Existing law establishes the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with services in order to permit them to remain in their own homes and avoid institutionalization. Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed and funded by federal Medicaid program provisions.

Existing law establishes, as part of the Coordinated Care Initiative, the In-Home Supportive Services Employer-Employee Relations Act, which serves to resolve disputes regarding wages, benefits, and other terms and conditions of employment between the California In-Home Supportive Services Authority (Statewide Authority) and recognized employee organizations providing in-home supportive services. Existing law establishes the Statewide Authority and requires the authority to be the entity authorized to meet and confer in good faith regarding wages, benefits, and other terms and conditions of employment with representatives of recognized employee organizations for any individual provider who is employed by a recipient of supportive services.

Existing law provides, as part of the Coordinated Care Initiative, that IHSS is a Medi-Cal benefit available through managed care health plans in specified counties. Existing law requires enrollment of eligible Medi-Cal beneficiaries into managed care pursuant to a specified demonstration project or other provisions, including managed care for long-term services and supports, as one of the conditions required to be completed before the Statewide Authority assumes specified responsibilities. Existing law requires the Statewide Authority, no sooner than March 1, 2013, to assume specified responsibilities in a county upon notification by the Director of Health Care Services that the enrollment of eligible Medi-Cal beneficiaries described in specified provisions of law has been completed in that county. Under existing law, the date of assumption of these responsibilities by the Statewide Authority is known as the county implementation date.

This bill would, instead, make the implementation date January 1, 2016, would delete the reference to the county implementation date, and would make conforming changes.

Existing law conditions implementation of the Coordinated Care Initiative, as defined, on whether the Director of Finance estimates that the Coordinated Care Initiative will generate net General Fund savings, as specified. Existing law, with certain exceptions, specifies those provisions of law that are within the scope of the initiative to become inoperative if this condition is not met.

This bill would modify the definition of the Coordinate Care Initiative for the purposes of determining which provisions become inoperative if the condition is not met, and exclude, among others, those provisions that establish the In-Home Supportive Services Employer-Employee Relations Act; establish the Statewide Authority and determine the duties of, and when those duties are assumed by, the authority; establish the IHSS Fund, which is used to fund the Statewide Authority; and require all counties, commencing July 1, 2012, to have a County IHSS Maintenance of Effort (MOE) and to pay the County IHSS MOE instead of paying the nonfederal share of IHSS costs, as specified. The bill would make conforming changes.

 THIRD READING  

Bill No: AB 211

Author: Gomez (D), et al.

Introduced: 2/2/15

Vote: 21

SENATE HUMAN SERVICES COMMITTEE: 3-1, 6/23/15

AYES: McGuire, Hancock, Liu

NOES: Nguyen

NO VOTE RECORDED: Berryhill

SENATE APPROPRIATIONS COMMITTEE: 5-2, 8/27/15

AYES: Lara, Beall, Hill, Leyva, Mendoza

NOES: Bates, Nielsen

ASSEMBLY FLOOR: 58-20, 6/2/15 - See last page for vote

SUBJECT: In-home supportive services

SOURCE: UDW/AFSCME Local 3930

DIGEST: This bill de-links the establishment of a statewide public authority for the In-Home Supportive Services (IHSS) program, and its associated bargaining functions, from other provisions and timelines of the Coordinated Care Initiative (CCI).

ANALYSIS:

Existing law:

1. Establishes in state law a program of public Medi-Cal benefits to provide health care for people who lack sufficient annual income to meet the costs of health care, and whose other assets are so limited that their application toward the costs of such care would jeopardize the person or family’s future minimum self-maintenance and security. (WIC 14000 et seq.)

2. Establishes the In-Home Supportive Services program to provide domestic supportive and personal care services for aged, blind or disabled individuals living at or below the poverty level for the purpose of enabling consumers to avoid institutionalization and remain safely in their homes. (WIC 12300 et seq.)

3. Requires each county to establish a public authority or nonprofit consortium for providers of IHSS to establish a registry to help consumers find workers, conduct background checks of prospective workers, provide training and serve as the employer of record for collective bargaining. Establishes that IHSS recipients shall retain the right to choose the individuals that provide their care and to hire, fire, recruit, select, train, or reject any provider, as specified. (WIC 12302.25 et seq.)

4. Establishes the CCI in eight counties, an integrated health and long-term managed care plan for individuals and seniors and persons with disabilities who receive both Medi-Cal and Medicare benefits, and includes IHSS within the managed care plans. (WIC 14182.16, WIC 14186.35)

5. Predicates establishment of a statewide bargaining authority, the California In-Home Supportive Services Authority, upon the completed enrollment of each demonstration county’s CCI participants, and establishes this may happen no sooner than March 2013. (WIC 12300.7 (a))

6. Deems inoperable the establishment of the statewide bargaining authority and related authority to obtain information about IHSS providers established in the CCI if the CCI becomes inoperative. (GOV 6253.2)

7. Creates an IHSS Maintenance Of Effort (MOE) requirement for each county and provides that this MOE shall be counted in lieu of the county’s share of nonfederal costs of the county services block grant and IHSS administration requirements. Requires that the MOE becomes inoperative if the CCI is inoperative. (WIC 12306.15, 10101.1 (d), 12306 (f))

8. Provides that each county’s share of the costs of negotiated wage and benefit increases will remain during the period in which a county’s MOE exists, however the MOE share will be in lieu of that share. Establishes that this becomes inoperative if the CCI becomes inoperative. (WIC 12306.1 (g) and (h))

9. Requires that participating managed health care plans enter into an MOU with a county’s public authority or related organization when a demonstration county has enrolled its eligible beneficiaries into the CCI. The MOU must include an agreement to continue to perform assessments and other specific activities. (WIC 14186.35)

10. Requires the state’s Director of Finance to estimate the amount of net General Fund Savings gained from implementing the CCI and to suspend the CCI immediately if it is determined that no savings will be generated, as specified. Specifies which sections of statute shall be deleted if the CCI is deemed inoperative and requires that the statewide public authority cease to be the employer of record and the counties resume that role. (Section 34, Chapter 37, statutes of 2013)

This bill:

1. Sets January 1, 2016, as the date that the California In-Home Supportive Services Authority assumes responsibility for statewide collective bargaining.

2. Deletes the state’s ability to eliminate the statewide authority, including language identifying associated duties, and to return the role of employer of record to the counties should the CCI become inoperative.

3. Deletes the requirement to link the establishment of the statewide authority to a county’s implementation of the CCI, and makes related language changes in numerous places in the statute.

4. Deletes the requirement that the establishment of the California In-Home Supportive Services Authority be tied to the completed enrollment of beneficiaries into the CCI and the notification of such by the director of the Department of Health Care Services (DHCS), and deletes redundant sections (WIC 12302.25, 12306.1) that have been replaced in statute.

5. De-links from the CCI the requirement that a county’s IHSS MOE can be counted in lieu of a county’s share of cost of negotiated wage and benefit increases.

6. Eliminates the requirement to revert a county’s MOE share of cost to the original cost-sharing formula if the CCI is inoperative.

7. Changes the required date for plans to establish an MOU with county public authorities that transfers bargaining responsibility to the statewide authority from the implementation of the CCI in each county to January 1, 2016.

8. Eliminates from the list of codes that shall be deleted if the CCI becomes inoperative those codes that establish the In-Home Supportive Services Employer-Employee Relations Act, establish and define the duties of the statewide authority, establish the IHSS Fund, which is used to fund the statewide authority, require all counties to have a County IHSS MOE, as specified.

Background

The Coordinated Care Initiative. The CCI was established in the 2012 Budget Act (SB 1036, Committee on Budget and Fiscal Review, Chapter 45, Statutes of 2012) to integrate long-term services and supports, including IHSS, into managed care. The intent of the CCI was to bring dual eligible beneficiaries -- people who qualify for both Medicare and Medi-Cal – into the same plan. In California, there are about 1.1 million dual-eligible beneficiaries; as many as seven in ten are age 65 and older, and most are women. About one-third are younger people with disabilities.

Initially, the integration into managed care was anticipated to begin in eight specified demonstration counties as early as March 2013, with the intent to ultimately expand statewide. But there have been delays in the implementation of the CCI, due in part to delayed approval from the federal Centers for Medicaid and Medicare Services (CMS). Seven counties remain in the pilot program. San Mateo County transitioned to the Statewide Authority in February 2015, followed by Los Angeles, Riverside, San Bernardino and San Diego counties. Santa Clara County is anticipated to transition January 2016 and finally Orange County in August 2016. Alameda is no longer participating due to concerns about one of its plans.

Continued implementation of the CCI is statutorily dependent upon an annual determination by the Department of Finance (DOF) that there are net General Fund savings for CCI. If CCI is not cost-effective, all components of CCI would cease operation. According to DOF, several factors are threatening the solvency of the CCI, and it could cease operations, effective January 2017.

1. More than 100,000 participants were exempted, including Medicare Special Needs Plans and certain categories of Medi-Cal beneficiaries based on age or health condition.

2. Medicare and Medicaid savings were intended to be shared 50:50 with the federal government; however, the federal government reduced the amount of savings California was allowed to retain to approximately 25 to 30 percent.

3. The federal government allowed a 3.975 percent tax on managed care organizations through June 30, 2016 which is attributable to the state’s participation in the CCI demonstration. However, recent federal guidance indicates that this tax will not be allowed to continue in its current form, and a special Legislative session has been convened to address methods to fix the MCO tax.

4. As of November, approximately 69 percent of eligible participants opted out of Cal MediConnect but initial projections suggested just a 33 percent opt-out rate. Of those that opted-out, about 80 percent are in the IHSS program.

IHSS. The IHSS program is a county-administered Medi-Cal benefit which provides low-income individuals who are aged, blind or disabled with specified personal care and domestic services that allow them to remain safely in their own homes and to avoid institutionalization.

IHSS services include tasks like feeding, bathing, bowel and bladder care, meal preparation and clean-up, laundry, and paramedical care. In an average month, about 462,000 recipients received care from approximately 470,000 IHSS providers, according to the Governor’s budget. Nearly three-fourths of the providers are family members and half live with the recipient.

Eligibility for IHSS is determined by county social workers who conduct an in-home assessment, and periodic reassessments, of an individual’s ability to perform specific activities of daily living. Recipients are responsible for hiring, firing, directing and supervising their own IHSS provider or providers. The counties or public authorities must conduct a criminal background check and provide an orientation before a provider can receive payment. In most counties, local public authorities are designated as “employers of record” for collective bargaining purposes, while the state administers payroll, workers’ compensation, and benefits. IHSS is funded through a combination of federal, state, and county money. The state historically has paid 65 percent and counties have paid 35 percent of the non-federal share of IHSS funding. The average annual cost of services per IHSS client is estimated to be around $14,217 ($1,185 per client per month) for 2015-16.

Role of the Public Authority. In-home care was first provided in California in the 1950s through grants to eligible consumers who hired and paid their own providers. Over time, as the eligible population grew along with the desire to keep individuals in the most home-like setting, the IHSS program was developed and has grown to the nation’s largest program of its type. Initially, care was provided by family members who received pay for a few hours of service. In the late 1980s state law established a county’s responsibility to create a local public authority or non-profit consortium, which became a mandatory in 1999.

Under the CCI, county public authorities will relinquish their employer of record status to the statewide IHSS bargaining authority, but will retain other duties, such as performing background checks and creating a registry for consumers to find appropriate caregivers.

This bill broadens the statewide authority that currently exists within the CCI pilot counties to encompass all 58 counties.

FISCAL EFFECT: Appropriation: No Fiscal Com.: Yes Local: No

According to a Senate Appropriations Committee analysis, this bill results in potential costs (General Fund) in the high tens to hundreds of millions of dollars annually to the extent this measure results in an increase in IHSS provider wages and health benefits with the implementation of the Statewide Authority in all 58 counties effective January 1, 2016. It projected annual costs of about $6.9 million (50 percent General Fund, 50 percent federal funds) to the Department of Human Resources (CalHR) to implement and operate a collective bargaining platform on behalf of the Statewide Authority expanded to cover all 58 counties, and additional significant one-time General Fund costs to CalHR for limited-term staff and overtime required to support the workload imposed under the accelerated implementation date mandated in this measure.

The analysis noted that to the extent the CCI would have otherwise become inoperative at some future date due to an estimate by the Director of Finance that the CCI would not generate net General Fund savings, as specified; the annual costs noted above would continue to be incurred. The counties’ share of cost limited by the County IHSS MOE would not revert to the original cost-sharing formula, and CalHR/DSS costs would continue to support the activities of the Statewide Authority.

SUPPORT: (Verified 8/28/15)

AFSCME

California Labor Federation

OPPOSITION: (Verified 8/28/15)

Department of Finance

ARGUMENTS IN SUPPORT: According to the author, the 2012 statute that established the CCI also created a statewide authority to transfer employer bargaining responsibility for the IHSS program from the counties to the state. Under statute, only the eight identified counties implementing the pilot project would be included in the statewide authority, and only upon full implementation of the CCI. The author states that at the time the CCI statute was enacted, the Administration intended the CCI to become operative in all 58 counties by 2015; however, due to the unprecedented and complex nature of the CCI, it has experienced numerous implementation delays. The author states this bill is needed because there is no plan to transition collective bargaining responsibilities to the statewide authority in any of the remaining 51 counties.

ARGUMENTS IN OPPOSITION: The Department of Finance writes that it is opposed to this bill because it would require the state to implement collective bargaining in all 58, even if the CCI were to become inoperative. The CCI is intended to be a complete package of reforms designed to improve care coordination for individuals who are eligible for benefits under Medicare and Medi-Cal. Allowing statewide bargaining responsibilities to function separately from the entirety of the CCI erodes the comprehensive nature of the initiative and places all fiscal risk of the CCI squarely on the state.

ASSEMBLY FLOOR: 58-20, 6/2/15

AYES: Achadjian, Alejo, Bigelow, Bloom, Bonilla, Bonta, Brown, Burke, Calderon, Campos, Chang, Chau, Chiu, Chu, Cooley, Cooper, Dababneh, Daly, Dodd, Eggman, Frazier, Cristina Garcia, Eduardo Garcia, Gipson, Gomez, Gonzalez, Gordon, Gray, Roger Hernández, Holden, Irwin, Jones-Sawyer, Lackey, Levine, Linder, Lopez, Low, Maienschein, Mayes, McCarty, Medina, Mullin, Nazarian, O'Donnell, Perea, Quirk, Rendon, Ridley-Thomas, Rodriguez, Salas, Santiago, Mark Stone, Thurmond, Ting, Weber, Williams, Wood, Atkins

NOES: Travis Allen, Baker, Brough, Dahle, Beth Gaines, Gallagher, Gatto, Grove, Hadley, Harper, Jones, Kim, Mathis, Melendez, Obernolte, Olsen, Patterson, Steinorth, Wagner, Wilk

NO VOTE RECORDED: Chávez, Waldron

Prepared by: Mareva Brown / HUMAN S. / (916) 651-1524

8/30/15 19:11:48

**** END ****

SENATE COMMITTEE ON APPROPRIATIONS

Senator Ricardo Lara, Chair

2015 - 2016 Regular Session

AB 211 (Gomez) - In-home supportive services

This bill meets the criteria for referral to the Suspense File.

Bill Summary:

AB 211 would require the California In-Home Supportive Services Authority (Statewide Authority) to assume employer responsibility for collective bargaining in all 58 counties effective January 1, 2016. This bill would remove the provisions in existing law conditioning the transfer of collective bargaining responsibility to the Statewide Authority that is currently limited to seven counties and contingent upon each county’s implementation of specified provisions of the Coordinated Care Initiative (CCI), and would delink various provisions of law currently contingent upon the continued operation of the CCI.

Fiscal Impact:

• Potential costs (General Fund) in the high tens to hundreds of millions of dollars annually to the extent the provisions of this measure result in an increase in IHSS provider wages and health benefits with the implementation of the Statewide Authority in all 58 counties effective January 1, 2016. The Department of Social Services (DSS) estimates annual costs of $518 million General Fund assuming an increase in provider wages to $12.10 effective January 1, 2016, for specified counties.

• Annual costs in the range of $6.9 million (50 percent General Fund, 50 percent federal funds) to the Department of Human Resources (CalHR) to implement and operate a collective bargaining platform on behalf of the Statewide Authority expanded to cover all 58 counties effective January 1, 2016.

• Additional one-time significant costs (General Fund) to CalHR for limited-term staff and overtime required to support the workload imposed under the accelerated implementation date mandated in this measure.

• To the extent the CCI would have otherwise become inoperative at some future date due to an estimate by the Director of Finance that the CCI would not generate net General Fund savings, as specified, the annual costs noted above would continue to be incurred. The counties’ share of cost limited by the County IHSS MOE would not revert to the original cost-sharing formula, and CalHR/DSS costs would continue to support the activities of the Statewide Authority.

Background:

The In-Home Supportive Services (IHSS) program provides in-home custodial care to aged, blind, and disabled individuals who meet specified eligibility criteria. Eligible IHSS recipients receive such services as housecleaning, meal preparation, laundry, grocery shopping, personal care services, accompaniment to medical appointments, and protective supervision. IHSS providers are organized into 56 bargaining units, totaling approximately 380,000 employees located within 58 counties. The administration of IHSS is a complex partnership that includes the IHSS recipients, the Department of Social Services (DSS), the Department of Health Care Services (DHCS), counties, public authorities, program advocates, providers, and employee unions. Currently, the employers’ interests for collective bargaining purposes under the IHSS program are represented either by each county’s public authority or by the county itself.

The 2012-13 Budget included changes to authorize the Coordinated Care Initiative (CCI), a demonstration project in eight counties to integrate the delivery of medical services, long-term services and supports (including IHSS), and behavioral health services through Medi-Cal managed care plans, with the intent to expand the integration into managed care statewide if the pilot proved successful. As part of the demonstration project, SB 1036 (Committee on Budget and Fiscal Review) Chapter 45/2012, also established a Statewide Authority for specified purposes of collective bargaining as IHSS became a benefit provided through managed care in those counties in the CCI.

Currently, seven counties remain in the CCI pilot program. Numerous delays in the implementation of the CCI have resulted in delays transitioning to the Statewide Authority. San Mateo County transitioned to the Statewide Authority in February 2015, and Los Angeles, Riverside, San Bernardino, and San Diego Counties are anticipated to transition in July 2015. Santa Clara County is expected to transition in January 2016, and Orange County in August 2016.

Continued operation of the CCI is statutorily dependent on an annual determination by the Director of Finance that operation of the CCI generates net General Fund savings, as specified. Under existing law, the transfer of collective bargaining responsibility to the Statewide Authority for CCI counties is contingent upon the continued operation of the CCI. Similarly, continued existence of the IHSS MOE share of cost, which is to be counted in lieu of a likely increasing amount of a county’s level of nonfederal IHSS program costs, is contingent upon continued operation of the CCI.

Proposed Law:

This bill would delink the statewide bargaining provision of IHSS providers and associated creation of the Statewide Authority from other provisions and timelines of the CCI. Specifically, this bill:

1) Eliminates the requirement to delete authority for the Statewide Authority and related requirements if the CCI becomes inoperative.

2) Removes the requirement to link the establishment of the statewide employee organization to a county’s implementation of the CCI, and makes related language changes in numerous places in the statute.

3) Eliminates the requirement to revert a county’s IHSS County MOE share of cost to the original cost-sharing formula if the CCI is not implemented or becomes inoperative.

4) Deletes the requirement that the establishment of the Statewide Authority be tied to the completed enrollment of beneficiaries into the CCI and the notification of such by the Director of the DHCS.

5) Sets January 1, 2016, as the date that the Statewide Authority assumes responsibility for statewide collective bargaining.

6) Eliminates language that renders inoperative the requirement to count a county’s

IHSS MOE in lieu of a county’s share of cost of negotiated wage and benefit increases, as specified.

7) Changes the required date for plans to establish an MOU with county public authorities that transfers bargaining responsibility to the Statewide Authority from the implementation of the CCI in each county to January 1, 2016.

8) Deletes statute that would eliminate the Statewide Authority and return the role of employer of record to the counties should the CCI become inoperative.

9) Eliminates from the list of code sections that shall be deleted if the CCI becomes inoperative those sections that establish the IHSS Employer-Employee Relations Act, establish and define the duties of the Statewide Authority, establish the IHSS Fund, require all counties to have a County IHSS MOE, and require counties to pay the County IHSS MOE instead of paying the nonfederal share of IHSS costs, as specified.

Prior Legislation:

AB 485 (Gomez) 2014 was nearly identical to this measure. This bill died on concurrence on the Assembly Floor.

SB 1036 (Committee on Budget and Fiscal Review) Chapter 45/2012 established the Statewide Authority, incorporated IHSS into the CCI, and established a statewide bargaining process to be implemented as each county implemented the CCI. The statute anticipated that as soon as March 1, 2013, the pilot would begin in the demonstration counties and provided that once IHSS was an established Medi-Cal benefit through managed care plans, collective bargaining would be transferred to the Statewide Authority. This bill also required all counties, commencing July 1, 2012, to have a County IHSS MOE, which required counties to pay the County IHSS MOE instead of paying the nonfederal share of IHSS costs, as specified.

Staff Comments:

Accelerating and expanding the implementation of statewide bargaining to all 58 counties could result in potentially major ongoing costs (General Fund) in the high tens to hundreds of millions of dollars to the extent the provisions of this measure result in an increase in IHSS provider wages and health benefits with the implementation of the Statewide Authority effective January 1, 2016. As only those wage and benefit increases that are locally negotiated or imposed before the Statewide Authority assumes employer responsibility result in an adjustment to the County IHSS Maintenance of Effort (MOE), any increases negotiated by the Statewide Authority would not require a county share of costs. The nonfederal share of costs would be fully funded by the state, resulting in major ongoing costs to the General Fund.

The DSS has estimated increased costs of $553 million ($250 million General Fund) in Fiscal Year (FY) 2015-16 and $1.1 billion ($518 million General Fund) in FY 2016-17 assuming an increase in provider wages to $12.10 effective January 1, 2016, for 56 of the 58 counties (two counties currently provide wages in excess of $12.10).

Under current law, the Statewide Authority becomes the bargaining entity for IHSS providers only in the eight counties participating in the CCI demonstration, and only upon the Director of the DHCS’ determination that enrollment into managed care plans has been completed for the Med-Cal beneficiaries in that county. Because existing law restricts the transfer to statewide bargaining to the seven CCI demonstration counties upon complete Medi-Cal enrollment to managed care, this bill potentially accelerates the implementation date for those counties not already transitioned to the Statewide Authority, and expands statewide bargaining to the remaining 51 counties.

The provisions of this measure could result in annual costs in the range of $6.9 million to CalHR to implement and operate a collective bargaining platform on behalf of the Statewide Authority expanded to cover all 58 counties effective January 1, 2016. In addition, CalHR will incur one-time significant costs for limited-term staff and overtime required to support the workload imposed under the accelerated implementation date mandated in this measure.

To the extent the CCI would have otherwise become inoperative at some future date due to an estimate by the Director of Finance that the CCI would not generate net General Fund savings, as specified, the annual costs noted above would continue to be incurred. The counties’ share of cost limited by the County IHSS MOE would not revert to the original cost-sharing formula, and CalHR/DSS costs would continue to support the activities of the Statewide Authority.

-- END --

SENATE COMMITTEE ON HUMAN SERVICES

Senator McGuire, Chair

2015 - 2016 Regular

Bill No: AB 211

Subject: In-home supportive services

SUMMARY

This bill de-links the establishment of a statewide public authority for the In-Home Supportive Services (IHSS) program, and its associated bargaining functions, from other provisions and timelines of the Coordinated Care Initiative (CCI).

ABSTRACT

Existing law:

1. Establishes in state law a program of public Medi-Cal benefits to provide health care for people who lack sufficient annual income to meet the costs of health care, and whose other assets are so limited that their application toward the costs of such care would jeopardize the person or family’s future minimum self-maintenance and security. (WIC 14000 et seq.)

2. Establishes the In-Home Supportive Services program to provide domestic supportive and personal care services for aged, blind or disabled individuals living at or below the poverty level for the purpose of enabling consumers to avoid institutionalization and remain safely in their homes. (WIC 12300 et seq.)

3. Requires each county to establish a public authority or nonprofit consortium for providers of IHSS to establish a registry to help consumers find workers, conduct background checks of prospective workers, provide training and serve as the employer of record for collective bargaining. Establishes that recipients of IHSS shall retain the right to choose the individuals that provide their care and to recruit, select, train, reject, or change any provider under the contract mode or to hire, fire, train, and supervise any provider under any other mode of service. (WIC 12302.25 et seq.)

4. Establishes the CCI, subject to federal approval, which establishes in eight counties an integrated health and long-term managed care plan for individuals and seniors and persons with disabilities who receive both Medi-Cal and Medicare benefits, and includes IHSS within the managed care plans. (WIC 14182.16, WIC 14186.35)

5. Predicates establishment of a statewide bargaining authority, the California In-Home Supportive Services Authority, upon the completed enrollment of each demonstration county’s CCI participants and notification by the state that such enrollment has been completed. Sets this date as no sooner than March 1, 2013. (WIC 12300.7 (a))

6. Deems inoperable the establishment of the statewide bargaining authority and related authority to obtain information about IHSS providers established in the CCI if the CCI becomes inoperative. (GOV 6253.2)

7. Establishes that a statewide employee organization may be established after a county’s CCI implementation date and makes related references in statute. (GOV 110003, et seq.) (GOV 110011 (e)) (WIC 12300.5)

8. Creates an IHSS Maintenance Of Effort (MOE) requirement for each county and provides that this MOE shall be counted in lieu of the county’s share of nonfederal costs of the county services block grant and IHSS administration requirements, but provides that this MOE shall become inoperative if the CCI is inoperative. (WIC 12306.15, 10101.1 (d), 12306 (f))

9. Establishes state rates for IHSS providers and permits counties to set wages based on their collective bargaining agreements. Provides specific conditions under which the state may participate in increased wages and benefits, as specified. (WIC 12306.1 (a))

10. Provides that each county’s share of the costs of negotiated wage and benefit increases will remain during the period in which a county’s MOE exists, however the MOE share will be in lieu of that share. Establishes that this section be inoperative if the CCI becomes inoperative. (WIC 12306.1 (g) and (h))

11. Requires that participating managed health care plans enter into a memorandum of understanding (MOU) with a county’s public authority or related organization when a demonstration county has enrolled its eligible beneficiaries into the CCI. The MOU must include an agreement to continue to perform specific activities including assessing, authorizing and approving each recipient’s initial and continuing need for services, conducting criminal background checks on all potential providers, providing assistance to IHSS recipients in finding eligible providers, referring all providers to the statewide bargaining agency, and other specified tasks. (WIC 14186.35)

12. Requires the state’s Director of Finance to estimate the amount of net General Fund Savings gained from implementing the CCI and to suspend the CCI immediately if it is determined that no savings will be generated, as specified. Specifies which sections of statute shall be deleted if the CCI is deemed inoperative and requires that the statewide public authority cease to be the employer of record and the counties resume that role. (Section 34, Chapter 37, statutes of 2013)

This bill:

1. Sets January 1, 2016, as the date that the California In-Home Supportive Services Authority assumes responsibility for statewide collective bargaining.

2. Deletes the state’s ability to eliminate the statewide authority, including language identifying associated duties, and to return the role of employer of record to the counties should the CCI become inoperative.

3. Deletes the requirement to link the establishment of the statewide authority to a county’s implementation of the CCI, and makes related language changes in numerous places in the statute.

4. Deletes the requirement that the establishment of the California In-Home Supportive Services Authority be tied to the completed enrollment of beneficiaries into the CCI and the notification of such by the director of the Department of Health Care Services (DHCS).

5. Deletes redundant sections (WIC 12302.25, 12306.1) that have been replaced in statute.

6. De-links from the CCI the requirement that a county’s IHSS MOE can be counted in lieu of a county’s share of cost of negotiated wage and benefit increases.

7. Eliminates the requirement to revert a county’s MOE share of cost to the original cost-sharing formula if the CCI is inoperative.

8. Changes the required date for plans to establish an MOU with county public authorities that transfers bargaining responsibility to the statewide authority from the implementation of the CCI in each county to January 1, 2016.

9. Eliminates from the list of codes that shall be deleted if the CCI becomes inoperative those codes that establish the In-Home Supportive Services Employer-Employee Relations Act, establish and define the duties of the statewide authority, establish the IHSS Fund, which is used to fund the statewide authority, require all counties to have a County IHSS MOE, as specified.

FISCAL IMPACT

An Assembly Appropriations Committee analysis identified ongoing costs in the tens of millions of dollars (GF) to the extent the provisions of this bill result in an increase in IHSS provider wages and health benefits with the implementation of the statewide authority in all 58 counties. Only those wage and benefit increases that are locally negotiated or imposed before the statewide authority assumes employer responsibility will result in an adjustment to the County IHSS MOE. Thus, any increases negotiated by the statewide authority do not require a county share of costs. The nonfederal share of the increase will be fully funded by the state, resulting in ongoing costs to the GF.

The Appropriations analysis also identified annual costs in the range of $7 million (50% GF, 50% federal funds) to the Department of Human Resources (CalHR) to implement and operate a collective bargaining platform on behalf of the statewide authority expanded to cover all 58 counties.

BACKGROUND AND DISCUSSION

Purpose of the bill:

According to the author, the 2012 statute that established the CCI also created a statewide authority to transfer employer bargaining responsibility for the IHSS program from the counties to the state. Under statute, only the eight identified counties implementing the pilot project would be included in the statewide authority, and only upon full implementation of the CCI.

The author states that at the time the CCI statute was enacted, the Administration intended the CCI to become operative in all 58 counties by 2015, however, due to the unprecedented and complex nature of the CCI, it has experienced numerous implementation delays. The author states this bill is needed because there is no plan to transition collective bargaining responsibilities to the statewide authority in any of the remaining 51 counties.

The Coordinated Care Initiative

The CCI was established in the 2012 Budget Act (SB 1036, Committee on Budget and Fiscal Review, Chapter 45, Statutes of 2012) to integrate long-term services and supports, including IHSS, into managed care. The intent of the CCI was to bring dual eligible beneficiaries -- people who qualify for both Medicare and Medi-Cal – into the same plan. In California, as many as seven in ten dual eligible beneficiaries are age 65 and older, and most are women. Approximately one in three are younger people with disabilities. California has about 1.1 million of these beneficiaries.

Initially, the integration into managed care was anticipated to begin in eight specified demonstration counties as early as March 2013, with the intent to ultimately expand statewide. But there have been delays in the implementation of the CCI, due in part to delayed approval from the federal Centers for Medicaid and Medicare Services (CMS). Currently, seven counties remain in the pilot program. San Mateo County transitioned to the Statewide Authority in February 2015, and will be followed by Los Angeles, Riverside, San Bernardino and San Diego counties in July 2015. Santa Clara County is anticipated to transition January 2016 and finally Orange County in August 2016. Alameda is not longer participating due to concerns about one of its plans.

Continued implementation of the CCI is statutorily dependent upon an annual determination by the Department of Finance (DOF) that there are net General Fund savings for CCI. If CCI is not cost-effective, all components of CCI would cease operation. According to DOF, several factors are threatening the solvency of the CCI, and it could cease operations, effective January 2017.¹

• More than 100,000 participants were exempted, including Medicare Special Needs Plans and certain categories of Medi-Cal beneficiaries based on age or health condition.

• Medicare and Medicaid savings were intended to be shared 50:50 with the federal government; however, the federal government reduced the amount of savings California was allowed to retain to approximately 25 to 30 percent.

• The federal government allowed a 3.975 percent tax on managed care organizations through June 30, 2016 which is attributable to the state’s participation in the CCI demonstration. However, recent federal guidance indicates that this tax will not be allowed to continue in its current form.

• As of November 1, 2014 approximately 69 percent of eligible participants opted out of Cal MediConnect compared to initial projections of approximately 33 percent. Of the 69 percent that have opted-out, about 80 percent of these individuals are In-Home Supportive Services.

IHSS

The IHSS program is a county-administered Medi-Cal benefit which provides low-income individuals who are aged, blind or disabled with specified personal care and domestic services that allow them to remain safely in their own homes and to avoid institutionalization.

IHSS services include tasks like feeding, bathing, bowel and bladder care, meal preparation and clean-up, laundry, and paramedical care. According to the Governor’s budget, the average monthly caseload for IHSS in 2015-16 will be 462,648 recipients and approximately 470,000 IHSS providers. Nearly three-fourths of the providers are family members of care recipients and half live in the home with the recipient for whom they provide services.

Eligibility for IHSS services is determined by county social workers who conduct a standardized in-home assessment, and periodic reassessments, of an individual’s ability to perform specific activities of daily living. Recipients are responsible for hiring, firing, directing and supervising their own IHSS provider or providers. The counties or public authorities must conduct a criminal background check and provide an orientation before a provider can receive payment. In most counties, local public authorities are designated as “employers of record” for collective bargaining purposes, while the state administers payroll, workers’ compensation, and benefits. IHSS is funded through a combination of federal, state, and county money. The state historically has paid 65 percent and counties have paid 35 percent of the non-federal share of IHSS funding. The average annual cost of services per IHSS client is estimated to be around $14,217 ($1,185 per client per month) for 2015-16.

Role of the Public Authority

In-home care was first provided in California in the 1950s through grants to eligible consumers who hired and paid their own providers. Over time, as the eligible population grew along with the desire to keep individuals in the most home-like setting, the IHSS program was developed and has grown to the nation’s largest program of its type. Initially, care was provided by family members who received pay for a few hours of service. In the late 1980s state law established a county’s responsibility to create a local public authority or non-profit consortium and to create a registry for consumers find providers, to conduct background checks and to train workers. It also served as the employer of record for bargaining purposes. The requirement to form a public authority or similar entity became mandatory in 1999.

Under the CCI, county public authorities will relinquish their employer of record status to the statewide IHSS bargaining authority, but will retain other duties, such as performing background checks and creating a registry for consumers to find appropriate caregivers. This bill would broaden the statewide authority that currently exists within the CCI pilot counties to encompass all 58 counties.

Related legislation:

AB 485 (Gomez, 2013) was nearly identical to this bill, attempting to de-link the statewide bargaining authority from the CCI. It died on concurrence on the Assembly floor.

SB 94 (Committee on Budget and Fiscal Review) Chapter 37, Statutes of 2013, delinks the mandatory enrollment of Medi-Cal and Medicare beneficiaries, into Medi-Cal managed care from other elements of the CCI, including the integration of long-term supports and services into managed care plans, and the commencement of the In-Home Supportive Services (IHSS) Statewide Public Authority. Makes technical changes related to the statewide public authority’s ability to conduct closed meetings.

SB 1036 (Committee on Budget and Fiscal Review) Chapter 45, Statutes of 2012, provided for the integration of long-term services and supports, including IHSS, into managed care through the CCI.

AB 1682 (Peace) Chapter 90, Statutes of 1999, established that the state and county share costs of any increase in IHSS wages and benefits negotiated by a public authority or private consortium and required each county to act as, or establish, an employer for IHSS personnel for purposes of collective bargaining.

PRIOR VOTES

POSITIONS

Support:

AFSCME

Oppose:

None received.

-- END --

ASSEMBLY THIRD READING

ATR Bill Id:AB 211

Author:(Gomez)

As Introduced Ver:February 2, 2015

Majority vote

SUMMARY:

Disconnects implementation of the Statewide Authority for collective bargaining within the In-Home Support Services (IHSS) program from the state's Coordinated Care Initiative (CCI) and implements it separately, beginning January 1, 2016.

Specifically, this bill:

1. Requires the In-Home Supportive Services Statewide Authority to assume collective bargaining responsibility for IHSS providers in all 58 counties, beginning January 1, 2016.

2. Deletes the requirement that the statewide collective bargaining activities of the Statewide Authority are conditioned upon implementation of the CCI and therefore subject to the timeline and other restrictions within the CCI demonstration project.

3. Deletes the authority of the Director of Finance to terminate the Statewide Authority or the collective bargaining responsibilities of the Statewide Authority if the CCI demonstration project is terminated due to not generating anticipated General Fund savings.

4. Makes permanent the IHSS maintenance of effort (MOE) requirement for all counties in lieu of their share of non-federal costs, as well as the inclusion of a county's IHSS MOE when calculating that county's share of cost for negotiated wage and benefit increases.

EXISTING LAW:

1. Establishes the IHSS program as a benefit available to Medi-Cal beneficiaries that provides in-home care and supportive services to low-income aged, blind, or disabled persons who are unable to provide or care for themselves and who cannot live safely in their homes without assistance. Defines supportive services within the program to include domestic services, personal care services, protective supervision, paramedical services, and other services, as specified. (Welfare and Institutions Code (WIC) Section 12300 et seq.)

2. Establishes the CCI demonstration project in up to eight counties, subject to federal approval, to better serve the state's low-income seniors and persons with disabilities by integrating the delivery of medical, behavioral, and long-term care services. (SB 1008 (Budget and Fiscal Review Committee), Chapter 33, Statutes of 2012, and SB 1036 (Budget and Fiscal Review Committee), Chapter 45, Statutes of 2012).

3. Requires, as an additional component of the CCI, that all Medi-Cal long-term services and supports, which include IHSS, be services that are covered under managed care health plan contracts and be available only through managed care health plans to beneficiaries residing in counties participating in the CCI demonstration project, with specified exceptions. (WIC Section 14186 et seq.)

4. Establishes the IHSS Statewide Authority as a joint powers authority, as specified, that is required to be the entity authorized to meet and confer regarding wages and benefits with recognized employee organizations for IHSS providers commencing after the "county implementation date" within the CCI, which occurs when a county that is one of the CCI demonstration counties is notified by the Director of the Department of Health Care Services (DHCS) that the enrollment of eligible Medi-Cal beneficiaries, as specified, has been completed in that county. (California Government Code (GOV) Section 6531.5, WIC Section 12300.5)

5. Requires, beginning July 1, 2012, all counties to have a County IHSS MOE, as specified, which the counties pay in lieu of paying the non-federal share of IHSS costs, as specified. Also requires the MOE to be paid in lieu of a county’s share of the costs of negotiated wage and benefit increases. Makes these MOE provisions inoperative, and reverts counties back to the otherwise specified share of cost, if the CCI becomes inoperative. (WIC Section 12306.15)

FISCAL EFFECT:

According the Assembly Appropriations Committee:

1. Potentially major ongoing costs (General Fund (GF)) in the tens of millions of dollars to the extent the provisions of this bill result in an increase in IHSS provider wages and health benefits with the implementation of the Statewide Authority in all 58 counties. Only those wage and benefit increases that are locally negotiated or imposed before the Statewide Authority assumes employer responsibility result in an adjustment to the County IHSS MOE. Thus, any increases negotiated by the Statewide Authority do not require a county share of costs. The nonfederal share of the increase will be fully funded by the state, resulting in ongoing costs to the GF.

2. Annual costs in the range of $7 million (50% GF, 50% federal funds) to the Department of Human Resources (CalHR) to implement and operate a collective bargaining platform on behalf of the Statewide Authority expanded to cover all 58 counties.

COMMENTS:

In-Home Supportive Services (IHSS): The IHSS program provides personal care and domestic services to approximately 420,000 qualified, low-income individuals who are aged, blind, or disabled. Through the IHSS program, recipients are cared for and assisted with activities of daily living, allowing them to remain safely in their own homes and avoid institutionalization. IHSS services include: Paramedical services, such as giving medications and changing a colostomy bag; Non-Medical Personal Care services, such as toileting, dressing, and transportation; Domestic services, such as housework, shopping for groceries and meal preparation; and, Protective supervision for those who, due to cognitive decline or dementia, cannot be left alone for extended periods.

County social workers determine eligibility for IHSS and the authorized hours of care after conducting a standardized in-home assessment, and periodic reassessments, of an individual's ability to perform specified activities of daily living. Once eligible, recipients are responsible for hiring, firing, directing and supervising their own IHSS provider or providers. Prior to receiving payment for services, providers must submit to a criminal background check and a provider orientation. IHSS is funded with federal, state, and county resources, and prior to implementation of the CCI demonstration project, county public authorities or nonprofit consortia were designated as "employers of record" for collective bargaining purposes on a statewide basis, while the state administered payroll and benefits.

Coordinated Care Initiative (CCI): The Budget Act of 2012 enacted the CCI, also referred to as Cal MediConnect, a framework for integrating delivery of medical, behavioral and long-term care services through a single health plan for persons eligible for both Medicare and Medi-Cal. The CCI was originally limited to the following eight demonstration counties: Alameda, Los Angeles, Orange, San Diego, San Mateo, Riverside, San Bernardino, and Santa Clara, in which approximately 65% of IHSS recipients reside. Alameda County withdrew from the CCI demonstration in 2014.

As part of the CCI, collective bargaining responsibilities shifted, in the demonstration counties, from local county public authorities or non-profit consortia to the new Statewide Authority, which is composed of specified members and an advisory committee. The CCI also created an IHSS MOE funding requirement for counties, which replaced the previously existing county share of non-federal funding for IHSS. Under the demonstration project, the shift to the Statewide Authority is set to occur in each county once enrollment into managed care pursuant to the CCI has been completed in that county. According to the Department of Health Care Services (DHCS), this shift was scheduled to have occurred in April 2014.

Need for the bill: While the statute creating the CCI anticipated a fairly seamless roll-out within the eight demonstration counties, delays have resulted in enrollment still being underway for five counties, with San Mateo being the only county that has already completed enrollment and transitioned to collective bargaining under the Statewide Authority. According to the author, this bill is necessary to shift to statewide collective bargaining for all IHSS providers despite delays in the implementation of the CCI and despite the lack of a plan to transition collective bargaining to the state level in the remaining 51 counties not included in the CCI.

Analysis Prepared by: Myesha Jackson / HUM. S. / (916) 319-2089 FN: 0000599

Date of Hearing: April 15, 2015

ASSEMBLY COMMITTEE ON APPROPRIATIONS

Jimmy Gomez, Chair

ABPCA Bill Id:AB 211

Author:(Gomez) – As Introduced Ver:February 2, 2015

Urgency: No State Mandated Local Program: No Reimbursable: No

SUMMARY: This bill delinks implementation of statewide collective bargaining authority for the In-Home Support Services (IHSS) program from the state's Coordinated Care Initiative (CCI) and implements it separately under the new statewide California IHSS Authority (Statewide Authority) beginning January 1, 2016. Specifically, this bill:

1. Requires the Statewide Authority to assume collective bargaining responsibility for IHSS providers in all 58 counties beginning January 1, 2016, rather than in the eight counties participating in the CCI demonstration project.

2. Makes the Statewide Authority permanent by deleting the statute making statewide collective bargaining conditional upon implementation of the CCI.

3. Deletes the authority of the Director of Finance to halt implementation of the CCI, and therefore statewide collective bargaining by the Statewide Authority, if the director determines that the CCI will not generate anticipated General Fund (GF) savings.

4. Makes permanent, through the separation of statewide collective bargaining authority for IHSS, the IHSS Maintenance of Effort (MOE) requirement for all counties in lieu of their share of non-federal costs, as well as the inclusion of a county’s IHSS MOE when calculating that county's share of cost of negotiated wage and benefit increases.

FISCAL EFFECT:

1. Potentially major ongoing costs (GF) in the tens of millions of dollars to the extent the provisions of this bill result in an increase in IHSS provider wages and health benefits with the implementation of the Statewide Authority in all 58 counties. Only those wage and benefit increases that are locally negotiated or imposed before the Statewide Authority assumes employer responsibility result in an adjustment to the County IHSS MOE. Thus, any increases negotiated by the Statewide Authority do not require a county share of costs. The nonfederal share of the increase will be fully funded by the state, resulting in ongoing costs to the GF.

2. Annual costs in the range of $7 million (50% GF, 50% federal funds) to the Department of Human Resources (CalHR) to implement and operate a collective bargaining platform on behalf of the Statewide Authority expanded to cover all 58 counties.

COMMENTS:

1. Purpose. While the statute creating the CCI anticipated a fairly seamless roll-out within the eight demonstration counties, there have been numerous implementation delays. As a result, five counties are still in the enrollment process, one county has not yet begun, and one county withdrew from the demonstration. Thus far, San Mateo is the only county to have completed enrollment and transitioned to collective bargaining under the Statewide Authority. According to the author, this bill is necessary to shift to statewide collective bargaining for IHSS providers despite delays in the implementation of the CCI. The bill makes this shift for all 58 counties, not just the demonstration counties.

The bill’s co-sponsor, the American Federation of State and County Municipal Employees, notes that the implementation delays have delayed the transfer of collective bargaining to the state in all counties, and as a result, collective bargaining at the county level has either been delayed or met with reluctance to engage in bargaining when the transfer of responsibility is expected to be imminent. The sponsor writes that several counties have proposed one-year contract extensions, while others have opposed increases in IHSS spending because it would permanently increase the county’s IHSS MOE.

2. Background. The Budget Act of 2012 enacted the CCI (also called Cal MediConnect), a framework for integrating delivery of medical, behavioral and long-term care services through a single health plan for persons eligible for both Medicare and Medi-Cal. The CCI was originally limited to eight demonstration counties: Alameda, Los Angeles, Orange, San Diego, San Mateo, Riverside, San Bernardino, and Santa Clara, in which approximately 65% of IHSS recipients reside.

As part of the CCI, budget trailer bill language (SB 1036, Chapter 45, Statutes of 2012) shifted collective bargaining responsibilities in the demonstration counties from the county level to the new Statewide Authority. The CCI also created an IHSS MOE funding requirement for counties which replaced the previously existing county share of non-federal funding for IHSS. Under the demonstration project, the shift to the Statewide Authority is set to occur in each county once enrollment into managed care pursuant to the CCI has been completed in that county. According to the Department of Health Care Services (DHCS), this shift was scheduled to have occurred in April 2014. However, due to the unprecedented and complex nature of the CCI, it has experienced numerous implementation delays. Enrollment of the recipients into the CCI in six of the eight pilot counties will now be completed by July 2015. Enrollment has not yet begun in Orange County, and Alameda County withdrew from the CCI demonstration project in 2014.

According to the author, in 2012, the Administration intended for the CCI to become operative in all 58 counties by 2015. However, there is no plan to transition collective bargaining responsibilities to the state level in any of the remaining 51 counties.

3. In-Home Supportive Services (IHSS). The IHSS program is a Medi-Cal benefit, which provides services that enable the recipient to remain in his or her home. The IHSS program provides personal care and domestic services to approximately 420,000 qualified, low-income individuals who are aged, blind, or disabled.

County social workers determine IHSS eligibility and perform case management after conducting a standardized in-home assessment of an individual’s ability to perform activities of daily living. Based on authorized hours and services, IHSS recipients are responsible for hiring, firing, and directing their IHSS provider(s). In the majority of cases, recipients choose a relative to provide care. IHSS is funded with federal, state, and county resources, and prior to implementation of the CCI demonstration project, (July 1, 2012) county public authorities or nonprofit consortia were designated as “employers of record” for collective bargaining purposes, while the state administered payroll and benefits.

4. Prior legislation.

1. AB 485 (Gomez), 2014, was nearly identical to this bill. AB 485 died on the Assembly Floor, concurrence pending.

2. SB 94 (Senate Budget and Fiscal Review Committee), Chapter 37, Statutes of 2013: Enacted changes to existing law regarding the CCI and de-linked CCI components to allow the mandatory enrollment of Medi-Cal and Medicare beneficiaries (dual eligibles) into Medi-Cal managed care, the integration of long-term services and supports into managed care plans, and the commencement of the IHSS Statewide Authority, to proceed separately from the CCI Duals Demonstration Project.

3. SB 1036 (Senate Budget and Fiscal Review Committee), Chapter 45, Statutes of 2012: was the Human Services budget trailer bill that contained the necessary statutory changes to implement the human services provisions related to the integration of home and community based and long-term care services, including IHSS, into Medi-Cal managed care.

4. SB 1008 (Senate Budget and Fiscal Review Committee), Chapter 33, Statutes of 2012: Implements the Duals Demonstration Pilot Projects, including integration of long-term services and supports.

5. SB 208 (Steinberg), Chapter 714, Statutes of 2010: Implemented several changes to the Medi-Cal Program as proposed in the state’s application to renew the state’s Section 1115 Medicaid Waiver. Also gave DHCS the authority to establish the dual eligible beneficiary demonstration project to give those eligible for Medicare and Medi-Cal a continuum of services and maximize coordination of benefits.

Analysis Prepared by: Jennifer Swenson / APPR. / (916) 319-2081

Date of Hearing: March 24, 2015

ASSEMBLY COMMITTEE ON HUMAN SERVICES

Chu, Chair

ABPCA Bill Id:AB 211

Author:(Gomez) – As Introduced Ver:February 2, 2015

SUBJECT:

In-Home Supportive Services

SUMMARY:

Disconnects implementation of the Statewide Authority for collective bargaining within the In-Home Support Services (IHSS) program from the state's Coordinated Care Initiative (CCI) and implements it separately, beginning January 1, 2016.

Specifically, this bill:

1. Requires the In-Home Supportive Services Statewide Authority to assume collective bargaining responsibility for IHSS providers in all 58 counties, beginning January 1, 2016.

2. Deletes the requirement that the statewide collective bargaining activities of the Statewide Authority are conditioned upon implementation of the CCI and therefore subject to the timeline and other restrictions within the CCI demonstration project.

3. Deletes the authority of the Director of Finance to terminate the Statewide Authority or the collective bargaining responsibilities of the Statewide Authority if the CCI demonstration project is terminated due to not generating anticipated General Fund savings.

4. Makes permanent the IHSS maintenance of effort (MOE) requirement for all counties in lieu of their share of non-federal costs, as well as the inclusion of a county's IHSS MOE when calculating that county's share of cost for negotiated wage and benefit increases.

EXISTING LAW:

1. Establishes the IHSS program as a benefit available to Medi-Cal beneficiaries that provides in-home care and supportive services to low-income aged, blind, or disabled persons who are unable to provide or care for themselves and who cannot live safely in their homes without assistance. Defines supportive services within the program to include domestic services, personal care services, protective supervision, paramedical services, and other services, as specified. (WIC 12300 et seq.)

2. Establishes the Coordinated Care Initiative demonstration project in up to eight counties, subject to federal approval, to better serve the state’s low-income seniors and persons with disabilities by integrating the delivery of medical, behavioral, and long-term care services. (SB 1008 (Chapter 33, Statutes of 2012) and SB 1036 (Chapter 45, Statutes of 2012))

3. Requires, as an additional component of the CCI, that all Medi-Cal long-term services and supports, which include IHSS, be services that are covered under managed care health plan contracts and be available only through managed care health plans to beneficiaries residing in counties participating in the CCI demonstration project, with specified exceptions. (WIC 14186 et seq.)

4. Establishes the IHSS Statewide Authority as a joint powers authority, as specified, that is required to be the entity authorized to meet and confer regarding wages and benefits with recognized employee organizations for IHSS providers commencing after the “county implementation date” within the CCI, which occurs when a county that is one of the CCI demonstration counties is notified by the Director of the Department of Health Care Services (DHCS) that the enrollment of eligible Medi-Cal beneficiaries, as specified, has been completed in that county. (GOV 6531.5, WIC 12300.5)

5. Requires, beginning July 1, 2012, all counties to have a County IHSS MOE, as specified, which the counties pay in lieu of paying the non-federal share of IHSS costs, as specified. Also requires the MOE to be paid in lieu of a county’s share of the costs of negotiated wage and benefit increases. Makes these MOE provisions inoperative, and reverts counties back to the otherwise specified share of cost, if the CCI becomes inoperative. (WIC 12306.15)

FISCAL EFFECT:

Unknown

COMMENTS:

In-Home Supportive Services (IHSS): The IHSS program provides personal care and domestic services to approximately 420,000 qualified, low-income individuals who are aged, blind, or disabled. Through the IHSS program, recipients are cared for and assisted with activities of daily living, allowing them to remain safely in their own homes and avoid institutionalization. IHSS services include: Paramedical services, such as giving medications and changing a colostomy bag; Non-Medical Personal Care services, such as toileting, dressing, and transportation; Domestic services, such as housework, shopping for groceries and meal preparation; and, Protective supervision for those who, due to cognitive decline or dementia, cannot be left alone for extended periods.

County social workers determine eligibility for IHSS and the authorized hours of care after conducting a standardized in-home assessment, and periodic reassessments, of an individual's ability to perform specified activities of daily living. Once eligible, recipients are responsible for hiring, firing, directing and supervising their own IHSS provider or providers. Prior to receiving payment for services, providers must submit to a criminal background check and a provider orientation. IHSS is funded with federal, state, and county resources, and prior to implementation of the CCI demonstration project, county public authorities or nonprofit consortia were designated as “employers of record” for collective bargaining purposes on a statewide basis, while the state administered payroll and benefits.

Coordinated Care Initiative (CCI): The Budget Act of 2012 enacted the CCI, also referred to as Cal MediConnect, a framework for integrating delivery of medical, behavioral and long-term care services through a single health plan for persons eligible for both Medicare and Medi-Cal. The CCI was originally limited to the following eight demonstration counties: Alameda, Los Angeles, Orange, San Diego, San Mateo, Riverside, San Bernardino, and Santa Clara, in which approximately 65% of IHSS recipients reside. Alameda County withdrew from the CCI demonstration in 2014.

As part of the CCI, collective bargaining responsibilities shifted, in the demonstration counties, from local county public authorities or non-profit consortia to the new Statewide Authority, which is composed of specified members and an advisory committee. The CCI also created an IHSS MOE funding requirement for counties, which replaced the previously existing county share of non-federal funding for IHSS. Under the demonstration project, the shift to the Statewide Authority is set to occur in each county once enrollment into managed care pursuant to the CCI has been completed in that county. According to the Department of Health Care Services (DHCS), this shift was scheduled to have occurred in April 2014.

Need for the bill: While the statute creating the CCI anticipated a fairly seamless roll-out within the eight demonstration counties, delays have resulted in enrollment still being underway for five counties, with San Mateo being the only county that has already completed enrollment and transitioned to collective bargaining under the Statewide Authority. According to the author, this bill is necessary to shift to statewide collective bargaining for all IHSS providers despite delays in the implementation of the CCI and despite the lack of a plan to transition collective bargaining to the state level in the remaining 51 counties not included in the CCI.

PRIOR LEGISLATION:

AB 485 (Gomez), 2014, was nearly identical to this bill. It failed to meet the legislative calendar deadline for passage.

SB 94 (Senate Budget and Fiscal Review Committee), Chapter 37, Statutes of 2013, enacted changes to existing law regarding the CCI and de-linked CCI components to allow the mandatory enrollment of Medi-Cal and Medicare beneficiaries (dual eligibles) into Medi-Cal managed care, the integration of long-term services and supports into managed care plans, and the commencement of the IHSS Statewide Authority, to proceed separately from the CCI Duals Demonstration Project.

SB 1036 (Senate Budget and Fiscal Review Committee), Chapter 45, Statutes of 2012, was the Human Services budget trailer bill that contained the necessary statutory changes to implement the human services provisions related to the integration of home and community based and long-term care services, including IHSS, into Medi-Cal managed care under the CCI.

SB 1008 (Senate Budget and Fiscal Review Committee), Chapter 33, Statutes of 2012, implemented the Duals Demonstration Pilot Project, including integration of long-term services and supports.

REGISTERED SUPPORT / OPPOSITION:

Support

UDW/AFSCME Local 3930, co-sponsors

American Federation of State, County and Municipal Employees (AFSCME), AFL-CIO

California Labor Federation

Opposition

None on file.

Analysis Prepared by:

Myesha Jackson/HUM. S./(916) 319-2089