Assembly Budget Subcommittee No. 1 on Health

Good afternoon, everyone. This is a joint informational hearing between assembly budget subcommittee number two on human services and assembly budget committee number one on the topics of federal and state changes for aging Californians. The first four issues are part of the joint hearing, and I welcome my dear friend, chair chairperson Addis, and all of the members who have or will be joining us, today.

At this time of great risk and with so many lives, in our hands, I am grateful, to be here in partnership with, assembly member Addis, whose leadership and commitment in the health space, is something that we all value here, in the legislature. Today, we turn to our attention to the needs of our seniors.

As many of you may know, California is home to nearly 6,000,000 older adults, those aged 65 and older, representing approximately 17% of our state's population. Projections indicate that this number will grow to 9,000,000 by 2040, accounting for roughly 22% of Californians. Whether addressing federal policy changes impacting this community or the housing insecurity that many older adults face, there is no doubt that we must do better. As this population continues to grow, so much so must our commitment to serving them.

I have said many times, that society is often judged by two critical factors, how we treat and support our children and then how we treat and support our seniors, our elders who we must continue to value, in our society.

So I look forward to having the conversations that we've agendized for today's today regarding adult programs administered by the Department of Social Services, Medi Cal, and other programs administered, by the Department of Health Care Services under California Department on Aging. So with that, it is my honor to be able, to hand it over to assembly member Addis for her opening remarks.

Well, thank you so much, Chair Jackson. It's a pleasure to be back with you. I know last year, we did a a joint, subcommittee hearing between the subcommittees one and two on a similar on the same population, elderly people and what they were facing in terms of need for services. And I think the conversation is even more acute in the face of HR 1 being enacted.

And I certainly appreciate your leadership on food access, nutrition access, and all of the other topics that are specific to the, subcommittee number two.

I know in the health subcommittee, we've spent the last two months looking at the impact of HR 1. We really started talking about it as did as did, the chair here, last year in terms of thinking about what was gonna be coming towards us and trying to prepare ourselves and did everything we could in the budget to soften the blow.

And this year, we're finding that the rubber really is gonna hit the road in terms of the federal administration's attacks on our most vulnerable and particularly on the senior population who are the most vulnerable. And, chair, you mentioned the 22% of Californians that are 65 and above. I know on the Central Coast, our numbers are closer to 30%.

And in some parts of California, local numbers supersede statewide numbers. And I'll just add some figures to that. We know that the largest population of people falling into homelessness or being unhoused or age 50 and above. I was just with a group that came into my office yesterday that said they're seeing more and more families who are trying to qualify for various assistance.

And added to the family is a senior who is struggling to meet basic needs and is struggling to access what we need, what they need.

And we couple that with a age of the workforce that is relatively stagnant. We're not seeing changes in the age of the workforce, but we do have lower birth rates in California and across our nation. And so the population of people that's gonna be coming into the workforce is shrinking, meaning we have less people that are gonna be able to care for our elderly population at the same time that the federal government is cutting programs and cutting funds for those programs.

So in my opinion, it's a very, very dire situation, and I'm pleased to be here, as our subcommittees really cross over in many ways. So I wanna thank you, chair Jackson, for the opportunity to examine the governor's proposed changes to the in home support services and to other issues that we're gonna be talking about today.

Now we have four different issues that we're gonna talk about in our joint hearing. And then and then you get the honor of leading the rest of the items on the agenda after that, but really appreciate all of the public that is here. I know this is, near and dear to many people, and I'm optimistic that we can make movement and that the governor will come back in the May revise, with services and supports for our seniors.

Thank you, assembly member, for that. So we're gonna start with listening to the panel speakers for the issues on the agenda, and then we'll take public comment after all of the panels have concluded. Each person providing public comment will have one minute each to make remarks. And when we start public comment, we will start off with those who are utilizing wheelchairs to ensure, that their access is not impeded. There will be no votes taken in today's hearing.

So I'm gonna ask for the first panel to come forward and take your seats at the witness table. Please remember that you have three minutes each with an audible beep to remind you, and it is an aggressive and angry beep to remind you when your time is reached. Please introduce yourself before you speak, and, we will take everyone in the order listed on the agenda. And, as always, director Troyer, you may begin when you are ready.

Thank you so much, mister chair. It's good to be here with you and members and staff. My name is Jennifer Troia, and I serve as the director of the California Department of Social Services. I'm happy to be here with you today to speak about the way that ways that CDSS supports older adults as you've already referenced one of the fastest growing populations in our state.

To meet the needs of this growing population, CDSS administers programs that help older adults meet their basic needs and remain safe and independent in their homes and communities.

This includes the CalFresh nutrition program, in home supportive services, and SSI/SSP, as well as adult protective services and our licensing programs, which protect older adults from abuse, neglect, and exploitation. As your agenda highlights, HR 1 introduces major changes for federal funding and eligibility rules for CalFresh in particular. These changes will affect millions of Californians who rely on food assistance, including many vulnerable older adults.

One of the most significant changes involves the CalFresh time limit rules and the related work and community engagement requirements for individuals classified as able-bodied adults without dependents. HR 1 expands, in particular, the age range up to age 64 for individuals who are now subject to those work requirements and time limits and removes exemptions for people experiencing homelessness and veterans, among others.

Statewide, we estimate that 950,000 adults have uncertain exemption status or may and may newly become subject to the time limit, including as many 655,000 individuals who may lose benefits. Among them, adults ages 55 to 64 who make up just 10% of the CalFresh caseload represent 31% of those projected to be subject to the time limit. As we move toward implementation, we've emphasized that we're guided by three core commitments. First, mitigating harm and helping people retain benefits whenever possible. Second, making data driven and evidence based decisions.

And third, ensuring transparency and engagement. It's also important to note that the impacts of HR 1 on Medi Cal may have a significant impact on recipients of IHSS as the IHSS program is provided as a benefit of Medi Cal. Housing is also a critical part of the safety net for older Californians. Our homeless population is aging with older adults now as we've recognized the fastest growing age group among individuals experiencing homelessness.

CDSS administers three programs that serve older independent adults at this intersection of homelessness and social services, the Home Safe program, the housing and disability advocacy program, and the community care expansion program.

These programs have demonstrated strong outcomes to help older adults access and retain stable housing. In closing, CDSS is deeply committed to serving older adults across California with high quality person centered services. We look forward to continuing our work with all of you and with all of our partners to address the challenges facing older adults, particularly in light of these federal changes and to strengthening the supports they rely on.

Good afternoon, chairs. Michelle Baass, director of the Department of Health Care Services. I'm gonna speak to you today a little bit about the major provisions of HR 1, related to Medi Cal. HR 1, enacted 07/04/2025, mandates new eligibility and enrollment requirements for the Medicaid programs nationwide. California must comply with these requirements, which include community and work engagement requirements and semiannual reporting for certain adults.

These requirements are significant and will have devastating impacts to the Medi Cal program. Under HR 1, work and community engagement requirements, requires adults ages 19 through 64, what referred to as the Affordable Care Act optional expansion adult group, to demonstrate work participation or if they qualify an exemption to, be exempt from these requirements. It's estimated to lead to 233,000 Medi Cal members losing coverage in the budget year, rising to 1,400,000 in 2028. Six month eligibility checks, under current, law today, we redetermine eligibility once a year.

But under HR 1, that is twice per year for that ACA optional expansion group.

We estimate that will lead to 289,000 Medi Cal members losing coverage in the budget year growing to about 400,000 members, in full implementation. These HR 1 provisions, apply to a subset of Medi Cal members who are adults ages 19 through 65, and adults ages 65 and older are not subject to these requirements. The types of members that are most likely impacted by these provisions are 16 through 64, again, all noted as the ACA optional expansion group.

The department released our HR 1 implementation plan January 29, which outlines our strategy for implementing the program updates, required under HR 1. We are a leader in releasing such a plan.

No other state has done this. We used our experience during the public health unwinding redetermination process to really provide a kind of a one place to go for our stakeholders to find information about how the department, our counties, our plans are implementing various provisions. The budget funds health enrollment navigators and community based outreach, to mitigate some of the coverage losses. We have a proposed, up to $4,000,000 for clinic navigators, proposal for 17,500,000.0 for outreach engagement campaign.

We acknowledge that the governor's budget does not include funding for our county welfare departments to implement these new provisions, but have been working closely with counties and CWDA on on these, resources. With that, we'll close and happy to answer questions.

Good afternoon, chairs, members. I'm Susan DeMarois, director of the California Department of Aging. I was asked to talk about the master plan for aging. Is this good time to proceed with that? Alright.

The master plan for aging is a whole of government, all of society approach to meeting the diverse needs of older adults, people with disabilities, and family caregivers. Morning from directors boss and Troya, and I want to commend you for combining these hearings, proves to us that, it's not one program, one benefit, or one department that allows these priority populations to live with dignity, independence, and choice. It's all of us linking arms together at the intersections to mitigate against the most egregious cuts.

Under the leadership of secretary Kim Johnson, California Health and Human Services Agency secretary, Our departments at CalHHS currently have dozens of active master plan for aging initiatives underway, and well over 100 CalHHS agency initiatives have been completed in the five years since the master plan for aging was initiated.

Today, all CalHHS agency departments, as well as our strong partner agencies, housing, labor, transportation, contribute substantively to the master plan for aging, as together we advance the five bold goals that stand today and are more relevant than ever.

Housing for all ages and stages, health reimagined, inclusion and equity, not isolation, caregiving that works, and affording aging. Despite the devastating impacts of HR 1 and continued federal threats to our most vulnerable vulnerable communities, we continue to uphold California values in alignment with the master plan for aging, and we're grateful that we have this guide to lead us through these times.

Good afternoon, chair Jackson, chair Addis, Assemblymember Solache. I'm Yasmin Peled with Justice in Aging. We are a legal advocacy organization focused on strengthening the rights of low income older adults. To say that HR 1 Fwill merely bring new challenges for older adults who are already struggling is a gross understatement. As you've already heard, our state is aging and rapidly.

Many people think that growing older means a retirement with unlimited beach vacations, but many older adults in California face a older adults in California face a very different reality. Older adults have the highest poverty rate of any age group in the state. That's 21%, and it rises every single year. Older adults, as a chair Addis mentioned, are also the fastest growing group of people experiencing homelessness in the state as well as those leaving incarceration.

Additionally, millions of older adults struggle with the unaffordable cost of long term care.

And finally, one in five suicide deaths in California are those who are 65 and older. Given this reality and that HR 1 will result in billions of dollars being cut from the safety net, which many older adults rely on, we are at a critical juncture.

As already mentioned, HR 1's work requirements for CalFresh and Medi Cal, as well as more frequent eligibility checks, will apply to older adults who are not yet 65, who are more likely to have chronic conditions that prevent them from working and the least position to meet the administrative burden of complying with the reporting requirements. These same requirements will also impact caregivers who many older adults rely on for their care and well-being.

When caregivers lose their health care, their ability to care for their loved ones becomes much more difficult.

HR 1 also made harsh eligibility cuts to Medicare for certain categories of lawfully present immigrants. Many older immigrants who have been paying Medicare taxes for years are going to be kicked off the program or will no longer be eligible for the program. And in absence of the state covering income eligible immigrants under state only full scope medical, these older adults will have no options for health care coverage. The more existential threat to older adults, which h r one amplifies, is the significant state budget deficit.

We know from previous deficits, the programs that older adults rely on are often the first on the list for cuts.

For instance, home and community based services programs like IHSS and income security programs like SSP. HCBS programs specifically are categorized as optional, but they are not optional in the real lives of older adults who rely on them. They are the difference between living at home or being institutionalized or homeless. We recognize that the structural budget deficit is a major challenge, but we are up against the clock. The administration and legislature have long recognized this demographic shift, and it should be no surprise where we are today.

Older adults are a unique population with specific needs that require a targeted approach. We cannot cut our way out of the demographic shift. We know, for instance, that HCBS actually saves the state money. And so thank you for this opportunity, and happy to answer questions at any time. Thank you.

Thank you, chair, chairs and members. Andrew Cheyne, he, him, on behalf of the County Welfare Directors Association. Thank you for committing this joint hearing to spotlight the grave consequences on of HR 1 for older adults that really threatens the progress we've made since the New Deal when we came together as a society to stop elders from living in adduct poverty.

HR 1 exacerbates the challenges with an agent in California, which highlights urgency to release the 20,000,000 for counties to begin implementing the CalFresh changes coming June 1 and investing 373,000,000 general fund in this budget year to county workers to help save both Medi Cal and CalFresh for older adults and other vulnerable Californians at risk of a combined hunger health care crisis. You have in front of you the story of just one person.

These, requirements are unfortunately in place in other states, so I encourage you to read the story of Joseph Myers, who at 58 in this age bracket we're talking about, had to quit his job, milking cows as a farmhand because of the physical toll on his body. He says that was the most painful job I ever had. I got pains in my knees. They hurt when you get down and put the milkers on or even to stand here all day like this.

I'm only getting ten to twelve hours of work, not anywhere close to the eighty hours I need.

In April, when the CalFresh time limit comes up, I'm gonna be off everything. It's gonna be really suffering. Older adults also face the greatest challenge to reenter the workforce. So when these when these policies come into place, we know that 44 percent of workers aged 55 to 64 have been unemployed for fifteen weeks or longer. That's longer than the three months of food assistance and threatens medical, work requirements, for many.

Worker driven human assistance is critical for older adults to maintain their benefits. Older adults may not qualify for disability exemption, making eligibility worker review for the medical frailty on the medical side or CalFresh on fitness, vital for benefit retention. We know that many of the older adults who are experiencing homelessness also lack a digital footprint and may be outside of the automatic data system work that we have applied the state for pursuing.

And due to technological and digital inequities, older adults may also face barriers overcoming the administrative and technological

hurdles to reporting exemption verifications or documenting work hours. Reporting exemption verifications or documenting work hours, again, heightening the importance of human connection and worker support for benefit retention. Just a few points on the scope of impact in California. For Medi Cal, AARP estimates that 28% of Medi Cal expansion adults in California are fifty to 64. Director Troy also spoke to the disproportionate numbers of of older adults for the CalFresh time limit.

For IHSS, HR 1 also threatens the ability of older adults to age at home while exacerbating costs such as for increased skilled nursing facility usage because there are 42,419 Californians currently eligible for IHSS through the ACA expansion. And as the LAO noted, HR 1 coupled with the proposal to automate termination of IHSS concurrent with Medi Cal will create significant disruption of care. As your agenda notes, the stakes couldn't be higher.

The Center for American Progress notes that potentially four thousand preventable deaths, specifically older adults and families with children, could happen in California just due to the the CalFresh time limit. Investing in the eligibility workforce is our proven upstream solution to prevent the worst from HR 1 .

Thank you. You gotta hear the beef.

We got a we got a pro in the house.

That's very impressive.

Y'all better take note. The bar has been set. LAO.

Good afternoon. Karina Hendren, LAO. We have two sets of comments. The first is on the HR 1changes affecting older adults in Medicaid, and then the second set of comments is about the county administration. So first on the Medicaid changes.

For these comments on Medi Cal, we note that federal Medicaid law defines common eligibility pathways according to certain age groups. So individuals aged 19 to 64 are generally considered adults for the purposes of Medicaid eligibility. And as director Boss noted, this is the ACA optional expansion group, whereas individuals age 65 and older are generally qualified under separate eligibility groups. And so we structure our comments to align with these age ranges that are defined for Medicaid.

As director Boss noted, most of the Medicaid changes enacted in HR 1 focus on childless adult enrollees age 19 to 64, again, the ACA optional expansion group.

As a result, most of these changes do not directly apply to Californians age 65 and older. For example, Medi Cal enrollees age 65 and older are exempt from the community engagement requirements as well as the six month redeterminations, and those begin in January 2027. And then enrollees age 65 and older are also exempt from the, new requirement for co payments, which is gonna go into effect in 2028.

Additionally, enrollees aged 65 and older are exempt from HR 1 reduction of the federal matching rate for emergency services provided to adults with unsatisfactory immigration status. But that being said, there are a few Medicaid policies in HR 1 that do directly affect enrollees age 65 and older.

First, HR 1 creates a new home equity limit for long term care recipients. Starting in January 2028, HR 1 requires seniors who qualify for Medicaid under certain rules and who use long term care to prove that their home equity is no greater than 1,000,000 in order to remain eligible. This amount will not be adjusted for inflation over time. California has historically not counted Medi-Cal enrollees' primary residence when verifying their assets, but HR 1 removes the state's ability to exercise this option.

Currently, the estimated number of Medi Cal enrollees age 65 and older whose home equity value exceeds $1,000,000 is uncertain.

A second effect is that HR 1 narrows the definition of which immigrant groups are considered to have satisfactory immigration status, and this applies regardless of the enrollee's age. The new rules exclude some populations who were previously deemed to have satisfactory immigration status, including refugees and asylum grantees. These groups will now effectively be considered to have unsatisfactory immigration status under HR 1, meaning that most of the Medicaid services provided to them will no longer qualify for federal matching funds except for limited scope emergency services.

The administration has estimated that this change will affect about 200,000 medical enrollees. But at this time, we're not sure how many of those 200,000 are age 65 and older or who fall into those other eligibility groups for older adults.

And finally, as justice in aging noted, aside from the Medicaid changes, h r one also affects Medicare eligibility due to its narrow definition of satisfactory immigration status. So under h r one, Medicare coverage terminated as of January 2027. And then aside from these direct effects, we also wanted to note some potential indirect effects. As justice in aging noted, caregivers are an important part of this conversation. It's possible that caregiving for aging adults could be disrupted if caregivers lose their medical coverage due to HR 1 policies.

And to reduce this risk, it will be important for the administration to implement HR 1 in a way that maximizes the use of allowable exemptions. One prominent example is that HR 1 requires states to exempt individuals who are a caregiver of an individual disability from the community engagement requirements. And so the legislature could consider asking the administration what steps it's taking to exempt these caregivers from the new requirements under HR 1.

Moving on to county administration, we note that supporting county administration through HR 1 is a key fiscal priority. The administration's focus on leveraging existing data to identify exemptions or verify compliance with the new requirements is an approach that makes sense.

This approach will reduce administrative burden on beneficiaries as well as counties, and it will also reduce the risk that individuals are disenrolled due to administrative burden. As the legislature weighs its priorities in the constrained fiscal environment, it could consider providing additional funding for CalFresh administration to allow for more time to be spent working with enrollees and further limit disenrollment. If additional funding is provided, we recommend that the augmentation be temporary until the level of ongoing workload related to HR 1 is better understood.

And finally, for medical administration in the counties, as DHCS noted, the department has been working with counties to better understand their workload impacts. The administration plans to submit a proposal that may revise, and we note it will be important for the legislature to assess whether the forthcoming May revision proposal aligns with its priorities for HR 1 implementation.

Good after good afternoon. Thomas Locke, the Department of Finance. Nothing for it to add at this time. Thank you, very much.

We will now move to, member questions, and, we'll start off with, Assemblymember Addis.

Thank you so much, chair. And I wanna also welcome a member of the health budget subcommittee number one, Assemblymember Solace. And thank you for coming to the joint hearing. I actually have five questions, but across all of you. The first one is just building on what the LAO just suggested we ask on caregiver exemption, if there's anyone from the administration that could adjust that?

Good afternoon, chair Addis. Thank you for your question. Yingjia Huang with the Department of Health Care Services. So we have have done some pretty extensive data analysis on the caregiver exemption in relation to the Medi Cal community engagement requirements. We have existing data from the Medi Cal application that we will be using.

And secondarily, we also have, information that allows us through the application to figure out if the individual that is, the head of household, for example, caregiving for a member in the family, to kind of infer relationships amongst the family members. So we actually do have this information and is actually working to refresh the data based upon that additional analysis since the release of the governor's budget.

And if if I might add for the Department of Social Services, in addition to data like that, we are also, looking at whether or not we can utilize information in our case management information and pay rolling system for the in home supportive services program, which would provide us both information about the recipients of in home supportive services who have a disability and qualify for exemptions, as well as the caregivers, the providers who are caring for them, who would qualify as someone who is providing care for an individual with a disability.

We've not yet worked through all the questions about data access and privacy and all the things that we need to work out to make sure that we are able to use that data in that way, but it is something we are actively exploring. And as with all of these data sources, we are working in close partnership across the departments to make sure that something that is known to one will be used to the other to the maximum extent possible as well.

And the the idea on this would be to make work requirement, community requirement smoother.

Yes. Right?

Okay.

Well, individuals will qualify for an exemption.

To exempt. To be able to exempt. And then so given that you're not really sure all the, pieces of it, what's your timeline for being able to have something?

So many of the data sources we do already have and are actively using. So to the extent that for both departments, we have identified populations where we're saying we can already identify that they are exempt, and we will not be screening them for compliance with the requirements. That exists already. What I was talking about is an exploration we're doing to see if we can add to that population with this additional data source.

We're working as quickly as we can on that to try to come to a conclusion as fast as we can.

And I will say for the Medi Cal Estimated Governor's budget, I ran through the numbers of the potential impact. At May revisions, we will have updated numbers based on some of the new analysis that we've done, particularly related to the medically frail exemption. So at May Revision, we should have some updated numbers.

Okay. An updated I I guess my question is trying to get at we know these requirements are coming. If people should be exempted, we wanna make sure they are exempted before this avalanche hits. We wanna make sure whatever you're working on, you're working on it within a a timeline that's gonna match up so people don't end up losing coverage if they could have been exempted.

Right. And some of those rules will have to happen right before kind of they're up for redetermination or up for so, you know, the numbers will come out with May revise at it will be at kind of point in time, but then we will continually to run the kind of the actual determination upon their application or upon their redetermination. So kind of different different points in time depending on on the processing.

Okay. Okay. Thank you. And then my second question is, I think it was I don't know if it was LAO, talked about a million in, home equity, if you could repeat whoever said that about the if you have a million dollars in home equity.

Yes. So this is, Medicaid eligibility for older adults who qualify under certain programs and who receive long term care, they would have to verify their assets and show that their home equity value does not exceed $1,000,000 in order to retain Medicaid eligibility.

And this is HR 1 or this is part of the asset test that It's HR 1. This is HR 1. And there's and you said there's nothing we can do at the state level. Was that what you said? There's nothing we can do at the state level.

Correct. I just see this hitting a lot of my constituents pretty hard. I'll just have to say all of Coastal California, it's hard to find a house that has less than 1,000,000 in equity, and a lot of people would look at those folks and say they're very, very wealthy. But the truth is they're that that's just sort of house cost and they've lived in these houses for years by the time they're 65 years old.

And many many other parts of California maybe have this situation, but certainly, Coastal California does.

But I'm hearing you say there's literally nothing the state can do.

That is our understanding under HR 1. So under but prior to HR 1, DHCS did not consider a person's primary residence as part of their asset verification, but now HR 1is imposing in a re requirement for all states to have this sort of asset limit for this specific population.

Okay. And and my my third question was on the navigators, and I know we've talked about this in a couple different hearings. The 17,000,000 and the 4,000,000 are I think those are about the figures. And just how you're approaching the elderly population. I know you had a very robust outreach plan, and there was a lot of digital media and many components to that plan.

But how you're approaching the, you know, the elderly population. I don't wanna make the assumption they're not as good with social media, but some people might make that assumption. And so what your approach there is?

So some initial thought process. You know, we had a very similar, kind of issue during the redeterminations campaign just because that was, like, a statewide everybody needs, to be redetermined. So a thought is we will be looking at based on, like, the demographic spread using census data, and we understand certain communities prefer certain, like, print media, for example, and radio.

So depending on the analysis, because the idea is we would wanna invest in a a vendor who knows this how to run this strategy very well to kind of do this analysis for us. And depending on, kind of the the results of the analysis, we will, decide on the investment on print, radio, or, like, also, like, a media toolkit that we actually also, created, for seniors during the redeterminations campaign when we hope when we're hoping to kind of leverage very similar strategies.

Yeah. But that's the thought process in terms of making sure that we're including thought, and, into kind of all the various demographics.

And I'm assuming that I think, maybe justice in aging mentioned the figure of 22% will be 65 and above. I know the chair said it. I add similar figures. Are you do you have demographic breakdown on that? Race, gender, gender identity, LGBT?

Not necessarily right now with you, but in general, do you have that data? And the reason I'm asking the question is if we're doing a communications plan around this I think it's important to have the demographic data of the 50 and above population that we say we're trying to reach, but really understanding who they are because I I do think there's some demographic trends within that age group.

Yes. Certainly. That data some of that data is available. I think director Damaris from the Department of Aging, there's a demographic tracker on the Department of Aging's website that has a lot of this information that's actually, I believe, age 60 and older, right, that it's tracked?

Right. 60 and above is the figure. Yeah.

So some of that data is existing is continually sort of updated as more you know, as time passes and there's more data. So that data does exist, and we can make sure you and your staff get information there.

And just that I I guess what I wanna get at is that the departments are sharing the information and that, I mean, the data we've seen says that, you know, the largest group of people falling into homelessness are 50 and above the, you know, 65 and above the population is twenty two percent of the population, but really most of them are women. And so as we're rolling out communications and as we're talking about needs, it's largely older women whose spouses have passed away.

They may live in these very, very expensive homes. They can no longer afford these homes. They begin to fall into homelessness, and this is the very group of people that's often overlooked.

Doesn't ask for help, isn't able to ask for help, sometimes does ask for help and is just completely ignored. And so I think it's important in this in this kind of outreach that we're thinking about those. And then we also have a large population of LGBT LGBT people, who we just talked about at a press conference with Equality California and then, LGBT caucus who are aging adults and don't always have the same family structure because they simply weren't allowed to.

And now we're gonna be facing, some of these very, very harsh cuts. So I just I just think we wanna be, cognizant of that.

And I guess my I think my last question is for county welfare directors, and it's probably the hardest question. But, yesterday, somebody said to me, why why don't why don't our institutions just go back to the way it was? So there was a time pre expansion when our hospitals and our care systems were sort of, you know, meeting needs. And then we had this expansion. We put money into the system.

Why can't we just go back to what we used to do?

Well, I think that's a really large question if we're looking at indigent care. And I would just point to the information that's been put up by the, California State Association of Counties that really shows the full impact to our public hospitals, to our indigent care systems. But what we've seen is that during the expansion, during the public health emergency unwinding, that it's been the county eligibility workers who've helped put folks on these cases, federal cases.

We've established a culture of eligibility in partnership with the state, And so there is a pathway to actually mitigate harm in this moment so that we don't have to entirely go back to the way it was before and and leverage as much remaining federal policy as possible to keep folks onto food assistance, keep folks onto health care, where we're still leveraging, for example, on the medic Medicaid side, 75% federal financial participation trying to draw in those dollars still where we can against h r one.

So I think, you know, there is absolute both end of needing to look at the way the system was before.

And as, you know, there is a need to triage, but, like, the our emphasis is to start upstream and keep folks on federal assistance wherever possible.

Thank you, and thank you, chair, for allowing so many questions from me.

I'm I'm here all day. Can you I want us to make sure that we really zero in on the type of population that we're trying to make sure we try to keep stable, and who are more the most at risk at being harmed by HR 1. Can you kinda give you know, what are the characteristics of these older adults that will make them more susceptible to being disconnected from Medi Cal or CalFresh or, I believe, Medicaid in terms of asset test. Right?

Can you is can you enlighten us on some of those characteristics?

So for the work and community engagement requirements, those apply to individuals age 19 through 64.

They do not some I'll just maybe go through some of the exemptions so you could get a a sense for of the 4,600,000 medical members who these requirements might apply to, we will be exempting based on if they have children 19, they are foster youth or a former foster youth, parents and other caretaker relatives, pregnant or postpartum, receiving Social Security income, entitled to Medicare part a and b, American Indians and Alaska Natives, parents and caretaker relatives of a dependent child, we mentioned that, and or a a disabled individual, veterans with certain disability status, medically frail, individuals meeting TANF requirements or exempt from the the CalFresh work reporting requirements, participating in a drug addiction or alcohol drug treatment program, Inmates of a public institution are really recently released.

There will also be exemptions. These are more temporary exemptions related to living in a county that has been declared a federal disaster or emergency, living in a county with high unemployment rate. Right now, 22 counties fall into that category, receiving inpatient or skilled nursing facilities for a certain acuity and certain stay or and traveling out of the the country to access medically necessary care.

So those are the the flavors of the exemptions.

Lord, have mercy. I almost it's almost like we're playing Clue. Like, which one? I mean, it seems to me I mean, obviously, we don't I don't think we have to worry about any someone 64 and pregnant. Right?

Hold on.

Unless okay. Anyway.

And then I would also highlight many individuals on Medi Cal are working today, and so they would meet the requirements in this space because they work or they have income above $580 a month, or they're participating in school or a volunteer

as well. So In terms of older adults, I mean, who who are you I'm trying to kinda figure out who's most likely. Like, what what does a person look like and their circumstances look like? Who's most likely going to suffer the most amount of harm?

I'll jump in a little bit here for CDSS. So in the CalFresh space, we actually, prior to HR 1 , had some exemptions, which were helpful to individuals who are older. So we we mentioned the change of the age for the work requirements from 54 to 64. So there are individuals

So now we're talking about those who are 60 to 64.

Fifth 55 to 64. Five to 64. There's a large group of individuals who are now subject to work in community engagement requirements who previously were not. We also had before exemptions for individuals who were experiencing homelessness and individuals who were veterans. And we no longer have those as outright exemptions. So this is a population or set of populations that we particularly worry about because while we have a similarly long list of potential exemptions on the CalFresh side, though there are differences.

Those many of the ones that are where we don't have data already available, it requires the individual to be screened.

So they need to come in more frequently. There's more paperwork involved. There's an interaction involved. And this is what we want to avoid is the idea that someone may qualify for an exemption or may be working but not complete the process. And so they are actually eligible, but they nonetheless lose benefits.

And that's what we most want to avoid. So we have an exemption on the CalFresh side for individuals in the federal law. They've used the wording who are unfit to work. Many people experiencing homelessness may qualify under the criteria of being, quote, unfit to work, But it now needs to be an individualized determination of that, whereas before we were able to grant them that exemption from those ABOD criteria automatically because they were experiencing homelessness.

So that's an example of a population where I think we're particularly worried about the impacts trying to do everything you we can to make sure that people maintain benefits.

Chairman, may I just . Okay. Well, I hope that the example is illustrative of someone who's 58 in the age category that director Troia pointed to. Just to add on a little bit to what was already I already said well, there are national data that show that amongst folks who are working and accessing food assistance or on the food assistance side, some of the top industries include construction, food assistance, and actually home health care. So it's often the folks who have inconsistent hours.

They've had the kind of careers where they can't continue to work all the way until age 64, and they may have some kind of chronic condition that may or may not be in the system such that they are automatically exempt and need screening for unfitness for work or medical frailty.

So just add a a little additional on what was was in there.

Got it. And then depending on the category, we're also talking about who may have extra may have higher assets than others depending on what programs that they like, if you're receiving Medicaid and you might be in some cases, you're talking about they they might be working, but maybe not working as much as they the federal government is saying that they should be given their age, those type of things. Okay. Thank you for that.

Obviously, one of the things is because we're trying to figure out, you know, I've always tried to make sure that we come from a perspective of who's most likely to face instability during changes and requirements no matter whether they're state or federal.

And how do we keep people as stable as possible? And and given that, one of the main concerns has been, especially those who are gonna be facing work requirements, how do we make sure that we are preventing as many of those people who are who are trying to stay eligible?

And how do we keep people as stable as possible? And and given that, one of the main concerns has been, especially those who are gonna be facing work requirements, how do we make sure that we are preventing as many of those people who are who are trying to stay eligible?

Right? But as we know, things happen when you missed something in the mail, forgot to turn in something on time. And so how do we prevent a lot of those things from happening?

Obviously, we're talking about the federal and state threats. And a lot of times, we're we're talking a lot about county workload requests that are meant to stem the possible disenrollment of these folks. February 25, we had a hearing about a month ago, and I asked the administration and the counties to sit down and start trying to figure out, how we all can get on the same page on what is needed to mitigate the harms of these cuts.

Can you tell me so far what is the status of the progress, and has there been a meeting of the minds in terms of what is needed to properly administer all of the new requirements to give people the best chance to stay enrolled in the social safety net?

I'm happy to provide some updates and along with the county welfare department or directors association. So we have been meeting. We've been meeting fairly regularly, both in terms of the implementation of the HR one requirements more broadly. We have a county operations work group that is dedicated as well as an all partners work group that are very actively engaged in helping us with the implementation of the requirements.

In addition, we have funding that is included in the governor's budget that is proposed to support county implementation of those screenings for the ABOD population, for example.

The County Welfare Directors Association has provided an alternative proposal for the time that one of the biggest pieces where we, have differences in our approaches is the amount of time that it will take to screen individuals who do still require screening. The data has not identified them as exempt, and a county eligibility worker will need to do that work. So we have included an assumption in our budget of the amount of time that it will take.

The County Welfare Directors Association has indicated that they believe it will take longer. And those are the the sort of heart of the conversations that we are having.

I I can't say that we, at this time, have a proposal to change something in the governor's budget, but we are working to better understand the assumptions that each was working off of and to try to identify what feels like a fair assessment to make. To the LAO's point, I think it may also take time, of implementation for that to become clearer and for us to to really know the answer.

But to be prepared in the meantime, I, understand your question, and we are working closely together to make sure that we, as much as possible, understand the assumptions that each other are making and try to identify what seems to be reasonable.

They're saying oh, I'm sorry. Did you wanna

I would I would just affirming including, really productive engagement just last week. So the engagement is it continues, and, you know, there was real discussion around what

Was there coffee and donuts there? Were there snack? Like, what was you know?

Yes. And I and our our partners at Department of Finance were there. So there's you know, it was it was good discussion and it included and and, yeah, just pieces of my time, but also the populations that would be potentially be be subject. And so just to affirm affirm what was said, and we would thank the Department of Healthcare Services. There was recent engagement on that side as well.

More and more, I'm realizing there's a timeline difference between our budget process and when a lot of these requirements are gonna be kicking in and people are gonna be losing benefits. During our recess between September and January, I was I was urging us to try to think about some early action items that will help fill in that gap.

Is there a need for early action to be able to make sure that we're fully prepared because our budget timeline does not reflect the reality that will be happening on the ground? There will be more uncomfortable questions, by the way, after

say so I'll I'll start and say, we don't have a proposal for early action. As you have referenced before, we did have funding in the 2526 budget that was set aside as a contingency on the social services side for the counties, and that is in process in terms of releasing those funds. The Department of Finance is reviewing a request related to that, the release of those funds. We do also have, a lot of work underway in preparation.

And on our side, I wanna emphasize that while it does not negate those individuals who will be up for redetermination or newly applying between now and, the beginning of the budget year, it is also important to emphasize that the policies are taking effect and they for the renewals, occur at the time that the individual is being redetermined for eligibility on the CalFresh side.

So it will be phased in over the course of a year or more. So it is not the case that on April 1 for immigrants or on June 1 for individuals who are considered ABOD, that everyone is impacted immediately. And, again, I don't wanna not emphasize that there are individuals who will be impacted, but the full impact will take effect over the course of a year or more. So I do just wanna also sort of make that point.

I think what is really time sensitive is the need to both hire and and train. When the director for San Francisco testified before sub seven recently, Trent Roar emphasized that it's about nine months. And we know that our partners at SEIU have really emphasized the need for that robust training, not just for new workers, but for existing workers, right, who are now have to learn all these new rules on on both sides of the house.

So I think that's where, for us at least, a lot of the investment is needed. Even as they roll out for a year, there's also a significant lag between when resources are available and and when we have folks really able to help people.

Department of Finance, where are we on the 20,000,000 general fund that we've been urging for a quick release, and how much do you plan on actually releasing?

Good afternoon. Lourdes Morales with the Department of Finance. Yes. We sort of understand, the the legislature and and stakeholders to more broadly interest around the $20,000,000. You know, it's been a sort of continued subject of discussion at our various hearings, and so we are tracking that and are working to provide something for the legislature soon, but can't provide additional details beyond that at this point.

So you don't have a timeline in which you plan on conclude that we can get to work on this important work?

As noted by the Department of Social Services, there are sort of resources already available as proposed in in the budget to support some of this initial work and continue this discussion. But around sort of the 20,000,000 sort of specifically, we're working to provide something to the legislature soon, but I can't be more specific sort of beyond that. Just sort of acknowledging that we sort of understand that the the shared interest in the urgency.

When when we're talking about the disbursement of the $20,000,000, this we're we're also talking about specifically to make sure that we're gearing ready for the HR one workload. And so is the process you're going through right now, to ensure that we're releasing additional dollars specifically for the HR one increase in workload?

So the $20,000,000 is specifically associated with ABOD related county administration. As noted, we sort of had ongoing sort of conversations with counties around HR one sort of more broadly, and so that discussion will continue.

Okay. At some point, we need to wrap this up. And so, we really need to start drilling down, into, more specifics that you can provide the legislature, because it is our expectation, and our because one thing we wanted to make sure then that didn't happen is that we leave in September, and we did not do everything we can to prepare for when we came back while we're going through a new legislative session.

Luckily, in collaboration with the administration, we were able to identify the funds that would help to that transition process. But now we're at a logger a log jam now at this point.

So is the final process now with the Department of Finance, or are you still waiting for additional information?

We're working within the administration to put something before the legislature.

Now now you you shouldn't have to put it before the legislature. Right? I mean, we've already allocated the funds.

So

Are you just saying just to inform us what's gonna happen?

The requirement associated with that require notification to the JLBC, and so that's the sort of next step once it sort of completes the administration's process.

Oh, so it's a notice. Got it. Got it. Got it. Now we have 68 days until, June 1.

Do you believe that you are on a timeline and such that we're gonna make sure that we are ready to start to, be ready for, for June 1?

Yes. That's our intention to have something to use sort of very soon in advance of that June 1 implementation.

Okay. CWDA, talk to me about I mean, obviously, you wanted the funds yesterday. At what point do you start to get worried in terms of when do you need these funds by to making sure that you're doing everything you can to mitigate harm to these people?

Yeah. We we are at that point. Right? I think as you said, first, many counties, they that point has been been crossed. As I just stated, there is a lengthy time that is needed to both post positions, hire, and and do the training.

And so we have heard from our our our members that that level of concern that the the clock is really running. A lot of counties are looking for that signal from from the state to even be able to start those processes. So to have something noticed to the JLBC, to have something come out in public, to have the sense that this is forthcoming is critical.

Thank you for that. Obviously, I would like to make sure that you all keep us updated on the discussions happening in terms of HR one mitigation funding request. It

but I think I'm at the the point where I'm gonna start requesting, weekly updates. I I wanna make sure that we are letting everyone know that we're doing absolutely all that we can, to to help these folks. And so, I'm gonna be asking, DSS and Department of Finance to keep us updated on the request in terms of the release of the $20,000,000, but then also also keep us updated on the discussions in terms of the type of resources needed to properly administer all the requirements.

Second, I want to request an analysis from the administration by or before April 30 on what the projected program drop off for Medi Cal and CalFresh means for the senior community and what human and system impacts would likely result in California. Can the administration commit to providing this to the subcommittees by that deadline?

I think from the Medicaid perspective, we we have our numbers that we shared as part of what our projections are for the implementation of the work work reporting requirements and semiannual redetermination. I'm not sure what other information you are looking for to want wanna be responsive?

I I think it's really about making sure that we continue to because, obviously, some of them these numbers are gonna start changing as we start going through the process of really narrowing down who's what the potential impacts are, unless you've already finished all your analysis and you're We

won't have updated numbers that may revision. But between now and May revision, we won't have updated numbers.

Okay. I think what we wanna do is even once you have those numbers, it'll be great that you update us Sure. Our committees on that so that we because I mean, as you know, once May revision starts oh, boy. And we wanna make sure that we have the most up to date information as possible as we start to make the many decisions that we're going to have to make. Any additional questions from committee members? Assembly member?

I think I think I'll just reiterate the point. We've talked about this in the health sub one net. And I know our budget chair has talked about it as well that it's been very difficult past budget processes where, you know, we have the hearings and then all of a sudden we get a big surprise for May revise.

And so there's been a clear desire on the part of the legislature not going to not go into May revise with huge surprises to understand sort of where the administration's going, what kind of figures you're using, and to have a more open transparent collaborative approach as we get into May revise so that we can all be responsive to the people of California as opposed to a mad dash to the finish because May revise has been so opaque in the past.

So I know when we opened the year this year, the budget chair talked about that.

So I don't wanna speak for the chair, but I certainly know from my perspective, there's a real desire that we have more forthcoming information as we head into May revise so that we can all make good decisions on behalf of our 40,000,000 Californians. And I just wanna compliment my sub one. I have almost my entire sub one here. It's not a contest by any stretch of the imagination.

Oh, I'm

always conscious of that. Don't make me call for backup.

But thank you to someone for being here.

Whatever. Well, I I might just close comments prior right now. I think but do you have any questions? Okay. No problem. One of the things and the purposes of us doing the joint budget hearing is so that we can break silos amongst each other too.

And how do we make sure that we are looking at the same older Californian holistically. And so what we really wanna do is, in addition to the information you're already gonna be providing us with, we also wanna see what are what part of the population will be hit by both Medi Cal and CalFresh. You see what I'm saying? How many of our population we're talking about are gonna be actually hit by both?

And to do that, it requires, both DHCS and, CDSS to kind of work together on that.

Can you all provide us with that information? It was gonna call it's gonna cause you all have to break down silos to do so. But that's the reason why we're here because we were we wanna make sure we're seeing this in a holistic way as well.

I hope you heard from our earlier comments that we are working quite closely together and really trying to maximize the degree to which an exemption in one program can lead to an exemption in the other. The federal government didn't give us the kindness of having exactly the same rules between the two programs, but as much as possible, we are maximizing to say, if we have the data, you can have an exemption. If you have the data, we get the exemption.

So, ideally, we're minimizing the number of people who have either impact, including also the number of people who end up with both. So we certainly share that goal and and understand the the multiplying effect of the impacts on people who rely on us for not only health care, but in home supportive services, CalFresh, and a number of other programs for to meet their basic needs.

Would echo that. And just note that 92 percent of individuals on CalFresh are on Medi Cal. So we know that there is a significant overlap between our programs, and and kind of the impact of these changes.

If you can drill down on that number that will be impacted by both and get it to this committee, that'll be helpful. If that's harder to do, let us know that too. But, I mean, the idea is we're we're trying to get a full snapshot on on the populations that we need to to look out for. Let's see if I have anything else. Assembly member, Schiavo, would you like to have any additional questions or comments?

Thank you. I'm sure a lot of this has been covered, but I just wanted to add my voice to the concerns around cuts, obviously, and especially, you know, the burdens that are going to be put on counties that really don't have the capacity for it, especially counties that I mean, all counties really at this point are are having budget deficits in our state and certainly, smaller of our rural counties, especially don't have capacity, or cushions to be able to kind of take on a lot of the the responsibilities.

But I also, as chair of military and veteran affairs, just wanted to flag that, in a recent tour that we did of, of our, you know, military bases in the San Diego area, we heard about those serving and who are receiving CalFresh.

This is, you know it it's embarrassing as a country that that is the case, but it also means that it has to do with our military readiness and and, you know, all kinds of other issues that we know are are facing our country right now.

And so there's just so many ripple effects when it comes to CalFresh and and, you know, all of the the mechanisms that we can put in place to make sure that people are not disenrolled, that they're not disenrolled for, you know, for technical reasons who should be in the programs.

We just everything that we can do to make sure that we're bolstering those processes and those programs and supporting our counties. Thank you.

If we find that there are a large amount of older adults who are losing both CalFresh and health care, What can we do to help them? That's a double whammy. One of them could lead you into a state of crisis. Right? But to have both of them at the same time seems like a even special category.

And how do we mean in a good way to say that the state probably should find a way to step in? I mean, have we thought about the double whammy?

I mean, I can say from the consumer's perspective that this is a big concern for us that, while older adults, 65 and older, are exempt from a lot of the provisions of HR 1, there is this category of, you know, folks newly eligible for the staff work requirements, newly eligible for the medical work requirements that are older, 60, 62, 64, you know, and these are folks that often have chronic conditions.

They may not they could potentially meet medically frail eligibility, but the process of getting that eligibility determination, the process to be determined to have a permanent disability and to then be moved on to a different Medicaid program to maintain your eligibility.

These are difficult processes, and so we are very concerned that people are gonna that is gonna be a double whammy of people losing their Medi Cal and their CalFresh prior you know, in at this sort of more vulnerable stage, especially maybe folks are no longer working anymore. And I think what's what I'd like to lift up is really the importance that folks have access to legal services who can help them to navigate these processes.

Appreciate that the department, is working on, you know, their outreach campaigns and navigator campaigns.

But the legal services, network in California is incredible. These are, attorneys who have dedicated their lives to helping low income, adults, families, older adults to navigate these incredibly complex systems. And specifically, when it comes to health care, there's the health consumer alliance, which is a consortium of a number of legal aids across the state that provide free legal help to any Californian that is struggling with navigating their their health insurance process.

So whether that's getting enrolled into Medi Cal, their Medi Cal redetermination, issues with covered California. I know that's was covered in a different hearing for someone.

But, again, these are these are folks that are day in, day out working to get people their health care coverage, and it's gonna be more important than ever that with the implementation of HR 1 that our legal services partners are fully funded to have the resources they need to help people so they don't experience this double whammy or if they do experience it, that they get the help they need to get it resolved.

Because, again, like both director Bass and director Troy has said, there are a number of exemptions. But navigating how to get that exemption, if they're not automatically able to apply it to you, you as a consumer, you're not gonna know that you have the medically frail exemption for x y z. Right? You just are gonna get a notice in the mail that says you lost your Medi Cal, you lost your CalFresh, you lost your IHSS.

But wouldn't counties be doing that if we provide them with resources to

Sure. But if someone did fall through for you know, even if it was misapplied, then I think what you're talking about is the on the consumer side, then there's the need for additional support to navigate that.

And what existing program exists for that? Is there already a fund that fund source of funding that already provides that?

So legal services and the health consumer lines, for instance, do, you know, have ongoing funding, but it is not enough necessarily realistically to to absorb the brunt of what is gonna come. Yes. People can work with county eligibility workers themselves to try to individually resolve their cases, but, again, that can be difficult for consumers. They don't understand the process. They need help going to how to navigate and work with the county eligibility worker, work with the county to elevate their issues.

And so that's why having an attorney who can help you. Unfortunately, again, we exist in a system here where you need an attorney to navigate your public benefits. But there is the there are people who will fall through the cracks, and it's most likely gonna be people who are have chronic conditions, have

Have you submitted a fund a a a budget request for that specific services?

The there is a budget request that Assemblymember Schiavo has.

Of course, she would've. Awesome. Okay.

And not oh, I Yeah. Did did mister chair, Susan DeMarois, director of the California Department of Aging. I would add also that the state's 33 area agencies on aging that cover all 58 counties do provide nutrition to seniors, home delivered, and congregate meals, and they're the target population is people with the greatest social and economic backstop for all of the unmet needs, that is existing infrastructure we'll be talking about later in the agenda.

Also, our 33 triple a's in the state are all required by federal law to have a legal services provider contract, and they do provide limit limited legal aid through the 33 triple a's in the state.

And are you projecting an increase in your caseload for those needs due to HR 1?

I would anticipate there will be an increase in demand.

Do you have any projections?

No. We do not. It it would vary by each community, and some of the triple A's might serve counties, some might serve one, some might be part of the county system.

I mean, is there a way to survey them or something? I mean, my whole point is this. We only got one shot at this in this budget process, And we need all the information that we need. And we need to make sure we can predict as much as possible because it'll be a while by the by the time we're able to address yet another round of funding. Right?

And so, I I I wanna challenge you to get us a projection somehow, and the associated cost with potential cost with that So that we can at least consider it as a legislature. Because if we know and we we know it's gonna be inevitable that we're gonna find a senior who's both losing food assistance and health care And whether it's through an eligibility worker saying that, hey. I'm sorry. You just don't qualify anymore.

And but while you are challenging this, you're still gonna need some type of help, and they're gonna need to come to you all.

Whatever it is, like, let's let's try to bring everything we can bear in terms of information. Now there's no doubt we're not gonna be able to take care of everything, but I think it's at least one of the considerations we should be making, as well. How hard would that be to get that information to us?

We we're happy to work with our 33 triple a partners in the California Association for Area Agencies on Aging. One of the challenges is because anyone could walk in the door with a triple a, there's not eligibility requirements per se. It will it will be hard to estimate, but we will do our very best for you.

Do your very best. Assembly member Solache.

Thank you, mister chair. If I could just add to this current discussion. For thirteen years of my life, I I helped run-in a Meals on Wheels program in my district, actually. And so that request, I know it's a little difficult because we have so many seniors. My program, we serve 700 Meals on Wheels program, 1,000 congregate site lunch meals.

So it's I was a very it's a lot of organization in Los Angeles area. And I know that the work to get that information would be a little difficult because, you know, we're working with the senior population. It's not always forthcoming with information, and then you just do need physically the staff to go and get that information. So it's not like they're gonna go on website and input their information. So it's gonna take a little bit of legwork.

Might as use it as an excuse, but I just wanted to add a local perspective of what that what that would look. And I'll I'll repeat those sums for our chair later again. But, again, I know that that it's it's it's not impossible, but it's obviously gonna take a little bit of extra work to get that information. But, yeah, just to your to your point, mister chair, it's it's very concerning.

Obviously, these seniors that obviously depend, you know, on on these services and, you know, you added the, you know, the Meals on Wheels program, for example, then you added the issues that we're talking on hand.

So, again, just wanna add that local perspective of a of a local nonprofit that serves Meals on Wheels program.

Assemblymember Schiavo?

I just since it's been raised how complicated our health care system is and to navigate. And I know that there's work happening right now to kind of streamline processes and make things automatic and all of that. And I guess, you know, can can you talk a little bit about and and I hope that there is a really kind of detailed conversation happening from beginning of and to the end in terms of the from the perspective of the Californian who needs these services. Right?

How do they how do they how can they come in?

How can they verify? How can they reverify? What is that experience like? And because I do feel like while nearly every aspect of HR 1 is horrific, and hurting people, because we are going through this process of improving our systems that it gives us an opportunity to kind of reimagine them to work better. And, you know, and can we if you were to drop someone into this system today, I'm guessing they would not set it up how it's set up.

That is my wild guess. And so can we think about just setting it up differently? Like, setting it up in a streamlined, super simple, easily accessible, you don't need an attorney to navigate it kind of way. And I know HR 1 is making that even more difficult. Right?

So I understand the irony of my comments. But that being said, you know, I I do think that there is a silver lining in terms of this being an opportunity for us to really shift and, like, the letter, you know, that you're talking about people getting when they're denied.

I hope the letter does not say you were denied, and it actually tells them, you know, where to go for information and, you know, what they may be eligible or how they were denied or something that gives them something, some kind of information that they know that they have other options that they can follow-up and they can figure out how to get back in to the programs.

And so, you know, maybe you can talk a little bit about what's being done in that space and just kind of think through how this is actually being operate operationalized, to make sure that this is really re removing as many barriers as possible for people to be able to access these programs. Write it down.

I think to your point, one of the our our first kind of principle in terms of implementing HR 1 is to automate to protect. And we are, like, scouring data sources that we can use to automatically determine someone is exempt or meets the requirements. Gig economy data, places where we've never really done anything before. And so really trying to do as much as we can behind the scenes to automatically exempt.

I will also say something that we're doing that I you know, we did it a bit during the, public health emergency unwinding and redetermination was really focused on how we engage with our members in terms of our communications, whether it's through ethnic media, the various channels, member testing, focus focus groups to really what resonates, what are the messages folks need to hear so that they first learn about what's gonna happen and then take action.

We just you know, we learned under the unwinding about the how important texts were for our members. We just did our first round of texts at the February to raise awareness of these forthcoming changes. We're almost a year away from the changes, but just to start educating folks about what you need to learn about, what you need to kind of, you know, click here for more information.

I think we had less than a 1% opt out rate from that first round of text, and then we will be coming out with the next round of text in the summer about more about taking action and what you need to do. So we are trying in kind of just the way we communicate, being very member focused and very clear plain language, in terms of how to do this.

Our mem Medi Cal member advisory committee, we launched that about two years ago. We are bringing our materials to them. We're asking them, does this resonate? How would you think about this differently? Where do you wanna get this information?

You know, we're hearing their providers, their enhanced care managers, those are the people that they go to to get information, and so trying to figure out our channels to those avenues as well. I don't know if you have anything to add. Yeah.

And I think one last thing, to add from Department of Health Care Services, I think through, like, the benefits Cal portal, the cover CA portal where people go and access and try to apply and do their renewals in the last couple years, we're really trying to strengthen the concept of human centered design. So a lot of the application flow online mimics very similar to things like TurboTax.

Really, the idea is to provide that very intuitive kind of, kind of perspective as the member's going through the process, and we're continuing kind of through the design using HR 1 as an opportunity as you were just sharing in terms of, like, how can we make this so that it's much more intuitive intuitive and dynamic. So everybody going into the application will not be asked the work requirements questions, for example.

Like, the system knows dynamically kind of what your profile may be going through, so we're not unnecessarily burdening people.

So I think just kind of grounding a lot of our current usability efforts in human centered design through the application development and testing that with actual members.

And how is this how is this happening? You know, the chair was talking about taking down silos and you know? So how is this happening across programs with CalFresh or it's still kind of separately as a a Medi Cal only program? No.

I will plus one for the Department of Social Services, much of what health care services has said. In some instances, it is literally the same system that we're working with. So in BenefitsCal, for example, as you go into that application, that is one system, that we use for all of those programs. Eligibility workers are also cross trained on all of the programs and many counties and will often be interacting with the individual across all the programs.

And then similar to what I was saying earlier about sharing information to make sure that we maximize exemptions across the departments, We're also trying to maximize these improvements to the system.

So we are also working, for example, on the gig economy piece. It's been, what we've discovered is one of the greatest sources of errors in our payment accuracy on the CalFresh side, which has very significant financial consequences under HR 1, for the state, individuals whose income is irregular and, difficult to report. And so that is a common source of errors.

So we have, contracted with a company called company called Truve, which is going to embed a consent based income verification strategy where if with the individual's permission, we can temporarily access their bank records and see what kinds of income comes in regularly and say, does this look right? And if they say, yes.

That looks right to them. They can sign there, and that is their submission of information which we consider verified for their income versus them needing to try to, like, collect records from multiple different gig work and the variance, we can actually look at the data, identify it for them. And so we are working sort of across all of the health and human services agency to make sure that we all benefit from that kind of an improvement.

I just wanted to add on that, you know, from the county perspective, and thank you for your leadership on that. As director Troia said, the the workers are cross trained, and we appreciate that on the DHCS side that there is an acknowledgment of of the need for county resources in in the governor's budget to be done at the at the May revise. On the CalFresh side, just to highlight that there are not additional resources right now. Yes.

There are some for AVOD, but they are offset by the caseload reductions.

And so while the implementation will be on a rolling basis starting in June, that means that people will start to have to fulfill these requirements in June, and the resources resources are needed. So while the LAO you know, we understand the point that, you know, we will have to refine during implementation. We know enough now that these estimates were built up based on detailed conversations with our counties who administer these programs about the time that they're they're going to need.

And on the CalFresh side, just to point out that all of the recertifications are due within the budget year. So this is the year to begin to invest as as you spoke to.

But, miss Chiavo, just, you know, hiring people helps provide that access, right, on the phone, in person. You know, we talked older adults, right, who really are gonna need that that human touch, especially for folks who cannot be administered by data, have those questions. And so that's really what we're talking about the both and. Obviously, do what we can with data and simplify, but make sure that we have a well trained, robust workforce for for those folks, especially older adults who need that assistance.

That's why I have a budget request for navigators.

If I may, I just wanna add one quick point that we didn't talk about earlier in terms of the recertification period. We talked about, like, most of this impacting within a year, but I do wanna also emphasize that households with older adults actually have their eligibility recertified every two years, And we have a federal demonstration project for households that have older adults and people with disabilities who don't have any earned income where they actually have a certification period up to thirty six months.

So for this particular population, we do have an even longer window of time before the full effect will occur on the CalFresh side.

So it seems to me, we don't have very much time to ensure that the counties have what they need and even and we should be expecting another population even to fall through those cracks, which means there's even some community based infrastructure that we may need as well for at least emergency services in terms of food, in terms of health care, in terms of those type of things as well.

You know, I I think my biggest worry at this point, and the more we talk, the more I'm starting to worry, so we probably should end this panel quickly, is that we predicted that something like this would happen, which is why we keep harping on the 20,000,000. And I would hate to be at a point where we're starting to get stories of people falling through the cracks and we haven't fully expended that 20,000,000 that's meant to preserve to prevent people from being hurt.

And I wanna avoid us getting to that point. And so I I think we need to really have some real honest conversations about, number one, what can we do to get counties what they need. But then also making sure that we're we have another conversation about what else could we be doing with funds we've already allocated in the last budget cycle to fully be prepared.

This is not time to hold on to money when it comes to these people being hurt. And I'm not saying that that's what's happening, but I wanna make sure that we're doing we can say that we've done everything that we can with what we have. And so I would just say stay tuned because I think we're gonna need to have some more meetings and discussions to making sure that we have that all hands are on on deck on this.

Because there seems to be some more layers we haven't yet uncovered here that I think with just a little bit more thoughtfulness and intention. We can even do more with what we with what we have.

So I any additional questions or comments at this time? So stay tuned. We're gonna have some more, conversations, about this. Really worried about some of these populations who are gonna be following through the cracks starting June, especially between June and October. There seems to be some things that we need to do.

Department of Aging, good luck on your projections. Looking forward to them, and, we'll continue our discussions. Thank you all very much. Issue number two. Come on up. Good luck to you.

Well, we're we're gonna go in the order. So if we need to rotate so why don't you if you're in the first order of so if you're not until the end of the agenda on this panel, why don't you give your seat to someone else who will be before you?

You guys stable it. Right? I think so.

Trust me. You probably don't wanna rush to sit at this table today. Again, we're gonna go in the exact order that's on the agenda.

I know. I did this because DSS, you may start when you are ready.

Thank you, Chair Jackson and Chair Addis and Members. My name is Claire Ramsey. I'm with the California Department of Social Services. I'm speaking today on our proposal to reduce the general fund cost by $233,600,000 beginning in fiscal year 27-28. So this is an out year proposal.

By removing the state's share of growth in in home supportive services hours per case. Under this proposal, the Department of Social Services will work with the counties to establish a statewide baseline for average authorized hours per case by May 2027. Once this baseline is set, any non federal share of cost for hours that exceed the baseline will shift to counties. It is anticipated that these costs will be distributed according to each county's proportion of the statewide caseload.

Please note, we have identified a drafting error in our TBL, and we'll be working, on a published correction.

Currently, counties are responsible for conducting all IHSS assessments, but do not share in the cost of the hours they authorize. The intent of this proposal is to not overburden any particular county with costs, nor is it intended to reduce services for IHSS recipients. Individuals should continue to receive the hours necessary to meet their documented needs, including by increasing those hours if needed.

Instead, the goal is to support accurate and consistent use of the mandated assessment tools and to ensure that increases in hours are tied to changes verified changes in a person's condition or circumstances. Currently, in order to determine how many hours an IHSS recipient should receive, a county social worker performs an in person assessment and based on that information, assigns a functional index rank ranging from one to six to measure the level of assistance an individual needs to complete daily tasks.

Using these rankings along with the hourly task guidelines, social workers authorize the appropriate number of hours needed for that recipient. We have observed that average authorized hours have continued to increase, although we are continuing to see that functional index rankings have remained essentially flat for approximately a decade.

We recognize that this proposal will require additional planning to implement, which is why we have proposed to make the change take effect in fiscal years 27-28, and the department is committed to working with counties and stakeholders over the next year to identify ways that IHSS assessments can be as accurate and, consistent as possible and to ensure that IHSS recipients are receiving the correct number of hours. I'll now turn it over to my colleague, Liora Filestina.

Good afternoon, Chair Jackson, Chair Addis. My name is Leora Philicina. I am the Deputy Director of the Adult Programs Division at the California Department of Social Services. As a follow-up to Chief Deputy Ramsey's overview, I'd like to take the opportunity to provide further context and detail with regards to this proposal. Most importantly, I would like to emphasize that this proposal is not intended to cut authorized hours for recipients.

IHSS recipients should continue to receive authorized hours based on their individual level of need as assessed using the functional index rankings and the hourly task guidelines as established for the IHSS program. The assessment process is a very human and personal interaction between a social worker and the IHSS recipient. I think it's very important that we point that part out. We want to ensure that social workers are are applying the rules of the program uniformly across their caseload.

If a recipient has a change in circumstances or a change in condition that requires additional services, they should absolutely receive the additional hours they need within the parameters of the program.

Nothing is changing there. The department has been trying to address the growth in hours per case for some time by providing training and technical assistance as well as performing quality assurance monitoring. We have not observed any real changes in when it comes to hours growth or the overall accuracy of assessments.

We are hoping that this proposal will change the current environment and incentivize counties to change their business processes that could include more internal trainings for their staff and robust case reviews that reinforce social worker knowledge of IHSS program rules and regulations as well as encourage a better understanding of the mandated assessment tools that lead to more accurate and uniform assessments.

Our goal, as always, for the IHSS program is to ensure individuals with disabilities, including children and adults, as well as individuals who are ages 65 and over, receive the services they need to remain safely in their homes and communities.

And as always, we're committed to working with our county partners on getting that done.

Good afternoon. Carlos Marquez on behalf of the County Welfare Directors Association. CWA strongly opposes the administration's IHSS cost shift proposal. The administration's proposal is premised on the faulty logic that counties are inaccurately authorizing IHSS service hours, notwithstanding the fact that the very tools that county social workers are using to grant these additional service hours are designed, implemented, and overseen by the Department of Social Services.

The assessment tools in question that are yielding the overall increase in hours, are used in conjunction with one another, and, ultimately assess for for two factors.

The functional index rankings measure physical ability and to what degree assistance is needed. The hourly task guidelines determine how much time should be authorized to properly respond to said needs. As IHSS consumers age, their service needs understandably increase, and the hourly task guidelines allow for such increases. The but it's important to note that it is allowable for these increases to take place irrespective of whether the client's physical ability changes.

That's because an individual with an f two ranking who requires only verbal assistance, for example, to perform tasks may be authorized up to the same maximum amount of seven hours as an individual with an f four ranking with much higher levels of acuity.

Take, for example, Maria, a 78 year old IHSS recipient living with dementia. While she's still physically mobile, she becomes easily confused and forgets that she's doing something mid task. Although Maria does not need constant physical assistance, the level of supervision and verbal prompting she requires is substantial and continuous. As a result, she does need a higher number of IHSS service hours to meet her needs even though her physical ability hasn't changed. We are confident that these tools are being applied properly to assess service hours.

These tools have been independently eval evaluated and validated by Sacramento State University, and the application of these tools is enforced through the state's quality assurance bureau through a range of mandated monitoring and accountability activities, including case reviews, home visits, on-site visits, and, of course, the state led trainings that, my state colleagues have described. In none of these settings have concerns been previously raised by the state about county's accurate use of these tools for the purpose of authorizing service hours.

Instead, we believe we're seeing an average increase in hours entirely due to needs based and population driven reasons as the administration cites in its written response, to CMS on IHSS program integrity in February. Specifically, California's 65 and older population has increased by forty four percent. And over the last twenty years, children with intellectual and developmental disabilities whom IHSS also serves has grown from four to eleven point five percent.

Additionally, IHSS also serves individuals with cognitive challenges like dementia and severe autism, which requires protective supervision and increased hours. This population has increased from seven to eleven percent. CWDA welcomes an opportunity to participate in additional root cause analysis with the administration. But in the meantime, we respectfully request that the legislature reject this proposal.

Thank you, Chairs. Justin Garrett with the California State Association of Counties. Counties are committed to the life saving and cost saving IHS program that helps older and disabled individuals remain safely in their homes. CSAC is strongly opposed to the IHS cost shift proposal that would undermine the existing fiscal structure, result in cuts to county HHS programs, exacerbate the safety net impacts of HR one, and negatively impact IHS recipients and providers.

The twenty nineteen county IHS MOE was established based on the recommendations of the Department of Finance and their SB 90 report after extensive consultation with counties.

In this report, finance outlined that if counties had any additional costs beyond the MOE amount, then it would take away funding from other social services, health, and mental health programs. The department also made it clear that the state needed to cover a larger share of the ISS program because the original state county split no longer made sense as the state and federal governments made decisions outside of the control of counties that made the program significantly more expensive and beyond what counties could cover within available revenues.

These things are still true today, and this proposal contradicts those statements and disregarded the MOE agreement and the fundamentals of realignment while forcing counties to make cuts to state mandated health and human services for vulnerable residents. What's even more concerning is this proposal comes at a time when counties are facing massive cost increase as a result of HR one. These include engine increased engine care enrollment, eligibility workforce needs, and direct cost shifts that all of which make demands on the same finite county revenues as IHSS.

This week, CSAC released an HR one budget request of 1,900,000, 1,900,000,000.0 in 26-27, and 4,500,000,000.0 in 27-28, funding that is critically needed to prevent our safety net from crumbling. The IHS cost shift proposal compounds these HR one fiscal pressures with the state shifting additional costs that will result in cuts to core county HHS programs. Even prior to HR one and within the current MOE structure, counties are facing significant fiscal pressures from IHS costs.

A recent UC Berkeley Labor Center study found that county IHS costs are growing at a faster rate than realignment revenues, that this disparity is likely to continue, and the counties will have less revenues available for other realigned programs. The past two years, there has been no sales tax growth, the source of revenue that is intended to keep up with growing IHS costs.

This means that there is 230,000,000 in unpaid caseload resulting primarily from the inflation factor and county adopted wage increase for IHS providers. The counties will continue to cover until realignment revenues grow sufficiently. In addition, IHS costs are taking up a larger portion of county social services realignment revenues with some counties MOE amount larger than the funding available in the social services account. This proposal will harm the recipients who rely on IHS, the providers who care for them, and vulnerable individuals who need other county services.

For these reasons, CSAC urges you to reject the ISS cost shift.

Thank you, Mister Chair, Madam Chair, Members. Tiffany Whitem with SEIU California on behalf of our over 750,000 workers. We have the honor and the privilege to represent both county workers that administer the IHSS program as well as over 400,000 IHSS provider, which gives us the unique position to speak to the impacts of the governor's proposal from both perspectives.

The governor's proposal to shift costs to counties would have far reaching negative consequences for both county systems and workforce that sustains them, which is why we oppose this proposal. From the county workforce perspective, this proposal implies that increases in authorized hours are the result of county error.

That framing overlooks a critical reality. Social workers rely on assessment tools developed and mandated by the state. If there are concerns about rising hours, the appropriate response is to examine whether the tools the the tools remain accurate and relevant. Do they reflect the growing number of consumers with complex needs and higher acuity? Have frontline workers been consulted about how these tools function in practice and whether they've observed meaningful changes over time?

Assigning blame to workers and counties without a full evaluation of these factors is not only misguided, it dismisses the very real challenges counties face and the evolving needs of the people they serve. Shifting cost to counties does nothing to improve the accuracy of assessment tools. Instead, it imposes significant fiscal strain, making it exceedingly difficult for counties to administer not only the IHSS program, but also broader network of safety net services that communities depend on.

The likely downstream effects is a harmful one, creating incentives to reduce authorized hours, which in turn may drive increased reliance on emergency rooms and nursing homes. Individuals will still need care.

It is not if it is not provided in the home, it will be delivered in far more costly and less appropriate settings. This proposal also comes on top of existing pressures, including the implementation challenges associated with HR one and last year's full Cisco cost shift. Counties are already stretched thin. They are not adequately resourced to absorb additional financial responsibility, nor are they sufficiently staffed to administer the IHSS program at the level required.

The result will be felt not just in budgets, but in the lives of the people who depend on these services.

From the IHSS, provider perspective, the proposal further complicates an already difficult landscape for collective bargaining. Counties are responsible for 35% of the non federal share of wages and benefit increases, and many have struggled to reach agreements even under current conditions. Adding new fiscal burdens will only make negotiations more difficult, and may embolden counties like Siskiyou that have historically failed to reach agreements to continue to do so. This runs counter to our ongoing efforts to stabilize the workforce through more consistent statewide bargaining structures.

At this time, the pressure to reduce hours will directly impact, providers.

Many will continue to care for their consumers regardless of reduced authorized hours, often without pay because the needs are immediate and, in some cases, a matter of life and death. This dynamic will place a burden on a workforce that is already undercompensated and overextended. Stepping back, the governor's proposal reflects a broader and troubling pattern. At a time when federal policies like HR one are placing increasing strains on states, California should stop the cycle of cutting critical services under the guise of cost savings.

Instead, the focus should be on a sustainable revenue solutions that makes corporations pay what they owe and ensure that essential programs like IHSS are protected and strengthened.

This is not simply a budget adjustment. It is a policy choice with real and lasting implications for county administration, for the IHSS workforce, and most importantly, for the individuals and families who rely on these everyday services. Thank you.

Good afternoon, Chairs, Members. Michelle Baass, director of the Department of Health Care Services. About a month ago, the Department of Healthcare Services submitted a letter, to the federal, Centers for Medicaid and Medicare Services, in response to various questions and concerns raised about the growth in IHSS expenditures.

And, in our response back to CMS, we really outlined just the predictable and intended result of decades long federal and state statute in this area, really called the rebalancing kind of policy where we've all worked so hard to design and promote growth in home and community based services. In our letter, we recognize, that IHSS is a fundamental home and community based service, provides personal care and related services to nearly 800,000, Medi Cal members in their own homes.

These services allow individuals to avoid unnecessary institutionalization, directly advancing the requirements of the supreme court's Olmstead decision and the federal government's long standing commitment to community based care and our long standing commitment to community based care. Aging in one's own home and community is not only the preference of the overwhelming, majority of older adults and persons with disabilities, it's also the law, and it is substantially less costly to taxpayers than providing care in an institutional or congregate settings.

With that said and with our continued commitment to advancing home and community based services, just recognizing that these services must be delivered within the constraints of the state budget. And so I'm happy to answer questions of the committee. Thank you.

Good afternoon, Mister Chair, Madam Chair, and Members of the Committee. My name is Christina Bas Hamilton. I'm here representing UDW, United Domestic Workers, representing 200,000 of the IHSS providers throughout the state. Supporting everything that director Baass just said, you know, the state is embracing and supporting home and community based services except when it doesn't. And, you know, this is I'm just gonna speak plainly.

This is my fifteenth year working in IHSS advocacy. I've sat before this committee probably fifteen years in a row disputing cuts to this program and opposing reductions in so many different shapes and sizes that, frankly, it's just exhausting on the provider and the consumer population to constantly be pushing back against proposals to cut the program. And this may have, policy basis to it, but in the end, we know that this is a cost shift.

Cost shift is really just a cut to the program that is going to negatively impact impact working families and middle class families who rely on the services in order to go to work every day, be active in the community, in the economy, and the recipients who rely on it in order to live independently. My perspective that I'm going to raise is being representing workers who deal with counties in collective bargaining and have for for decades now.

We know that, we're dealing with cash strapped counties for all the reasons that everyone has shared that I don't wanna repeat.

I wanna say that we are also dealing with counties that have supervisors elected supervisors who frankly despise the IHSS program, don't know why they have to administer it, lament the fact that the state has offloaded the program onto that onto them, and so we battle constantly in order to, negotiate wages so that our members can actually have a a ability to pay their bills and not live out of their cars, which is what's happening right now. So the average wage, of our workers is about $18.38.

So imagine trying to make, ends meet with that. I can tell you that we just settled a contract in Madera County for a whopping 50¢, 50¢increase over three years.

50¢ over three years. Do the math on that. Okay? Pennies. Madera County cited one of the reasons why you couldn't agree to anything more than 50¢ was because of the governor's proposal that is currently pending cost shifting shifting costs onto the counties.

So the real life impact is social workers are going to be told to assess less hours. That is the real life truth of the reality. Two, it will make bargaining, which you all know because we come here every year and advocate for statewide bargaining because we need to increase wages, is going to just get harder because we are bargaining over a shrinking pot of money that has to go and pay for all of these other things that people have just been talking about.

So the big picture is that IHSS is a program that needs investment, not reductions. Why?

Because the grow the state is growing aging population, a population that is getting more disabled and getting more poor, that is growing less and less able to pay out of pocket for these services. So you have middle class families that are depleting all their assets and becoming IHSS recipients. So we have to deal with the big picture reason why the caseload in IHSS is growing, not instead do death by a thousand cuts, which is what we've been dealing with for fifteen years.

And the time has come for the legislature to say no. And you all did last year, and I want to encourage you to continue to reject it and to be standing strong for the the people who are served by the programs and the working class families who are trying to live with these wages.

This is the working affordability issue that legislators love talking about. This is affordability right here in this proposal.

Good afternoon, Chair Jackson, Chair Addis, and Members of the Committees. My name is Hagar Dickman of Justice and Aging. IHSS is more than a personal care program. It ensures the civil rights of nearly 900,000 disabled Californians by enabling them to direct their own care in their homes instead of living in institutions. Without IHSS, California cannot meet its obligations under the Olmstead Supreme Court case that mandates that states avoid unnecessarily institutionalizing.

And I just ask saves the state money because as DHCS acknowledged, it prevents far more expensive institutional care. IHSS cost $30,000 per year compared to a 137,000 for nursing homes. That's a savings of more than a $100,000 per person per year. With California's aging population increasing, IHSS has grown to meet that need. DHCS put it plainly, IHSS growth represents fiscal prudence, not excess.

The cost shift proposal is a wolf in the sheep's clothing, undermining access to the very program that saves the state money, keeps people safe at home, and meets an aging population's growing needs. It claims to incentivize better assessments if the administration has offered no evidence that rising hours reflect poor assessments rather than rising needs. And it grants the Department of Social Services broad authority to reset the state's IHSS fiscal baseline each year without transparent data, without clear benchmarks, and without legislative oversight.

In practice, it shifts the state responsibility for statewide medical program onto counties, incentivizing counties to cut services and ultimately shifts the burden of a balanced budget onto older adults and people with disabilities. At the center of the proposal is a statewide average benchmark that is neither meaningful nor fair.

It is a statistical artifact. Based on county demographic makeup, it is just as likely that counties who allocate hours below a state average are under assessing IHSS need and that counties with higher averages are not overserving but meeting IHSS needs. For example, counties at the higher end of current hour per case averages have more than 40% of IHSS recipients over the age of 65. These counties would be fiscally penalized precisely because they are serving the people who need IHSS the most.

The burden of this proposal will fall on those least able to navigate the system.

When hours are under assessed, that means a person doesn't get the care they need, like help with getting dressed or getting out of bed or going to the bathroom. It means going without a cooked meal because someone isn't there to cook it or trash piling up because someone isn't there to take it out. Older adults with dementia will lose the protective supervision that keeps them safe at home, leading to more hospitalizations, injuries, and institutionalization.

The California family caregivers who already provide $81,000,000,000 in unpaid care annually will be forced to sacrifice even more or institutionalized loved ones. And aging IHSS consumers will lose the support and stable that stabilizes their housing, worsening a crisis in which older adults are the fastest growing segment of California's homeless population.

This proposal will result in more institutionalization, more older adult homelessness, and higher costs, not fiscal responsibility. For these reasons, we urge you to reject this proposal.

Oh, Juwan, that's you.

Hello. Hello.

How are you?

Doing well.

My man. Alright. LAO.

Alright. Good afternoon, Chairs, Members. Juwan Trotter, Legislative Analyst Office. With this being the first of several issues pertaining to IHS, I just wanna take a quick step back, and acknowledge that knowing the overall, governor's IHS budget, we do find it to be reasonable given that year over year cost growth, are attributable to increases in caseload, hours per case, and cost per hour.

However, as we continue to monitor these estimates compared to, actual, and the most recent actuals, we will let let you know if we identify any concerns.

Now specifically onto this issue, as noted in the agenda, this proposal would require the administration to establish, a statewide average hours per case baseline of which the nonfederal costs associated with any growth in hours above this baseline, would be the responsibility of counties. As noted by director Ramsey, there was an error in the post the charitable language for this proposal.

However, going off how the administration has explained this proposal here today, is in this proposal, in interpreting this proposal, as is being explained by the admission today, we do still have some concerns we want to to raise. So first, the administration has noted that over the past several years, the statewide average authorized hours per case has increased, while the statewide average functional index score has remained relatively flat.

The administration does propose that giving, counties a direct fiscal responsibility for the growth in hours per case will incentivize counties to ensure accurate assessments.

However, we remain unclear how much control counties have over authorized hours per case, strictly because, as you've heard from the panel today, county social workers utilize the standardized assessment tool designed by the state when assessing these hours. Further, this proposal as described today gives counties little ability to control their costs.

This is because, as noted previously, the amount a county will pay under this version of the proposal depends on the county share of the IHIS caseload and not whether the county increased their authorized hours per case, Meaning, a change in in an individual's county average hours per case will have little impact on the amount of increased cost the county will pay because of this proposal.

Lastly, as context with the this proposal, the administration has noted that since the establishment of the two two thousand nineteen maintenance of effort, the state has been taking on an increasing share of nonfederal IHSS costs compared to the counties, and this proposal would shift the cost of some of this growth back onto counties.

However, we do have concerns regarding the rationale for shifting additional costs onto the counties outside of the established maintenance maintenance of effort of which both the state and the counties have previously agreed to.

It has been almost ten years since the most recent MOE was established. And if there is concerns for how non federal IHS costs are shared between the stat between the state and the counties, the legislature may want to consider if the current MOE is still working as intended. If it is not working as intended, the legislature may want to consider making adjustments, to the current MOE rather than shifting costs from outside of the MOE.

With all that being said, ultimately, this proposal is not, set to take effect until 2728. I mean, the legislature has additional time to clarify how the proposal will work in practice and ask additional questions regarding the rationale for this proposal and if this proposal is the best option to achieve the legislature's goals.

Department of Finance.

Kia Cha, Department of Finance. In response to some of the concerns that LA raised, we'd we just wanna note that the savings tied to this proposal reflect the state no longer having that cost, but counties would only incur cost to the extent they exceed the baseline. To the extent counties are below the baseline, they would not incur additional costs. And we also wanna note that the baseline is proposed to be reset annually, which will allow room for growth consistent with changing needs.

Thank you very much. Questions, comments from committee members?

Assemblymember of Schiavo.

So I I mean, I think it'd be helpful to hear from the department's response to the discussion around, you know, basically, there's an increase in who we're serving and the number of people we're serving. There's all kinds of explanations for why this increase has happened. And is is the are the is the department taking that into consideration or not?

Yeah. Thank you for your question. Claire Ramsey from CDSS. We are certainly cognizant of the increase in the older adult population and do see caseload growth in IHSS and are not in any way trying to change anything about the eligibility criteria or the way in which the hours are assessed through our tools.

So we certainly aren't trying to limit, again, growth in the program that is going to naturally occur because of our population shifts. However, we do want to make sure that the tools we use are being used effectively. In the context. I think we're very open to the idea that there may be more consultation needed and understanding of the ways in which the tools are working well and the ways in which we continue to support county use of them.

And understand, that as, Deputy Director Philicina mentioned, it is a very human process. So every individual social worker working with every individual recipient. So we do think there are ways that we can continue to strengthen those processes and make sure, the state is working well with counties to assess hours appropriately.

Yeah. I mean, I agree. I think that if the tool that is created by the state that you're seeing serious problems to the point of wanting to cut the program, then there has to be discussion, training, consultation, feedback from what's going on on the ground to better understand what's happening there. I mean, you know, I I'm very concerned about this. I see it as a shift to counties for people who need these services.

And, and in the end, it's really not going to save us money if people are institutionalized or on the streets. We know that both of those options are way more expensive than in home care. And, you know, and I think this is another, as is often the case in this area of our budget committees, penny wise pound foolish options being put forward by the administration. So, you know, this this is a no go for me. Just

Thank you very much, Assemblymember. Obviously, I'm concerned about that we counties are gonna have a lot on their plate in terms of HR one and those ramifications. And and then to do another cost shift, I think it just doesn't seem wise to me. I'm having a lot of red flags. So I'm just gonna cut to the chase.

I'm gonna be rejecting this proposal until the administration begins a series of working group meetings with stakeholders and legislative staff to continue the conversation. This root work group, should work to foster dialogue not only on this proposal, but also some of the other cut proposals on the table for IHSS, including issues number three and four, as well as consideration of the related stakeholder proposals on issue number five and options or alternatives for all these subjects in IHSS.

Also, the idea is we you gotta help us reach a better understanding around the proposal and discuss possible alternatives as well, and also ensuring that you are able to address the issues raised by, LAO. As always, we look forward to partnering with the administration on this to find a path forward that, we believe is not just passing the buck to counties, but really addresses a real issue. Again, we will not balance this budget on the back of our seniors.

It's just not going to happen. And I am not in I do not intend to support proposals continue to shift more cost onto counties. This is my belief that many of them are on our on many of them are on life support right now in many other ways. And so we're gonna have to figure this baby out. If I'm missing something, there's plenty of opportunity to educate me and my colleagues on this.

I'm always up for it. But at this time, I wanna see, a stakeholder, group as well as including some of our legislative staff members. If you like would like your staff to be included, in this working group, please send it to my chief, so that we can continue to work forward on this. So great start to a conversation. A lot more work to be done.

But right now, this is a no go until we have some further discussions. Appreciate this panel. Thank you.

I'll be quick be I'll be quick because I'll be quick. A lot's been said already. I I actually really consider this a cost shift to nowhere. We talk a lot about, you know, wanting to be transparent with the public. And I would say if the administration is intending to cut the program, just say we're intending to cut the program.

But to say we're gonna cost shifted onto the counties at a time when, the counties actually are gonna take drastic hits because of the work requirements and the increased requirements around Medicaid documentation and reenrollment. And those things actually are, in real life, being shifted onto the counties. And the counties and we are desperately searching for ways to find funding for that.

And the administration has said they are opening up the conversation and understand that the counties are going to have to cover those costs to do the reenrollment and the or excuse me, the reverification. And the counties are working already very hard to try to figure out how to make enrollment easier.

We just had this panel, talking about how people can be exempted, and we wanna exempt the right people. So that stuff is real. And the administration has said that stuff is real. We also worked very hard. I think it was my first year in the legislature we had I was on the PERS committee or the one of the committees I was on my first year on the IHSS worker issue and on the wage issue.

And the legislature tried to start making movement on this issue knowing how important. And I spoke at that time about how IHSS workers made a huge difference, as my father-in-law was very, very ill and what it means to a family to be able to have this kind of care, which has already been illuminated here.

But I do think, and I appreciate that the chair of sub two being so strong on this, that if the intention is to cut the program, we just need to be transparent about that's what the intention is. And then we need to deal with the fallout of that and figure out how to navigate that and what we're gonna do. But to pretend that another entity in this moment, it might be different without HR one.

Maybe the the counties could absorb it if we didn't have HR one. But with HR one, it just ends up being a a a falsity, I would say, to say that we're that we're shifting the cost because those costs can't be picked up in this budget atmosphere. So thank you to the panel and to, my colleague, particularly the chair for taking, such a strong stance on this.

Mister Chair, if I may.

Absolutely.

Once again, Lourdes Morales with the Department of Finance. Just wanna elevate for the committee the comments made by the department around sort of the intention and vision from the administration for this proposal really to sort of work with counties to ensure that we are sort of accurately and sort of consistently assessing needs across counties in this this program.

The administration is not proposing any changes to sort of eligibility or or sort of the structure of the program more generally, but sort of look forward to those continued conversations you mentioned.

I've got go ahead.

Oh, go ahead.

No. Go ahead.

No. I would ask then because the comment has been made in other committee hearings, particularly around h r one and the cost of of reverification. And we've been assured in other committees that the administration is in conversation and that there were some signals in the January 10 budget, that the administration wants to work with the counties to get some kind of a budget item in there for the May 10 revise.

So I would ask if your level of interaction and collaboration with the counties on HSS and the this proposal has that same level of of commitment that has been made around the HR one work verification requirements.

Yeah. We're happy to sort of continue conversations with sort of stakeholders around sort of issues. We're always open to those discussions. I could say the discussion on HR one has been sort of particularly heightened, and we sort of spoke in the prior comment around, our sort of ongoing engagement with counties around the assumptions from the administration, sort of the request from counties, and their own assumptions.

We sort of understand, what the moment may may need and and plan to have more information, in the future on those ongoing conversations.

Absolutely. We definitely wanna make sure that we avoid any unintended consequences. So we're gonna need to have some deep and substantive discussions on this. And I just wanna be be clear, this committee will not be moving from our position of not supporting this, if we do not see some stakeholder meetings happening. Also, some of our legislative staff may be need to be included in those conversations as well.

We need to make sure that we know exactly what we're doing, the unintended consequences to this, or we are just not comfortable. You've heard from my colleagues already. I'm scared of many of them on here. And so we will and we will not so let's make sure that this happens. If there needs to be further clarification with me on what my expectation is, please feel free to reach out.

More than happy to be of assistance. I will provide some of the food to make these meetings work, and so everyone is happy. And so we can work this out. Any additional questions or comments? Okay.

Thank you very much for this issue. Appreciate you all. Oh, yeah. Issue number three, please come on up. And CVS says she may begin when you're ready.

Thank you. Again, good afternoon, chairs and members. My name is Leora Philicina. I am the deputy director of the adult programs division at the Department of Social Services. The governor's budget proposes an $86,000,000 general fund reduction residual program with the timing of MediCal coverage beginning in 2627 by automating disenrollment and retroactive reinstatement for IHSS recipients who lose and regain MediCal, thus streamlining county workload and ensuring program rules are applied consistently statewide.

It is anticipated that this proposal will impact approximately three to 6,000 recipients per month. Individuals are folks are really interested in knowing about this impacted population. We did review data, and we found that their demographics are similar to the IHSS population as a whole with mixed levels of needs, authorized hours, and impairment levels. For this, particular impacted par population, we noted a few things. The average authorized hours per month was 111.

They're a little bit below the statewide average of average of 117. Protective supervision cases made up 8%, a little bit less than the statewide average of eleven percent. Sixty two percent of these individuals are 65 and over with eight percent of them being minors. IHSS is a medical service, and it is not our intent to interrupt services for recipients. However, individuals must be eligible for the services they receive.

When a recipient does not complete their medical redetermination, they become ineligible for all in medical services, including IHSS. When a case moves into IHSS residual due to failure to comply with MediCal requirements, the state loses federal funding it should otherwise receive. And our goal is to preserve this funding by enforcing program rules.

This proposal will have the effect of temporarily pausing IHSS services while recipients restore their Medi eligibility, which we find the majority of them do. Once MediCal is reestablished, the individual's IHSS eligibility would be automatically reinstated.

We believe this automation on both the termination and the reinstatement will help streamline the process and relieve the counties of the manual workload. It is also important to note that the IHSS residual program was never intended to serve individuals who lose MediCal because they did not complete their redetermination. Additionally, counties are operating in conflict with policy and state law if they are managing cases in this manner.

Under current rules, individuals qualify for IHSS residual only if they receive state funded MediCal or are presumptively eligible for IHSS during their initial medical determination and for those who lose their medical for reasons other than failure to comply. Well, understandably, there are concerns with pausing IHSS services while an IHSS recipient completes the MediCal redetermination process.

This proposal also provides an opportunity to close an existing communication gap for IHSS recipients, reminding them that IHSS is a service they receive as part of their MediCal. We believe better awareness will encourage timely completion of MediCal redeterminations and help recipients maintain their eligibility and services.

Thank you. Michelle Baass, Department of Health Care Services. We're here to answer any questions. Our our colleagues at the Department of Social Services really did a great job providing, responses on the medical space.

Thank you. Good afternoon, chairs and committee members. My name is Anna Leach Proffer. I'm a managing attorney with Disability Rights California. I'm here to talk about the importance of maintaining, the the allowance for counties to be able to use the IHSS residual program in this way.

This has been used to maintain critical IHSS services for individuals who experience a lapse in medical eligibility. Disability Rights California opposes this proposal because of the impact it will have on disabled Californians. Californians with disabilities, particularly those with the most significant support needs, face enormous barriers to accessing the services necessary to allow them to remain living in their homes. Severe caregiver shortage and complicated eligibility processes make it extremely difficult to maintain essential care.

While the state may have the legal authority to immediately terminate IHSS when MediCal ends, requiring counties to do so will cause real harm to some of the most vulnerable people in our state.

Historically, some counties have used the IHSS residual program to continue IHSS services for a short period after Medi Cal termination. In practice, this policy has been a literal lifesaver for people with disabilities. Many IHSS recipients cannot go a single day without their caregiver's assistance. So even a short lapse of a few weeks or a month could be catastrophic. You have an individual with mobility impairment impairments who suffers a preventable fall resulting in a costly hospitalization.

An older adult could become malnourished because there is no one to grocery shop or prepare food for them. And an individual who requires total assistance with their activities of daily living due to a disability like quadriplegia could be forced to enter an institution. These are outcomes that are far more costly than short term continuation of IHSS. The vast majority of people who temporarily move into the IHSS residual program remain eligible for Medi Cal. These are not individuals who no longer qualify.

These are people who've been terminated for procedural reasons. Often because the paperwork has not been submitted on time. This can be due to issues receiving mail, lack of Internet access, language barriers, or in many cases, disabilities that make completing these phones without assistance impossible. It is extremely difficult to find and retain an IHSS provider, and even a short dis disruption can lead to a loss of a long time caregiver.

While it is true that many providers are family members, it is not reasonable to assume that just because someone is a family member, they are able to continue providing IHSS services without pay while the medical issues are resolved. For many families that Disability Rights California works with, a gap in IHSS wages can also lead lead to food insecurity and housing instability for an entire household who's relying on those IHSS wages.

The use of the IHSS residual program prevents unnecessary institutionalization. It protects families, and it upholds California's commitment to community based care.

Thank you.

LAO.

Jawan Trotter, LAO. So as is noted in the agenda, this proposal has come before the legislature several times and has been so far rejected each time. As is also noted in the agenda, we do post some options for alternatives that can be adopted instead of or alongside the governor's proposal. We would note that some of these alternatives may result in different levels of savings than those estimated for the administration proposal, and some of these alternatives may result in additional cost.

But briefly, these alternatives include, better communicating with recipients that losing their medical eligibility may result in potentially losing their IHS services. This may potentially decrease the number of IHS recipients who lose MediCal due to noncompliance. Two, providing additional administrative funding to countings so that they may better position themselves to prevent MediCal disenrollments or to help recipients re-enroll into MediCal after, termination.

Three, the legislature could consider excluding certain populations from the governor's automatic termination proposal, specifically those who may have great difficulty completing, the administrative tasks required to remain, in compliance with MediCal.

And, four, the legislature may consider establishing a standardized grace period for the residual program, meaning rather than automatically terminating IHS recipients as proposed by the governor, the legislature could allow recipients to remain in the residual program for a set period of time, allowing recipients more time to re-enroll in MediCal before losing their IHS services. Now let's take a step back.

We would note that currently, it remains unclear in statute who and what the IHS residual program is for. Really, this has led to different counties utilizing the residual program in different ways. In our opinion, this lack of clarity in the statute has created a sort of equity issue where recipients are treated differently based on what county they happen to reside in.

So regardless if the legislature chooses to adopt the government's proposal or not or any of our alternatives, we do recommend the legislature consider what they believe the residual program should be and make clarifications in statute to reflect that vision. This level of clarification should increase the likelihood that the policy is implemented consistently throughout the state.

Lastly, if the legislators should choose to adopt go the governor's proposal in some form, we would recommend the legislature consider asking the administration, some of the following questions for them to monitor and report back on. So one, how long does it take recipients to reinstate their MediCal and IHSS eligibility after being terminated from the program?

Two, to what extent do recipients experience disruption in care? And three, what number recipients ultimately do not return to MediCal and IHSS after being terminated from the program? We believe with that level of data, the legislature can consider further tailoring the policy in the future in order to better maintain services for, eligible IHSS recipients.

Department of Finance?

Kia Cha, Department of Finance. So the there's a few things that, we would like to clarify about the administration's proposal. First, like, the proposal does not make any policy changes. It does not change eligibility for IHSS or the IHSS residual program, and it does not eliminate the IHSS residual program.

What it does do is it automates a manual component of the current process and it to help relieve workload for counties, and it also allows the state to retroactively receive federal funds, federal reimbursements when recipients reinstate their MediCal eligibility and therefore their IHSS eligibility.

We do also wanna flag that the specific subset, of the IHSS population that is impacted by this proposal are recipients whose annual Medicare redetermination is not completed timely. And under current law and program rules, these individuals do not qualify for the IHS residual program. And then I we under sorry. One second.

We also understand that the LAO has proposed some alternatives, and we're happy to engage, you know, on those alternatives.

But we do wanna note that it's very likely that those alt I mean, those alternatives are policy changes, and it's likely that they're gonna result in new workload for counties and new general fund costs.

Thank you very much. Questions, comments from members at this time? Seeing none, I think my the question is just, you know, obviously, this legislature has rejected this proposal twice already in the past for concerns of IHSS recipients who will lose services due to auto auto termination. Why is this being proposed for a third time?

So we continue to think this is a reasonable proposal to implement existing law. Like I've mentioned, like, this proposal doesn't is not a policy change. It doesn't change eligibility for, you know, general ISSS IHSS services or the IHSS residual program. And so the proposal really is to like I've mentioned, just really automates a manual component of the current process. And as I've also mentioned, the specific population that we're talking about is are not eligible under, you know, existing program rules in current law.

We would note that the county we would note that there is an all county letter dating back to 2012 that specifically requires counties to disenroll manually disenroll these types of individuals from the IAGES program after the system, you know, defaults them into the IAGES residual. And so, again, just we think it's it is a reasonable proposal that implements existing well.

Okay. Thank you for that. DHCS, what are you doing to improve the redetermination process? Obviously, there's folks who are who believe that it is it's a difficult process. So what are we doing to make it more user friendly?

I'm a firm believer that systems should be serving the needs of the clients, not clients serving the need of the system. So what are we doing to make it easier so that those who we who clearly need the service are able to not be disrupted.

Yeah. Thank you for your question, chair. Ying Zheng Huang with the Department of Health Care Services. So I think maybe firstly to acknowledge, we know the renewal process for the Medicaid, Medi Cal program is complicated. The journey for the member is complicated.

And I think maybe with through the unwinding work that we did during the redeterminations, I think we've put in quite a few in terms of kind of relooking at the consumer journey from, like, a user experience perspective. I in the last few panels, I talked about the human centered design component in terms of, like, ensuring the application flow plus the renewal flow is much more intuitive.

And I think we are also currently one of the initiatives that we're doing right now is looking to streamline the actual renewal packet, both for the Magi group, which is the the the bigger kind of coverage group under the Medi Cal program and also for the seniors and persons with disabilities. Because we know it's a very lengthy process in terms of the paperwork that they have to go through in order to kind of complete the redetermination process.

So kind of using, streamlining that and doing the kind of the user testing to make sure the actual people that are actually filling out the forms, it makes sense to them.

I think also, secondly, we also have flexibility in the kind of the program currently when in terms of individuals that may or are at risk or vulnerable individuals where are hard to reach populations where if they're calling the county for to change their address, for example, we have an ability to provide that assessment at the county level and actually reset or advance their renewal date because, you know, we have that flexibility under Medicaid law.

And I think also through a lot of the work we've done in the last few years with the redeterminations campaign, we are partnering with the managed care plans. So they also have the information on people that are coming up for a redetermination and also individuals who are actually kind of at that circumstance where they are disenrolled, and it's now they've they're getting the data to do outbound calls.

Josh should call members because they do actually have this information because individuals do have ninety days after their disenrollment month to come back on and be reinstated into their kind of current Medi Cal scope of coverage. And by that, usually full scope, so they will be their IHSS will also be reinstated.

So that touch with the managed care plans is super important given that they probably have more kind of, touch with the member more so than the state departments. So they're also, a very critical partner, kind of in the current, kind of, workflow as it relates to the redeterminations process to remind them before and after the renewal process.

So you're saying that, you are working on some improvements in terms of the process. I mean, how how well do you think do you anticipate that helping to limit the amount of people being terminated But help them get through the redetermination process easier.

I think we did look at some eligibility statistics. So before COVID, before all the different mechanisms and tools that I've just shared, our kind of reinstatement rate for the Medi Cal monthly disenrollment. Like, every month, say, we will only the number of people that we disenroll, we may have less than fifteen percent of people who are disenrolled to come back on the program within the ninety day period.

But as after all the different tools that we are currently looking and have implemented in the last few years, that reinstatement rate has gone up to about anywhere between nineteen to twenty three percent. So we're continuing to monitor that, and we take this as a good indication that, you know, we have kind of targeted kind of the right areas for people to pay attention, that they do have those ninety days to come back on.

But also more importantly, in order before you even get disenrolled and even be considered in the cure period that you actually complete your redeterminations on time. So I think I did not, talk about this, but through the redeterminations campaign, and we're continuing this, tool is anytime a Medi Cal renewal packet comes into the mail, we use yellow envelope. Kind of disseminating that through an outreach campaign the last few years.

So people know it is that around that time of the month and the year, you know that there's a yellow envelope in the mail. It's more than likely a Medi Cal renewal packet, and you must fill it out.

Different stats and tools, that I've talked about, are critical in terms of making sure people come back on on time or completing the redetermination process.

When you mentioned that yellow envelope, that reminded me, I think I think I have a parking ticket I need to pay that I got in the mail. We might need to recess until I get good. Yes. Assemblymember, Adesh, you have questions?

I I do. I I think this is the third or maybe fourth time I'm hearing about all that outreach efforts. So I really wanna appreciate that. We're putting, I think, close to $21,000,000 into outreach, the 17.5 and the 4.0 something. So $21,000,000 we're putting in a ton of time and effort.

We've already gone through this with the winding down or the unwinding and now using. So lots of conversation, lots of effort. So it's it's kind of astounding to me that that that then there's a proposal to just terminate people.

So we have massive effort going into keeping people in Medi Cal, keeping people qualified, addressing and then we're also, I think, talking about potentially hundreds of millions to the counties to, help them with this effort for redetermination and requalification and keeping people qualified and exempting those who are supposed to be exempted. So there's just massive amounts of money and time and effort going into making sure people keep their Medi Cal and yet a proposal to automatically terminate people.

Knowing all that, knowing the effort, knowing the amount of money, knowing the, blood, sweat, and tears going into this, and then to have a proposal that just says, well, let's just cut people. If it doesn't work out is a very, jarring juxtaposition to me that on the IHSS side, we wouldn't also be proposing to try to keep people in knowing how much effort we're already making to keep people in. So it's it's just a strange I don't really understand.

I heard you say, you believe it's good proposal or, you know, whatever the the administration not picking on you personally, but still backs this proposal. But I don't understand this juxtaposition of putting so much effort in while also being so willing to cut people so quickly.

Yeah. So I I think just to explain that a little bit further, I mean, I I've I've mentioned this already, but this proposal release just kind of implementing, like, what's already in current law. Right? These individuals as a default of the system, like, they or maybe it's like a function of the relic of the system. But when they don't renew their medical redetermination timely, they they get disenrolled from medical once IHSS is a benefit of medical.

When they're no longer eligible for medical, they're not eligible for IHSS. So the system defaults them to the IHS residual. Counties are required to then, like, manually disenroll them from the program because under, you know, existing law and, existing program rules and, you know, guidance provided by the department to counties, they are required to disenroll them because these individuals actually are not eligible for the justice residual program.

Once they cure their, you know, the the redetermination within ninety days, and I think we have data that's that's that indicates most people cure within twenty eight days. And so once they do that, Medi Cal is restored retroactively to the date of enrollment and so is their IHSS.

So once they do that, then, like, that's the part that allows us to because they didn't fall into because they weren't in the residual being paid with general fund, we we are still able to retroactively claim federal funds for that duration where they were, you know, working to cure their redetermination with with with medical.

If I can just add sort of a few additional comments to my my colleague's points. I would say sort of all all the good work that you highlighted, you're headed by by DHCS sort of helps here as well. Right? Sort of ensuring that folks are completing their Medi Cal redetermination process sort of timely, ensures that they are not an individual that is is caught in this scenario and all the supports to help who move people to be successful if they were not timely to secure their redetermination.

It also ensures that individuals can regain their medical eligibility and have the benefit of supporting and regaining their IHS eligibility.

Because as we're saying, sort of as IHHS being a a medical benefit, these two things really work hand in hand. And so here, we are really saying that we are automating that existing existing law and ensuring that when those sort of supports to make sure that individuals regain their eligibility, that we can then claim federal funds. As my colleague noted, individuals that are not timely in their redetermination and counties sort of move them into the residual, we cannot retroactively claim general fund during that period.

And so this sort of ensures that the state can sort of really draw down federal funds that these individuals are eligible for.

I mean, I I think I think we're talking about a population that, in many cases, if they could, they would. And it sounds like you've got the data that most people then become, compliant within 28 days. So I don't understand why not allow a 28 day grace period. I also I'm concerned with the perspective that people just aren't doing this in a timely way. When we know the population that we're talking about has has major struggles.

They could be health care struggles. They could be disability related struggles. They could be struggles related to housing or unstable housing. I mean, there's an untold number of struggles that we've talked about both in sub one and sub two. So I have concerns around the assumption or the perspective that I think I'm hearing that people just aren't doing things in a timely manner.

And if they would just do things quicker, everything would be okay. And that there's the onus of these massive cuts on the federal level and the state's reaction is now an individual's problem because they just haven't done it in a timely manner. I find that perspective to be inhumane and problematic, to be totally transparent with you. And then I don't understand. Again, I'll repeat it. If you

have the data that says most people requalify in twenty eight days, why remove their services automatically? When you're talking about making things easier, actually, I think you're saying making it easier to terminate, not making it easier on the person, but making it easier to terminate the service.

And it sounds like per you have data that says maybe you could, not make it so easy to terminate, allow a grace period, understanding most people will requalify when they have the help to do that, and in the meantime, not cut the services. It just seems kind of backwards to me in perspective if we're trying to care about people.

Answer? Hear you. And I don't mean to suggest that there are not real challenges faced by individuals that are navigating these complex processes. So, again, once really appreciate the sort of ongoing work spearheaded by DHCS on that front. I think more broadly to to your point around the 28 days, that is not sort of approval from from the administration.

I would say that would reflect a policy change to discretionarily allow state only IHS benefits for a a period of time. And so we're happy to sort of engage if there's legislative interest for that, but that certainly would be a new general fund cost to sort of allow that across the board within the IHHS program. As it stands now, as mentioned, there's sort of inconsistent application or while it's not sort of state guidance, counties are sort of inconsistently using the program in this way.

And so sort of established it sort of statewide would result in additional general fund costs.

Thank you.

Thank you for that clarification. I think I mean, obviously, it seems as though there is more work to be done. I think we do agree that this is an issue that we should continue to try to find ways to solve in a way that is as budget neutral as possible and in a way that really ensures that we are honoring the lived experiences of those who are going through this process of redetermination as well. And so I think there's room for improvement.

I think the issue is and, I mean, there shouldn't be any surprise that we we are not okay with the method as the administration has proposed.

And so we are gonna continue to reject this item, but I think there's room to make better progress still. And so what what I would like to see, is the administration, to work with the LAO to developing no harm recommendations to ensure that more IHSS consumers avoid inappropriate discontinuances due to errors at met at Medi Cal redetermination. LAO, I would like you to to ask you to please help with providing those options to us by or before April 30. Do you think that would be possible?

I think that's something we can work on and get in touch with the office about the reasonableness of the the timeline, but that's something we can definitely work with the administration on and get into you as soon as possible.

Absolutely. I'll feed you if you need some encouragement. Just just let me know. I'll hook you up. Does the administration agree to assist LAO and kinda work with us on this?

I mean, we we do think that there's an issue that we still need to improve on. Very happy to see the work that you're doing to improve the process in terms of redetermination too. That that is some great bright spots to making sure that it's more user friendly, more reminders, more reach out, those type of things.

Although, it'll be nice to see if the administration can provide additional resources so that that so we can assist IHSS recipients who lose a Medi Cal to be able to reenroll. But these are some of the things we wanna reach out.

I mean, we don't wanna I mean, I guess this is year three, so the third time. So at some point, we should be trying to make some progress on this and more than willing to be at the table to help to do this. We just gotta figure out something else. Is are you willing to work with us on on this issue?

Of course. I I wanna just make sure everybody's aware. We don't want to disenroll anybody for

Oh, yeah. Yeah. Yeah. Yeah. Yeah.

Yeah.

Yeah. But Yeah. Yeah. And I think we do have some opportunities here that we've we've seen stuff that worked during the unwinding. We saw very few people falling off of Medi Cal and falling off of IHSS During that period.

And I think we'll gladly work with our counterparts at DHCS and and see if there are some opportunities there for us to plug into their processes and see if we can do some additional noticing and and whatnot. We did that before, and I don't see a problem with doing it in the future. So definitely, our our goal is to keep people on their benefits at all costs.

Have we not has notices been updated to advise and warn consumers about the potential loss of IHSS if they are determined terminated from Medi Cal?

Have we not has notices been updated to advise and warn consumers about the potential loss of IHSS if they are determined terminated from Medi Cal?

Currently, the notices of action for IHSS do not contain that information. Doesn't mean they cannot be changed. Right now, if somebody is terminated for no Medi-Cal, they get a notice of action that says they were terminated for no Medi-Cal. I'm not sure on the DHCS side. I know they also receive a notice of action on their side as well.

I'm not sure if they have that type of verbiage on their notice, but we do not as of today.

Do we find that that might be helpful or if that's just something that

Yeah. We also I mean,

I don't know. You're you're all the experts on this one.

So And I think we could definitely take that back and work with CDSS on this. Currently, as it stands, the Medi-Cal notice of action also does not include references to IHSS. And I think and the reasoning is just the way the systems are designed, and so we are happy to

Okay. Sounds great. Did you have something you wanted to add? Or

Oh, yes. Thank you, Chair.

You got you got to weigh me. You gotta be aggressive.

Okay. Yeah. I, I just wanted to to jump in a little bit and add that I was, you know, excited to hear about some of the things that DHCS has been doing, particularly collaborating with managed care plans. I was quickly drawing here, you know, why don't why don't we look and see if we can do some of that same collaboration with counties? So for example, the county IHSS program, they need to go out annually to do an IHSS reassessment to look at somebody's needs.

I think that would be a great touch point to also remind somebody, okay. Let's check and see when your Medi-Cal redetermination is coming up. You need to be sure that you're getting that paperwork in because your IHSS will stop if you don't have Medi-Cal anymore. So I think, you know, similar to sort of at a at a minimum updating the notices to include information that also states that IHSS will end when Medi Cal ends.

You know, a lot of this us in this room, probably all of us know that IHSS is a Medi-Cal program, but there are a

lot of people in the community who, you know,

they call us and they don't know that their IHSS community who, you know, they call us, and they don't know that their IHSS is tied to their Medi-Cal in that way. So, you know, often a different office at the county. They don't know if it's coming from the regional center or coming from a, you know, totally different system.

So if they were, I think, to have clear information on their notices, you know, even if it needs to be on everybody's notice and say, if you receive IHSS, you know, in in home supportive services, that will also terminate. I think the more times that you can remind someone that that paperwork needs to be completed and ideally offer them assistance with completing that paperwork.

I mean, what I think what we want is all the same in a lot of ways. We want people to keep their IHSS services, and we want people to keep, their Medi-Cals.

So to the extent we can work together to let people know what they need to do to make that happen in as many ways as possible, I think, you know, the folks on the, you know, disability and aging advocates, like, we we would also love to be part of the conversation, talking about sort of mitigation member, you know, measures and solutions so that we don't, you know, we don't have 1,000 you know, between 1,003 people a month who are not completing their paperwork and losing their IHSS.

You know, can we get how small can we get that number so that, you know, the the fiscal impact, if any, is gonna be lower, the less people that need the protection of being transferred to IHSS are. We'd all like to keep, you know, eligible for the IHSS services that they're entitled to.

Okay. Thank you. Thank you for that. As many notices as possible. I agree.

I mean, that's how I feel about my car registration.

Yeah. My different color on

the phone says he made me. Never works, baby. I need the I need some help. So if if we can, LAO administration, if you can assist each other in ensuring that we provide us with some no harm recommendations, any additional recommendations to improve the process, some best practices that we may have seen in other areas that we could utilize here, would be awesome.

LAO, I'm also interested in the, residual, clarification, to ensure that people are being treated the same way or served the same way, no matter what county you're in.

And so if you can provide us with some more of that information as well and assistance, we would, I would appreciate it. Okay? Obviously, we need to also make sure please make sure that, obviously, DRC is very knowledgeable about the population, and so I ask that you please kind of run some of those ideas with stakeholders as well and the counties to make sure that how you see it to them would actually work, with the actual consumer and on the ground. Okay? Alright.

Anything else, committee members? If not, we will go on to issue number four. We're only on issue number four. DSS, you may begin when you're ready.

Thank you, Chairs. Again, Leora Filosena, deputy director of the adult programs division at Department of Social Services. I'll let folks get settled here for a second.

Good afternoon. My name is Willie Grace. I'm first with DSS. Oh. And Sorry.

We're gonna start off with DSS, and then you'll you'll have your chance after 123. I think you're number four in line. Looking forward to your testimony, though. DSS?

Thank you. Liora Filicina, deputy director of the adult programs division at the Department of Social Services. The governor's budget proposes a 3,500,000.0 general fund reduction to eliminate the IHSS supportive services backup provider system, or I'll refer to as BUPs, beginning in 2627. After reviewing program data, we found that BUPS has been significantly underutilized. Although we expected requests for backup providers to grow as counties implemented their systems, that growth has not occurred.

In addition, administrative costs far exceed exceed the cost of actual services, which is understandable given the extensive effort counties and public authorities must undertake to to locate a backup provider. The permanent buffs was established in 2022 as a replacement for the temporary system created under during COVID nineteen. It allows eligible recipients to receive up to eighty hours of backup services per year with the option to grant an optional eighty hours in in certain exception circumstances.

To qualify, an IHSS recipient must have an immediate need that cannot be delayed without jeopardizing their health or safety or risking the need for emergency services or out of home placement. Some concerns have been raised regarding protective supervision cases.

About ninety eight thousand IHSS recipients receive protective supervision roughly 11%. Recipients in these cases generally have an authorized representative who would be responsible for requesting a backup provider on the recipient's behalf. In addition, protective supervision recipients have a required twenty four hour coverage plan that identifies how their needs will be met outside IHSS hours and what steps to take if their provider is not available. So that is a current process for protected supervision cases.

It's important to note that the BUPS system program is meant to be a short term solution when there's immediate need and offers only a limited number of service hours.

If an IHSS recipient is experiencing a health or safety emergency due to the absence of their provider, they should contact the emergency services as their immediate well-being is the priority. Given the low utilization and high administrative costs, eliminating BUPS allows counties to return to using their prior backup systems, many of which existed before the permanent program was implemented.