then-Gov. Arnold Schwarzenegger attempted to cut IHSS wages by $2 per hour. But SEIU and other advocates filed suit, saying the state had not considered the potential consequences of reducing care providers, and courts blocked the wage reduction.
To avoid IHSS cuts last year, Democrats approved a maneuver in which IHSS workers "pay" a tax that gets reimbursed when the state draws additional federal funds. It was proposed by SEIU, UDW and other advocates.
The change was expected to save $190 million in the 2010-11 budget, but has yet to be implemented because the state has not received federal approval.
No comments:
Post a Comment