Senate Budget and Fiscal Review Subcommittee No. 3 on Health and Human Services

Welcome to budget subcommittee number three in health and human services. Today, we will be going over, IHSS and then dive into some DDS issues. We will be doing two public comment, public comment periods.

We're gonna break after the IHSS items and then go public comment and then move on. On the second public comment, I apologize.

We might have to cut it really short. I have a hard out at 03:15. So if we could be mindful of the public comments in the first time, I will limit it to no more to no more than a minute on the first round of public comments. Okay. Let's get going y'all.

If I can have a welcome back Director. Department of social services and those participating in our first panel to go over the IHSS overview and the governor's proposed reductions. Michelle is already up here with us.

You could no. You could stay there. We're just gonna switch those we're gonna put Carlos in yeah. Next to Tiffany right there. Yeah. But when, yeah, we'll put that chair over there. Oh, perfect. Yep. Shuffle over. Perfect. We got this, y'all. I got this.

Professional chair movers. So the department's gonna provide an overview in how, I just wanna clarify how we're gonna go over this. Since there's three items on it, we're gonna go item by item. So the department will go over the first item of the hours.

Then we'll have, each panelist and LAO, Department of Finance, you wanna add anything to that. And then that's how we'll go. So we don't So we focus on each topic. So director, if you wanna readjust your Alright. Director, Kick us off. Will do.

Good morning. Jen Troia. I'm the director of the Department of Social Services. Joined here by Leora Filicina who's our deputy director over adult programs.

Thank you for the chance to speak today about the ways that CDSS and our programs support older adults, one of the fastest growing populations in our state, and people with disabilities.

I will first do, answer the questions you asked related to an overview of the governor's budget for AHSS, and then move to the first, governor's budget proposal as requested.

So the in home supportive services program, or IHSS, is a cornerstone of California's long term supports and services system. It provides domestic and personal care services to children and adults with disabilities and to older adults to keep them safely in their homes and avoiding institutionalization.

IHSS is a very large program. We have over 900,000 authorized recipients served by over 800,000 providers. The governor's budget includes $30.4 billion in fiscal year 25-26 for the IHSS program, which reflects an increase of $504 million from the budget act of 2025.

The governor's budget also includes $33.4 billion in fiscal year 26-27 for the IHSS program, which reflects an increase of $3.5 billion from the budget act of 2025.

In general, increases to the IHSS budget are due to growth in the projected caseload, growth in the cost per hour, and growth in the number of hours per case for IHSS overall. There are three proposals in the governor's budget, which I will cover, in turn.

The first is related to shifting costs associated with growth in IHSS authorized hours per case. The second is eliminating the IHSS backup provider system. And the third is aligning IHSS eligibility terminations with Medi Cal Eligibility terminations.

Before I turn to those, you did also ask some questions related to the Community First Choice Option or CFCO and the change in penalties that we made last year in the budget. The community forced choice option or CFCO is a federal Medicaid program within IHSS.

It covers specifically individuals who have higher care needs and would otherwise require institutional care. As a result of that high level of need, the state receives an enhanced federal match related to, the care for those individuals.

Under CFCO, the Federal Government requires that recipients are redetermined every twelve months. If a reassessment is not completed timely, the state is required to repay the enhanced 6% of federal funding that we received for each case for every month it is not reassessed.

As part of the 25-26 budget, state law was amended to shift the responsibility for paying those penalties to the counties, who are also responsible for ensuring that reassessments are completed in a timely manner.

The language specifies that counties pay 50% of those penalties in the 25-26 current year, and 100% of the penalties beginning July 1st of this year.

Since the law was amended to shift the responsibility of paying these penalties to the counties, the number of overdue reassessments has decreased by about 79%.

We appreciate all the work the counties have done to reduce the number of overdue CFCO assessments and anticipate that CFCO penalties will be lower than prior projections as a result of that work.

Your agenda notes that counties have expressed concerns regarding the workload associated with the reassessments and the impacts on timeliness associated with other responsibilities like processing applications.

We think it's important to note that applications for IHSS have been increasing by an average of 20 to 25,000 each month.

It's difficult, therefore, to determine whether any recent delays in application processing are attributed to that volume change or to the CFCO reassessment prioritization. We'd also note there was a significant backlog of overdue CFCO reassessments.

And it's our hope that once counties are caught up, it will be easier for social workers to maintain and complete those assessments in a timely manner because there won't be such a large backlog to clear.

Finally, CDSS has been working with counties to implement automation to streamline application processing, including automating the healthcare certification process, electronic forms, and providing technical assistance to help counties identify best practices.

So we hope that that will also be helpful in timeliness related to, application processing. With that, I'll turn to the first governor's budget proposal, which is the shift of costs associated with growth in IHSS average hours per case to the counties.

The governor's budget proposes this cost shift or change in the cost sharing, policy. It is estimated to reduce general fund costs by $234,000,000 beginning in fiscal year 27-28, and then to increase by more in the out years.

Under this proposal, CDSS would work with the counties to establish a statewide baseline for average authorized hours per case by May 2027. Once the baseline is set, any non federal share of cost for hours that exceed that baseline would shift to the counties.

The proposal is for those costs to be distributed according to each county's proportion of the statewide caseload. It's important to emphasize that this proposal does not change IHSS recipients eligibility for services or additional hours.

Currently, counties are responsible for conducting IHSS assessments, but they don't share in the cost of the growth in hours they authorize. This proposal would change those cost sharing responsibilities between the counties and the state associated with the growth in hours.

We're committed to encouraging and supporting accurate and consistent use of the mandated assessment tools which include functional index rankings and hourly task guidelines. And to ensuring that increases in hours are tied to verify changes in conditions or circumstances.

We recognize the importance of social workers applying the rules of the program uniformly across the case load. And in keeping with these goals, we provide training and technical assistance and perform quality assurance monitoring.

You asked about what we expect to change as a result of this proposal. We do believe this proposal may incentivize counties to change business processes.

For example, they may make more internal training and robust case review practices that reinforce social worker knowledge of the IHSS program rules and regulations, and encourage a better understanding of how to use the mandated assessment tools to lead to more accurate and

uniform assessments. You also asked what we know about the growth in hours per case and its causes. Currently, to determine how many hours an IHSS recipient should receive. A social worker performs an in home, in person assessment.

And based on that information, assigns a functional index ranking to measure the level of assistance the individual needs to complete the daily tasks safely. In general, higher FI rankings are associated with a higher level of need for assistance.

Using these rankings along with hourly task guidelines, social workers authorize the appropriate number of service hours. We've observed that the average number of authorized hours has continued to increase in recent years while the functional index rankings that indicate level of need

have remained essentially flat. Over the last ten years, the average hours case have grown over twenty seven hours, while the same metric had only grown by four hours in the prior decade.

When we look at the demographics of the program, we've seen that it's grown in size, but no particular group of recipients has been identified as driving such a large identified as driving such a large growth in the authorized hours.

The intent again is for recipients to receive the hours of service for which they are eligible. If a recipient has a change in circumstances or requires additional services, they should receive those additional hours they need within the parameters of the program.

The counties are responsible for using the established tools to accurately assess the number of hours a recipient needs and is eligible to receive. What this proposal will change is the cost sharing between the state and the counties for any additional hours of, growth in hours.

With that, I'll wait for your questions. I think you wanted to hear from the other panelists.

Thank you so much. I'm gonna turn over to, Department of Finance for any additional comments on the first proposed reduction.

Kia Cha Department of Finance. No additional comments at this time.

Jawan.

Good morning, Chair. Jawan Trotter, LAO. So acknowledging that we'll be talking about the governor's IHS budget reductions, process in a few minutes. I did want to begin with sharing some comments over the overall IHS budget more generally.

As part of the review of the governor's budget, we take a close look at the underlying cost drivers of the program. And as known in the agenda and by the administration, for HSS, these main cost drivers of caseload, cost per hour of care, and hours per case.

When we compare the governor's estimates of these three cost drivers to the most recent actual data we have available, We find that the governor's estimates appear reasonable.

Meaning the growth in case load and these other factors appear to be tracking relatively closely with the governor's estimates.

Of course, these estimates will be updated at the mayor vision and we'll review them again at that time. Moving forward to the hours proposal, I'll begin my comments by reviving some historical context around the hours per case in the IHSS.

As the administration and the agenda has noted over the past decade or so, the statewide average authorized case and actions have grown steadily by an average of around 2% every year.

And this is in contrast to the change in the statewide average functional index score, a score that roughly represents the recipient's level of need, which has remained flat over the same period of time.

As we just heard, the administrative proposal will shift the cost of growth in IH's hours from the state to the counties. This proposal raises several questions and issues we think are worth considering as you work to evaluate the administration proposal.

So first, while the average hours per case have increased steadily at a statewide level, the administration has not conducted a comprehensive assessment of the root cause of this increase in hours per case.

And indeed, and if these growth in our case are indeed growing faster than would be expected or needed given the level of care. So for example, are increasing hours per case related to aging population? Are they related to an increase in the percentage of minors?

Are they an increase of the percentage of recipients requiring protection supervision? As the agenda also knows, the counties conduct assessments using standardized and state provided tools.

And they have limited control over how to apply those. So and because so because of this, we remain unclear about the level of control counties have over the number of authorized hours per case that they approve or if statewide average hours per case is even the best metric for determining

whether IHS' hours are being accurately assessed by the counties. Second, under this proposal, should the statewide authorized hours per case exceed the determined baseline, the cost of that gross will be shifted to the counties in proportion to a county share of the IHSS total caseload.

And will not be based on an individual's county's average authorized hours per case. Because of this, under this proposal, counties will have little ability to control their potential growth and costs as the cost will increase even if their own average hours do not.

Third, for over ten years, county share of costs and IHS has been set by a maintenance of effort primarily that primarily grows annually by an inflation factor. This proposal would potentially increase county share of costs and IHS above this MOE.

And this MOE that, agreement that was originally agreed upon by both the state and the counties. If there are concerns about how non federal IHSS costs, are shared between the state and the counties, the legislature may want to consider if the current MOE is still working as intended.

And if the current MOE is not working as intended, the legislature may want to consider making adjustments to current MOE rather than shifting cost to counties outside of the MOE.

Lastly, the administration has made it clear that counties would only take on additional costs if the statewide average hours per case is above determined baseline and the counties would only be responsible for the cost associated with any growth in hours above that baseline.

The administration has also noted that this baseline may be adjusted year to year to account for kind of a natural growth in statewide hours per case.

However, because this hours per case baseline is yet to be determined and may shift year to year, it does remain unclear what the total amount of costs, if any, that will be shifted to the counties.

And it also remains unclear what the what the amount of general fund savings will be as a result of this proposal, particularly when we're estimating kind of the potential savings in the out years.

So ultimately, with all that being said, this proposal is not set to take effect until fiscal year 2027-28, meaning that as the administration noted, the 2026-27 budget does not assume any savings for this proposal.

As such, legislation may, does have additional time to, gain some additional clarity about first, how this proposal will work in practice.

Second, if the administration has considered other options to address this increased, number of hours that we've seen including if the assessment tools themselves or the state's oversight of these tools should be reevaluated.

And three, further consider, how this proposal will impact the counties and the overall MOE.

Thank you so much for that. I would like to turn over to CWDA with Carlos.

Yep. Good morning. Carlos Marquez on behalf of the County Welfare Directors Association. First, thank you, Chair Menjivar and Senate leadership for, your proposed rejection of, the administration's, IHSS proposals. CWCA CWDA shares in strong opposition to shifting additional IHSS cost count to counties.

The administration's latest IHSS cost shift proposal is based on a flawed assumption that counties are inappropriately authorizing IHSS service hours and that there are adequate local resources for counties to bear a higher burden of costs in the program.

Regarding regarding county assessments, our county social workers use state designed and state mandated assessment tools. These tools have been in place for twenty years, were independently validated, and are enforced through rigorous state driven quality assurance processes,

including case reviews, home visits, and on-site monitoring. At no point has the state notified us about systemic, concerns of misuse of these tools so that we maintain these tools are being used appropriately and as intended as, to assess service hours.

We appreciate the recent LAO analysis of IHSS cost drivers since 2019-20, which highlighted that the number one cost driver in the IHSS program is an increase of eligible individuals served by the program.

That eligibility process is informed by licensed health care practitioners who certify consumer need on a state required form. According to the LAO, the growth in hours per case only accounted for 10% of the cost increase in IHSS.

That 10% is not surprising given the growth in the aging population. As IHSS consumers age, of course, their service needs naturally increase, and the assessment tool allows for this flexibility.

Individuals living in rural counties are especially reliant on IHSS services because they have fewer other home and community based services to meet their needs.

Penalizing counties for statewide growth, particularly when the growth reflects demographic realities, risk destabilizing access to care in regions with fewer alternatives.

Under this proposal, counties would be required to pay for statewide growth regardless of their own authorization patterns, as the LAO pointed out, leaving them with little to no control over IHSS costs.

This proposal undermines the core fiscal structure established in the 2019 IHSS MOE agreement when the state itself recognized that counties lacked control over many of the decisions that drive IHSS costs and warned back then that shifting additional cost to counties would inevitably

force cuts to other health and human services programs. These conditions remain true today. In closing, we respectfully urge the administration, to engage with counties in a thoughtful root cause analysis that preserves this critical program.

Thank you. Going over to SEIU, Tiffany.

Madam Chair, Tiffany Whiten with SEIU California on behalf of 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 providers, 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 cost to counties would have far reaching negative consequences for both county systems and the workforce that sustains them.

From the county workforce perspective, this proposal implies that increases in authorized hours are a 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 those tools remain accurate and relevant and if the current MOE remains appropriate.

Assigning blame to workers and counties without a full evaluation is not only misguided, it dismisses the very real challenges counties face and the evolving needs to the people that they serve. Shifting cost to counties does nothing to improve the accuracy of assessment tools.

Instead, it implies significant fiscal strain making it exceedingly difficult for counties to administer not only the IHSS program but also the broader network of safety net services that communities depend on.

The likely downstream effects is a harmful 1. Creating incentives to reduce authorized hours which in turn may drive increased reliance on emergency rooms and nursing homes. Individuals will still need care.

If it is not provided in the home, it will be delivered in a far more costly and less appropriate setting. This proposal also comes on top of existing pressures which we've heard including the implementation and challenges associated with HR 1 and last year's full CFCO 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 levels required. The result will be felt not just in budgets but in the lives of the people who depend on these services.

What's more concerning is that at a time when our Federal Government is challenging the very existence of the IHSS program, the state's response is how great the program is yet they propose to balance the state's budget on the backs of counties,

the workers and the IHSS provider seems like every year. 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 with only, will only make negotiations more difficult and may embolden counties like Siskiyou that have historically failed to reach agreements continue doing so.

This runs counter to our ongoing efforts to stabilize the workforce through more consistent statewide bargaining structures. At the time At the same time, the pressures to reduce hours will directly impact providers.

Many will continue to care for their consumers regardless of reduced out authorized hours, often without pay. Because the needs are immediate and in some cases, a matter of life or death.

This dynamic will place a burden on a workforce that is already under compensated and over extended. Thank you, sir. And finally, the governor's proposal, reflects a broader and troubling pattern.

At a time when federal policies are placed in increased rate on states, California should stop the cycle of cutting critical services under the guise of cost savings. Thank you. Thank you so much.

We have a consumer advocate joining us today, Michelle.

Hi. Is it on? Yeah.

If you just wanna move a little closer to you.

Let me start on this.

Hopefully Oh, I

can't never mind.

A little bit. I can speak up if that helps.

Thank you. Okay. Alright. Welcome and thank you for having me here today. My name is Michelle Rousey.

There you go.

I live in Oakland, California. I use IHSS everyday. The program works for me. I've been on it since like 1992. Before that, I was a a worker with a quadriplegic and a cell under the IHSS program in the late eighties.

I for me, the care I get under IHSS looks like six to seven hours per day of care in my home, which is not full care in any means. It does meet my needs minimally. Very minimally.

Personal care, bathing, cleaning me cleaning my home, doing laundry, cooking, shopping, medical appointments. Everything most of us do for ourselves that I cannot do for myself anymore.

Not by choice. If I could do these things on my own, I would. With IHSS, I can live independently in my own home. I with without this care, I'd be in an institution and or hospital setting for my care. That would cost the state much more.

And it would be terrible to live in a nursing home and or hospital. I've done it before. As in nine months in a hospital slash rehab when I was 18. So I know what that looks like. I know that's not an option.

It's not an option for many of us. Not only that, the cost is horrendous. I lost some of my care for life because of it, because my insurance covered it. Now I don't have that insurance. So IHSS under Medi Cal is my option.

And for many of us, it is. I'm on oxygen. I'm on a respirator. I use a power wheelchair to move around. IHSS made it so I receive my care in a manner that is respectful of my understanding of my needs and that I deserve care to maintain life.

I've been on IHSS since early nineties, as I stated. And I have watched and been part of IHSS policy changes and part of advocacy around the program for most of my adult life. I'm 55 now, and I've seen how IHSS has enhanced my life, but I also it has also made me worry yearly of pending

cuts to the program. It scares the DBs out of me. I'm sorry. Yearly having to come and fight to make sure that we have the care that we need. This program should not be optional. I'm gonna say that again. It should not be optional. It is a vital program for most of us who use it.

When IHS hours change, that makes things harder for me right now. My needs have not changed, but the hours today are less than they were a few months ago. Talk about the evaluations and and how they're based on our need.

And if our need hasn't changed, then our hours shouldn't change. That's not true. Because the pending cuts, when a social worker comes in and sees you, they don't necessarily see that your needs haven't changed even though you tell them my needs have changed for the worst.

I need more care and I have pending issues that I need more care, but then I'm cut, turned out a cut days later. So, you know, there's high caseloads for the workers. I get it. And I get it that this state needs to cut back on things. But it hurts. It hurts a lot of us.

And it hurts where the most worldable should not have to buffer these cuts every year. I'm an advocate, and I know how to talk and get my needs met with my case worker. But I worry the large case loads of system. It wants cuts to IHSS's hours, like mine must be reduced and and be reduced.

And it's not just me. California has a growing aging community and people with disabilities too. We're we're everywhere there's gonna be a tsunami of seniors. And what are we doing to prepare for it except for cutting the programs that they're gonna very much need and to have in place.

And it just doesn't make sense anymore. We need to improve the programs. We need to enhance the program.

Some final thoughts. Okay, Michelle?

Yeah. Sorry. I'll go ahead and give a second about that. I respectfully urge you to reject any proposal for the 2026 cuts to the California Support Services IHSS program. Instead, strengthen, enhance, and expand this essential lifeline for seniors and people with disabilities. IHSS is a vital program.

It's not an optional program for those who use it. And I challenge you, care and others here. There's a large group of consumers and providers who have put in statements to your hearing.

Yes.

I urge you to read them.

Thank you, Michelle. Thank you.

Thank you.

And then I'll have Justice and Aging, some remarks.

Good morning. My name is Hagar Dickman of Justice and Aging. IHSS is more than a personal care program. It ensures the civil rights of the 900,000 Californians who use it by enabling them to direct their own care in their homes instead of living in institutions.

Without IHSS, California cannot meet its obligation under the Olmstead Supreme Court case that mandates that states avoid unnecessary institutionalization. And IHSS saves the state money because as the PHCS recently acknowledged, it prevents far more expensive institutional care.

IHS costs $30,000 per year compared to a $137,000 for nursing homes, and that's a saving of more than a $100,000 per person per year. With California's aging population increasing, IHSS has grown to meet that need. And DHCS put it plainly, IHSS growth represents fiscal prudence, not excess.

The cost shift proposal is a wolf in 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, yet the administration has offered no evidence that rising hours reflect poor assessments rather than rising needs.

And its current implementing language removes any connection between county assessment performance and county costs by spreading the cost of the proposal across all counties, which is counter to the stated goal.

The proposal also 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's responsibility for a statewide Medi Cal 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's just as likely that counties who allocate hours below the state average are under assessing IHSS need,

and counties with higher averages are not overserving but actually meeting needs. For example, several counties at the high end of hours per case averages have more than 40 of IHSS recipients over the age of 65.

Under recently updated trailer bill language, all counties would share the burden of that cost. It's an incentive for all counties regardless of where they fall on our allocation spectrum to cut hours. 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 go 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 the dementia will lose protective supervision that keeps them safe at home, leading to more hospitalizations, injuries, and institutionalization.

The California family caregivers who provide $81 billion in unpaid care annually will be forced to sacrifice even more or institutionalized loved ones.

And aging IHSS consumers will lose the support 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.

Thank you so much. Oh, wait. Department of Finance. I mean, look at this crowd. I mean, I don't know why we do this to ourselves.

It's I think, you know, as we're balancing the budget, we we continue to ask, the same recipients, providers to come up every single year and fight for fight for their services.

And while sub three kind of, kind of fared a little better this year than last year. There's still some really drastic proposals in here. And I think for me in particular, I always say like, we don't make billionaires come up here. We don't make corporations come up here and beg us not to cut stuff.

And we always make the same people come up over and over again just to beg us to not cut their services. So if there's a way to avoid this moving forward, I would love to never see them ever again. Okay. Let's jump into it. I have a lot of questions here.

You can imagine. Department of Finance, I'll start with you. If you can help me understand, there's no established baseline yet. However, there's already a savings to it. So we must have already established a baseline to calculate the savings.

Kia Cha, Department of Finance. So the savings as estimate is point in time, and it was based on holding 26-27 hours flat. However, subsequent to the to, you know, January 10, we did finalize the trailer bill language, which included resetting the baseline annually.

So this allows for some room for, for growth consistent with changing conditions and needs.

And, as with any other governor's budget local assistance estimate, we continue to look at this, in the spring and consider any changes as part of the May revision.

The you kind of alluded to it. But the director mentioned that there's gonna be ability for flexibility for potential growth as you have conversations with the county. But the savings grows upwards to $800,000,000. So how do you have upwards growth in savings but allow for flexibility in growth?

So our as I mentioned, our original estimate was point in time. It was before we finalized the trailer by language as well. So we're going we're we're looking at that. So don't look at the savings right now?

Yeah. So we're we're continuing to look at that, as part of the May revision.

So you don't have right now, the 200 whatever $230,000,000 savings goes to 800,000,000. Ignore those numbers right now?

Yeah. Because I think those for a point in time, they don't reflect this annual resetting of the baseline which is is gonna, reduce some of those savings.

Okay. So in the May revise, you're gonna have updated numbers of the potential reduce in savings if we're gonna allow flexibility for growth?

Yeah. I think we've been considering that as part of our, you know, review of the local assistance estimates as part of the May revision process.

Okay. Director, what I heard and what I've read is the goal, two part on the first question. The goal is, you mentioned to more adequately assign hours to recipients. But we're not changing the tools utilized to assigned hours. And while you've mentioned the FI scores stay the same, same, the HTGs increase.

But we allow the current tools allow for flexibility. So within that structure itself, the increases aren't violating the structure itself. So how how have we determined that they're inadequately assigning hours if the base is what I'm hearing is HTG is increasing FIs aren't, but that's allowed.

I do wanna be careful to say like, we are offering those observations about the differences in the growth and trends. We also do work really closely with the counties to try to provide that training and technical assistance about how to use the tools.

We are not necessarily, making a judgment on the outcomes that are existing now so much as observing that a change in the cost sharing may also change the incentive for counties to utilize those tools with Fidelity.

As it stands now, they don't have a share of the cost as a result of the hourly test guidelines. So I I don't want to conflate our observations about the trends and the facts of sort of where they have gone and the need for accuracy with an accusation that something is wrong in how it's happening now.

But even in that incentive alone is not a true incentive. Because take for example, LA County, they're they disproportionately have a higher number of cases. If by some miracle they meet the whatever established baseline, they still will have an increased cost of share.

But the whole goal is to make them fall within that under baseline. So even if they need it, there what incentive do they have? Why should they need if they're still gonna have to pay more?

I think our, and and finance may wanna add to this. But I think our, decision to make sure that all counties share in the cost is because we we are attempting to avoid what has been raised about the idea that people may be eligible for hours,

but there could be an incentive not to provide them. We are not trying to change the eligibility for hours that individuals have. And so the outcome of that could vary in different counties depending on the needs of their population.

And so we don't want to create we don't want to swing the pendulum so far that we've created a circumstance in which counties are incentivized to perhaps not provide those hours.

But what incentive then actually exists?

What we are hoping is that it is an incentive to, use the guidelines accurately. We recognize that there is a cost shift inherent in this proposal if the growth continues. And that I would

Sure, sure.

of finance about that. But I do want to say like it's not that we're assuming that the growth will automatically go away and there will be no increases in hours. It is a change in the cost sharing between the state and the counties.

But if counties, and I'll come back to you Carlos right now if you prepare it. But if counties, they're if they don't have the money for it, they're gonna have they're gonna wanna stay within the baseline. The statewide established baseline to be able to pay for other human services.

I mean, this is about 85% if I'm not mistaken of their entire realignment funds. And the rest is left for CalFresh or whatever.

That's a huge chunk already. I don't understand in the carrot and the stick situation, there's no there's no there's no incentive department of finance. There's no true incentive. It's a cost shift. Great.

Not great but sure. It's a cost shift to the counties. But hey counties, only if it grows, it's a cost shift. If you maintain and you meet this number, you don't grow. But now we're adding into a group project that if I do great in my group project, other people don't do great, I still have to pay for them.

I think I need a little bit more explanation of that second point to this incentive approach.

Oh, sorry. I'm gonna defer to my colleague.

Department of Finance. As the Director mentioned, really, it is around a focus on the accuracy of assessments and ensuring that we're not creating negative incentives as has been raised for any particular county.

I think it also reflects an acknowledgment that characteristics of recipients sort of may differ. They're not sort of equally distributed. So there may be counties that have, a much older population with more severe needs.

And so looking at all counties as a whole and looking at sort of a statewide baseline, is our effort to ensure that those, negative implications sort of do do not take place.

Okay. Stick around with this if you can. Carlos, what are what are counties gonna do if they don't have the money to pay for the extra hours?

Well, first, I think it's important to just, I think, level set that the way that our social workers are trained to use the tools and the assessments today that we've been using for two decades, are really under the auspices of the state. So state runs the training academy.

The state joins us in the site visits and and the case reviews. So the idea that the state isn't participating in the ways in which social workers conduct their work when it comes to the utilization of these tools, It's thought that's not accurate in terms of how it works on the ground.

But we know what would happen if this cost shift were to be enacted because before the most recent MOE, we were sort of at crisis proportion.

This is why the state had to to change the MOE cost share in the first place because bargain collective bargaining and wage increases essentially stalled because the state essentially had to bail out other health and human service programs that were being

encroached upon by run runaway IHSS costs. So if that situation were to persist, we think it's untenable. And we do think it leads to perverse incentives to artificially restrict very needed hours.

And look at this. I get the explanation as to a statewide. And when we come up with the baseline, maybe due to director, if we come up with a baseline, is that gonna take into consideration the different needs across the state for the actual baseline?

That's certainly our intention. I think that's why we have a BY1 implementation. So we can continue to have conversations with the legislature and counties around implementation because we realize that the specifics of that will be really important.

These tools aren't being touched at all, Director. At all.

We don't presently have any proposals to make changes.

If the I don't that I'm struggling to understand why the tools that are causing the the heartburn in the department and department of finance are not being addressed if that's the root of how we've got here. Why is there no proposal for FIFIs and HTGs to change? Deputy Director?

Thank you for the question, Leora Filosena, Deputy Director of Adult Programs. So I think with this proposal, the budget year plus one implementation really require will require us to do some policy work with the counties. Looking at those tools are definitely not off the table.

I think it's something that we can definitely talk about with our with the counties and CWDA. We have put resources.

So we did just a few years back to refresh training for all social workers. We required all social workers to go back through, refresh training. We've put a lot of resources into quality assurance monitoring, those kinds of things that provide technical assistance for counties.

So this is not something that we have not identified in the past. We, that refresh training required every single social worker, social worker supervisor, program manager, QA staff, as well as their, hearing staff to go through that training with us.

It was a eight hour training, that we worked with them to reinforce the importance of FI scores and ranking ranking and using the hourly task guidelines because we have seen that the FI ranking has remained flat for a long time. And but the hours keep increasing.

So I But maybe we should remove the range of hours per each FI. Well, it's something well, we would have to have that conversation. Right?

We don't have a proposal currently for any of that but not saying that policy changes are not necessary to implement this proposal should it move forward.

And to SEIU's point, I would like to know, have we seen violations in how a social worker is calculating the hours? Are they going outside of the range per each FI?

Yes. So quote the quality assurance monitoring both at the county level and at the state level find that a lot of assessments need to be recalibrated.

There are errors there. Sometimes it's just documentation like the the FI rank is correct, but the documentation doesn't substantiate it.

But other times, we do find that there are errors in those rankings and the and the hours that are being authorized. And the counties do go back and fix those assessments. So we do see that as part of a regular process.

So there are get going back and getting fixed? Yes. And then the department states that this is not in violation, not violation, this isn't touching the MOE.

I'd like a little bit more justification how the department feels that this isn't touching the MOE but this will go above the 1,600,000 required, payment from counties with a 4% increase. This is gonna go above that 4% increase.

How then do you stand and say that this isn't touching the MOE whatsoever?

So there's no proposal from the administration to sort of modify any of the legislation associated with the MOE. As we've noted before, with the implementation sort of of the TBL as we've put forward in in February, the idea is sort of set a baseline and allow for growth.

So to the extent that counties would bear any cost, it would depend on the extent to which they are sort of over that sort of annually resetting baseline. So we do sort of see this as separate. And again, not

But even if they don't go over, Lourdes, even though if they don't go over, they're gonna have to pay more. I mean, it's not only if they go over. They can be under and they're gonna pay more. So I don't think we can say that only if they go over, they're gonna pay more.

The cost shift across all states is gonna be proportional. So I mean, LA, regardless of whatever happens, will always pay more.

If on a statewide basis, we are sort of above that baseline.

Even if even if a specific county is not above that baseline, they will pay more if other counties are above it because that will be distributed across all the counties.

That's correct. It's not sort of certain though that all counties sort of as a whole would be above the base line. That would depend on sort of how that process is set. If counties are sort of below the base line, then the state would continue to bear those costs.

That would then say that, counties would then have to determine. By that, that would mean that services would get cut. Because going above the baseline doesn't mean that it's an excess or it's inadequate or it sorry, it's inadequately, assigning hours.

It just means that a person needs more hours and we're cutting the hours. But the thing and I've said I'm a broken horse here, broken record here, is the the Federal Government incentivized states to take on the state costs.

That we were incentivized, with refugee's cut those being cut, HR stuff. We were incentivized. They're like, you take it on. You take it on. And we didn't take on a single one of them and we actually cut the services.

So I'm assuming, because we cut the services and we're doing this to the county, the counties are gonna cut the services as well. If we don't have the funding for it, counties don't have the funding for it. The services will get cut with IHSS.

If hours were cut with IHSS and even to where, the growth is, we're seeing a lot of the growth in minors with autism and IDD. It's mostly in case growth versus case hours.

I'm wondering if hours are limited by the county, which I anticipate they would have to be even though no one wants that and maybe counties won't say it out loud.

If hours are limited for the IDD population, given that it's an entitlement, they're now gonna have to go to pair of their last resort, which is the regional centers. And by default, the state is now gonna have to pay for it.

So in the savings that we're accounting for, are we accounting for the fact that most of the people here that are gonna be cut are IDD people who are entitled regardless. And now instead of social services paying it, DDS is now gonna have to pay it and the state is still paying for it.

Is that being accounted for in these savings?

As noted by the department in their opening comments, there's no, change to the entitlement nature. So if an individual is deemed eligible, they will continue to remain eligible for the hours that they are authorized.

I definitely know that. We can't I know we can't touch that. But because of that, are we accounting that all those people can't be counted as a savings? Because regardless if they go up or down, they're still entitled to those hours.

We're sort of not scoring any sort of offsetting changes because we're not foreseen in our proposal to sort of impact the number of hours that an individual is eligible for.

So this is an assumption that the all the hours that everybody has right now is gonna be completely absorbed by the county and no one's gonna decrease hours. That's a comp

We're holding sort of we're we're holding costs For hours as they sort of stand now. Yeah. And so the state will sort of continue to pay their share.

And on a go forward basis, it's really around growth above the baseline that sort of we understand will require work to identify as we move forward if this were to move forward.

CWDA, do you have the capacity to absorb every single status quo hours that are being paid right now?

Absolutely not. No. Especially when and again, I think the questions around what the ultimate baseline will look like and above that baseline, what our liability will will ultimately be that we would have to bear.

The only numbers that we have to go off of today is growth or potential savings up to 800,000,000. And we know that that's absolutely untenable.

We also know that within our realignment funds, we haven't seen any actual growth in in the revenue that that funds our social service sub account for the last two years.

So that's flat. We also have to contend with the fact that CalFresh administration is increasing, and that's also a realigned program. So all part of the same pie. Not to say anything about, behavioral health and public health.

How would this one thing. It's a little difficult. You know, Deputy Director, you said that readjusting the tools is not off the table. But legislators are being asked to vote on a TBL without that really said inside.

That's not part of the language or anything sharing that we're gonna be in conversation with the baseline. The baseline's not even, you know, defined in this TBL whatsoever.

It feels like, it sounds like, especially since this is a 07/01/2027 proposal, that more time is needed to actually have the conversations with the stakeholders on first coming to the legislature with an actual baseline and coming to the legislature on actual tools on how we can

change the tools that come up with these hours and so forth.

And then my other question is, given that this is about like a really small percentage of the actual growth of IHSS. I mean, growth cases as a whole is is what's really driving the cost to IHSS. This is a really, really tiny, tiny part of it.

Are we trying to get at I mean, what are we I didn't I guess I didn't really understand is like, HSS is growing, yes. But this isn't the driving factor for it. Is it that this is just the the only way we can do some cuts since we can't cut people from being eligible for HSS?

As I said previously, the vision here is really around accuracy and Fidelity, and consistency across the state for the assessments. As we continue to have sort of broader conversations with the legislature about the overall general condition and efforts to address that.

We look forward to continued conversations on options to achieve those goals on budget resiliency moving forward.

Deputy Director, what can you share that would be considered in the baseline? In establishing the baseline?

With regards to the work with the counties, sure. So I would not knowing how that process would necessarily work, we would look at the data across the program, what the hours are currently, what they are per case, and, come up with some type of methodology with the

counties to determine what that baseline would be. And then probably figure out together with everybody else about the any type of growth factor or whatnot as in the out years that would be all part of that conversation.

Are there any parameters you're already thinking about to include into consideration?

Currently, no. We bake we do a basic calculation today. So when you see us put out average authorized hours per case, we're lit it's just a math exercise. Right? So it's that number of hours divided by the number of people and that gets your average.

I do anticipate that this will be, a bit different considering we need to provide flexibility. We need to ensure people get the serve the services that they need. We also need to also provide flexibility for our counties as well.

And obviously, we know that the Senate plan has already proposed to reject this and I know negotiations are still happening. But this trailer boat doesn't go into effect now. It's missing a lot of information.

I would prefer and as you know, the Senate plan would prefer if there needs to be a change that stakeholders have those conversations first and come back to the legislature with an actual detailed plan. There's so many unknowns in this proposal.

Like I mentioned, it's a MOE. So we're looking at the MOE consideration of that. This has been in place since 2019. The MOE has been in place in 2019 and a lot has changed with that. I recognize that the state has less support from the Federal Government.

I do recognize that that maybe, you know, everybody has to step a little bit, step up a little bit. But I think this is a side step and I think it's just a unfun creative way to get around the MOE without actually looking at the MOE and establishing and both parties are unhappy about it.

I do recognize that that maybe, you know, everybody has to step a little bit, step up a little bit. But I think this is a side step and I think it's just a unfun creative way to get around the MOE without actually looking at the MOE and establishing and both parties are unhappy about it.

Okay. And then just, just to clarify, because I'm still stuck on the 800,000,000 potential savings and so forth. In May, we'll have more of an accurate number of the potential savings here.

Pardon me? Yeah. It's noted by my colleague. I think we sort of are looking at updated sort of fiscals that would be sort of true to the language put forward in the TBL. Okay.

Okay. Okay. Justice in Aging, I know I cut you off a little bit. I just wanted to see if there's anything else after these questions that were asked that you'd like to add here.

I think our main concern from Justice in Aging is this narrative around incentivizing accurate assessments that are really within the parameters of the current tool being used.

It sounds like the state already has a way of reviewing accuracy of those assessments, and they should be continuing doing those reviews for accuracy and ensuring that when a person gets assessed for hours, they're able to access those hours.

The impact on older adults is particularly severe for this proposal, because any sort of incentivized cutting in hours is going to be mostly falling on older adults, particularly because they don't have any sort of other backup system that can catch them, like the IDD regional center system.

And so, we do want to highlight that the

It might be sent to more expensive.

Yes. So, yes. Because there's no other place for them to go. So there's going to be an increased utilization of both hospitals and nursing facilities when those nursing facilities are available. Okay.

Thank you.

Okay. That's on the first issue. Director, if you can give the proposal on the second one.

The second proposal that the agenda highlights in the governor's budget is to eliminate the In-Home Supportive Services backup provider system.

This backup provider system, this permanent statewide one, was established in 2022 as a replacement for a temporary system, which we had created during the COVID-19 pandemic.

The intent is to allow eligible recipients to receive up to eighty hours of backup services per year, with the option to grant an additional eighty hours in very exceptional 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.

The governor's budget proposes to reduce general fund costs by 3 and a half million dollars by eliminating this system beginning in 2026-27.

Program data shows that the backup provider system is significantly underutilized. Although requests for backup providers and utilization of enhanced funding were expected to grow as counties implemented their systems, that growth has not occurred.

In addition, administrative costs far exceed the actual cost of services. We estimated the associated general fund savings by projecting the cost that would have been incurred had the program remained in place.

The projections include both services and administration costs, and assume consistent year-over-year growth comparable to other IHSS programs.

The estimated savings really reflect the elimination of the projected program and admin costs resulting from the elimination of the program. You asked about how the program works today.

And the answer to that is that IHSS recipients or their authorized representatives can contact their county IHSS office or the public authority when they need a backup provider in insists where their current provider is unavailable for unforeseen reasons or their being

discharged from the hospital or a nursing facility and they have not had the opportunity to hire a provider.

Once the county receives the request they try to find a provider to work for the recipient as a backup provider. The backup providers receive $2 an hour in pay differential for providing those backup services.

It's important to note that this takes extensive effort on the counties and public authority part to undertake to locate a backup provider and that seems to be a significant factor in driving the low utilization.

You also asked what would be the outcomes of eliminating the system and what options IHSS consumers would have in the absence of the backup provider system.

Many counties had established backup provider systems before we implemented the statewide program during Covid. Additionally, public authorities have generally provided assistance with locating backup providers for recipients when they reach out.

Given the low utilization and high administrative costs, eliminating the backup provider system will essentially allow counties to return to using their prior backup systems, many of which existed before that permanent program was implemented.

Counties without a previous system can hopefully use the existing infrastructure to develop any replacement models that are needed to fit their needs. They could also use contract mode or county home maker mode as alternative ways to Identify needed backup services.

Anything to add Department of Finance? LAO?

Juwan Trotter, Legislative Analyst Office. So as was noted by the administration, compared to the initial conception of the backup provider program, this program has not been widely utilized.

Further, given the current budget challenges facing the state, the legislature may wish to consider the trade-offs associated with this proposal. And to help better consider those trade-offs, the legislature may wish to ask the administration the following questions.

One, is there a way to reduce administrative cost of of the program while maintaining a version the statewide backup program. And two, as had the administration noted. Many counties have and continue to operate local backup provider program outside the state system.

So should the legislature choose to accept the governor's proposal you may wish to ask the administration if there are ways to for the sake of kind, better support these local programs.

Thank you. Okay. Coming back to you, Carlos.

Carlos Marquez, on behalf of the County Welfare Directors Association. CWDA supports the Senate's plan to reject the proposed elimination of the IHSS backup provider system, or BUPS.

The governor's proposal would dismantle a critical safety net for IHSS recipients who rely on uninterrupted care to remain safely in their homes. BUPS exists to prevent dangerous gaps in care when a regular provider is unavailable due to unforeseen circumstances.

Those with the most complex care needs would be hit hardest, facing increased health risks and avoidable hospitalizations. According to a survey by the California Association of Public Authorities in FY 24-25, more than 4,100 requests were submitted statewide, and nearly 2,500 were successfully filled.

These numbers are likely understood as data from all 58 counties. This data should be understood as not representing all 58 counties, I should say. The administration has cited low utilization as justification for eliminating BUPS.

However, county and public authority staff report the utilization challenges are often driven by limited availability of backup providers. Rural communities in particular face significant provider shortages, as well as longer travel distances and wage competition from other sectors.

As a result, individuals leaving hospitals or skilled nursing facilities in rural areas may lose access to immediate care if no provider can be found on short notice.

It is also important to note that BUPS funding was already reduced by 3,000,000 general fund in 24-25 to true up funding for program utilization. Rather than eliminating BUPS, CWDA encourages the exploration of targeted improvements to address utilization concerns.

And then Justice in Aging.

IHSS consumers rely on their providers to show up to work day in and day out to assist with activities of daily living that we all require to live in our homes.

When providers are not able to come to work due, for example, to a personal emergency like illness of a child or a spouse, IHSS recipients must scramble to find a backup. When there's no one, IHSS recipients, particularly the many older adult recipients who live alone at home, must go without care.

Let's be clear about what it means to go without care. For an older adult who is bedbound, this means not being able to use the restroom or have their soiled sheets changed.

It means going without water or without food. And we know that when people go without their caregiving needs, there are increased risks of harm, higher risk of missed medications, falls, illness, hospitalization, institutional placement, and sometimes death.

Understanding what is at stake, the backup provider system first became mandatory for counties in 2023, but it can hardly be called a system.

County public authorities are simply required to provide consumers with a list of registered backup providers, and consumers must call these providers one after another until identifying a provider that is both available and able to provide the needed care tasks.

Residents in large counties that had backup provider systems prior to 2023 may have better luck, but many simply must go without the care they need.

So it's no wonder that utilization is currently low. For many, it's simply too challenging to find a provider in this way and on short notice. But low utilization does not reflect the need. Those consumers who manage to use the system often express gratitude for its existence.

But many consumers consistently speak about frustration about the need for an accessible system and about fear of being without a caregiver. California has taken the first step in 2023 in mandating counties to have backup provider registries.

Now, a couple of years later, it's time to revisit. Rather than eliminating a faulty but critical system in the face of low utilization, the CDSS and legislature must go back and look at what changes and enhancements must be made to ensure that older adults and people with disabilities who

rely on IHSS don't have to go without care. We urge you to reject this proposal.

Thank you. Director, sorry. I have one final question on the other one. On the previous topic we just, do we have any information on any common or demographic commonalities on who has above or below statewide average for hours? Maybe Deputy Director, do we have that?

By county or by individual? So

More like, is there, are we seeing more above the statewide average in hours for IDD population? Is it for seniors? Is it for adults, IDD, minors?

So minor kids with protective supervision are gonna be on the higher part of the scale. Right? Because they have protective supervision. Same with protective supervision clients. People with high physical needs.

We do see, we have noted across counties, there are lots of counties lower and lots of counties higher than the average authorized hours.

But the same demographic, though.

But they have different demographics. So, like in the case of Placer County, their caseload is made up of like 25% of minor children. So their hours are often much, much higher than another county that doesn't have that demographic.

So across counties, the demographics change. Their authorized hours change. The average authorized hours change based on that. But when we look at the state as a whole, we take all of that into consideration and just do one basic calculation.

Okay So I'm just so struggling with, like, even how do you take that into consideration with the statewide? If, like, I'm struggling to find how we're gonna come up with a good statewide baseline when some counties are so skewed that way. That's

Yes. And it does make it difficult.

Right.

And that's, I think the hope is, working with the county partners should this proposal move forward, that we would want to find some middle ground there that gives them flexibility but also helps get those more accurate assessments. So I think that's really our intent.

Okay. On the backup provider county, this isn't the first time that the program has come up and shared the underutilization of this program in particular. So this isn't brand new news to us. But since then, nothing has happened, and we continue to have underutilization of these programs.

I'm wondering what more the county can do, knowing that this is an ongoing issue, because I've sat here on other programs and have judged the departments on why they're asking for more money on admin and not a lot of funds for services.

This program in particular is 4,200,000 for admin and only 298,000 for services. Really unbalanced. So what has the county done to address the underutilization?

Well, I appreciate the question. I think we are looking forward to working with the administration to understand at the county level what the expenditure data actually looks like.

It's a pending request, and I think it's gonna be really instructive for the conversations moving forward in terms of what efficiencies we can help, you know, really spearhead at the county level. But it is important to note that if the BUPS system were to be eliminated today, not every county.

In fact, the overwhelming majority of counties don't have their own backup provider system, short of just a few large counties.

And, I'd love, maybe if Justice in Aging, you can answer this question to Michelle. I'm hearing people will call in and they're giving potentially maybe a long list. Like, what is the process when someone calls in?

And do the counties have an adequate list of people who actually are backup providers that really are working? Because the data shows that most of them go unfulfilled. Michelle, if you can

I actually was with the IHSS Alameda County advisory board as chair for about 14 years, years ago. And this came up quite a bit, with not being able to have access to the backup providers.

You show that there's not adequate use of it, and so that's always on the chopping block to be cut. Although, from my experience and my understanding of the program, most consumers don't know it exists.

And most consumers don't know that they can utilize it when their provider isn't there available. And as far as the lists normally that are provided by the public authority, at least in Alameda County, are normally for new providers to get a new provider for a consumer;

their lists are given out and not necessarily for backup. In fact, as far as I knew, the backup provider in my county was cut a long time ago. So I don't know if that's true still, but it had been because of underutilization. So, I can't say if that's true today.

This program has been in effect for about five years, and it's been struggling since. It takes a coalition to do the awareness, and I recognize the Senate plan is rejecting it. But it's still a little hard to justify that given the ongoing underutilization. Is, yes, is it an awareness thing? Yes.

But it's been five years, and each time that it's proposed for cuts, nothing changes past that. So it can't be just a matter of continuing to fund it and watch it be underutilized without anyone putting actual changes into it. If you can add a little bit more to that.

Sure. I think we do a lot of consumer education and partner education. We've done education about the backup provider system. But at the end of the day, knowing that there is a backup provider system is a different thing than knowing how to access it.

Every county is different. Every county has got a different number and a different methodology.

And I think the biggest difficulty in this backup provider system is how much burden it puts on the consumer in an independent provider system to actually identify and coordinate that care on an emergency, last-minute basis.

And so the underlying difficulty here is the lack of real case management, identification, and dispatching of a backup provider.

What is the most, I mean, of 4,200,000, what does that cover?

So I think really rethinking the way this operates in a way that meets that emergency urgent need for the consumer and also the limited capacity that a lot of consumers have and coordinating last minute care. Is going to really improve the program.

Director and Department of Finance is there a way to keep this program afloat with cutting admin costs?

So I think we're open to having conversations with the legislature about how to efficiently administer a backup provider system.

What is the most, 4.2 million, what does that cover?

I think that covers both the county and the public authority admin cost. I don't have details beyond that.

Anybody? Like, what is the admin like?

So it covers the cost, and those costs have been subsequently reduced after we did the initial implementation. They've been reduced, so we know that. That covers

So it's not 4.2?

No. It is 4.2, but it was something higher before that. It covers the cost for the public authorities and the counties to administer the program, which is the piece of finding a provider, the part of getting somebody enrolled as a provider, as a backup provider.

And also on the county side, the county side does work to hook the provider and the recipient together so that the person can get paid the differential. So that is supposed to cover those costs. Oh.

But it's not doing that part. Like, the people aren't finding those backup providers for the recipient.

So I can tell you from my own personal experience, because these come to me sometimes when somebody needs a backup provider, and I have to do the work with the county. A lot of times it's when the request comes. So I had one that happened on Christmas Eve.

And that one we could not find. So the county did, in that case, did call every provider themselves, to try to get somebody. They spent hours on it I had called as many people as I could and then I had to actually reach out over because the individual recipient was on a waver.

So we were able to reach out to DHCS and get a contract provider from the waver side to cover the services. That's the kind of difficulties that we have with this program in particular. I think it's that level of effort. I don't think some counties may just be giving lists.

Other counties are trying to call people on the list, but if you get a Christmas Eve, a weekend, a late night, I think that becomes very difficult to find somebody. And I think that's one of the, when we look at this program, how do we resolve that?

I just wanted to add that I think it's important how we how we define utilization. Because if the calls are being made through the provider list, and these are providers who are specifically able to provide personal care services, and a successful placement isn't made

because the provider is not available, or the provider is sent out and the consumer has decided for one reason or another that they are not happy with that provider, certainly, the utilization numbers might look low. Right? But the calls were made.

You know, the registry was accessed and exhausted, and a successful placement was yet not made depending on the timing or the preferences of the consumer, which are critically important because you have to imagine folks are, like, dealing with someone who is

different from their traditional provider, unless they're leaving the hospital or urgent care or something, in which case they've never had a provider.

That's a good point. Do we track that? Do we have. I know the utilization tracks the actual fulfillment of it but do we track how many people.

There is no way to track the requests. Only we track when people get paid for backup provider systems, but I do want to make sure there is a difference. Because I know we've gone, we've had conversations in particular with CAPA about the data.

Because counties are using backup provider systems that are outside of this program. So this the state funded backup provider system but other counties like San Francisco. They get, their data is added in sometimes to the numbers and they are actually using a different model.

So they actually use their home bridge contractor to do this work. And so that is outside of, we would not know who those individuals are. It is the same thing with Los Angeles County.

They've had their backup attendant provider program for a long time, much longer than this program has been implemented. So those systems, if that data is being added in here, it's a little, we're not apples to apples.

Right? So for us, I think that's sometimes something that we talk with CAPA and the counties about a bit on the data piece.

Okay. So we don't know if this is clean data on just our state run. Okay.

Yeah. We know that these are the folks that got paid as a backup provider. We know the hours they were paid, and we know all of that data, but we don't know if that person had made a request, that recipient made a request two or three times before they got a provider.

We would not know that information.

Do we know if there's capacity for CAPA, CAPA? CAPA to collect the data of the amount of calls to request this?

I would not be able to speak for CAPA.

That's the state agency for the public authorities.

Okay.

Okay.

The public authorities.

There's someone here in the audience from them. Put them on the spot. Do you have do you have the ability to collect that data? Or do you track that?

We track the data. We track 4,100 calls made in fiscal year 24-25. And of those 2,400 or 4,100 calls, the, 2,482, requests were fulfilled. So it's roughly 2,500. So I did surveys more

or less.

Yeah. A little over 50.

A little over 50%.

I surveyed each of the public authority directors. Now, there are couple counties that are not members of the, Association of Public Authorities. So I did not receive their information. I'm sure we can reach out to them separately. But we did do, a survey and I have shared, that data.

So I'm happy to resend it. Thank you. Sure.

Thank you.

We get everyone involved in these conversations. Okay. Thank you, for on that second one. Move on to the third one.

The final proposal for this panel's discussion is related to aligning the IHS terminations with Medi Cal Terminations. And you've asked a number of questions about that proposal. The proposal to align those terminations is meant to automate work that counties are currently responsible for performing manually to ensure that IHSS eligibility is tied to medical eligibility. The governor's budget assumes $86,000,000 in general fund reduction as a result of that more consistent alignment of the timing of Medi Cal coverage with IHSS eligibility beginning in 2627.

As a foundation, I think it's helpful to emphasize that IHSS is a service of Medi Cal.

When a recipient does not complete Medi Cal redetermination and they are no longer eligible for Medi Cal, they also become ineligible for all Medi Cal services including IHSS. Under current rules, individuals qualify for the IHSS residual program only if they receive state funded Medi Cal or in a limited number of other circumstances.

Even though it is currently happening in some counties because of the manual work, it is not allowable under current state law or policy for individuals to be served in the residual program at general fund only expense because they did not complete a Medi Cal redetermination. When individuals are served in IHS residual after they've lost Medi Cal eligibility by not completing a redetermination, the state cannot later recover federal funding once they restore Medi Cal eligibility, which most recipients do do.

So the goal of this proposal is to automate implementation of the current state law about Medi Cal and IHSS eligibility being aligned.

The proposal has the effect of temporarily pausing IHSS services while recipients must restore Medi Cal Eligibility. Once Medi Cal's reestablished, the individual's IHSS eligibility would also be automatically reinstated. Automation of both the termination and the reinstatement streamlines what is now a manual process and brings implementation of the program rules into compliance with existing law. Although we understand the concerns people have with pausing IHSS services while the IHSS recipients complete the Medi Cal redetermination process.

We'd also note that aligning the implementation of Medi Cal and IHSS eligibility policies will increase recipients' understanding that IHSS is a service they receive as a part of Medi Cal.

Making the link between Medi Cal and IHSS eligibility implementation more timely and consistent may encourage more timely completion of Medi Cal redeterminations that result in recipients maintaining their eligibility in healthcare services and the state getting better federal matching funds. We estimate the associated general fund savings from this proposal by projecting the number of individuals who may otherwise be served in IHSS residual at general fund only cost and lose Medicaid matching funds in the absence of the proposal.

The savings are calculated based on the projected increase in individuals retaining or regaining eligibility for federal matching funds as a result of the automated disenrollment and retroactive reinstatement process. The proposal is not expected to result in net program cost changes, but rather a fund shift from the general fund to increased federal reimbursement.

Anything to add? Department of Finance, nothing to add at this time. Thank you.

Jawan Trotter, LAO. I'll begin my comments by noting that this proposal has come before the legislature several times before and so far been rejected each time. With that in mind, we have posed a range of options for alternatives to this proposal. The other ones have been listening to the agenda, but one of the alternatives I would emphasize here, which can be implemented instead of or alongside the government's proposal, is to improve communication with recipients.

Currently, when a recipient is informed that they are that they may be terminated from Medi Cal, it is not made explicitly clear that they may also result in a loss of IHSS services. The state could work to ensure that recipients understand as the director said that IHSS is a benefit of Medi Cal and by losing Medi Cal eligibility they may be at risk of losing IHSS services.

However, we would also emphasize that this or any other alternative to the governor's proposal will likely result in differing savings estimates or may result in kind of increased costs. We would also emphasize that as the agenda mentions, the administration savings estimates at the time of governor's budget assume that roughly 10,000 individuals would lose IHSS as a result of this proposal and that a hundred percent of those individuals will regain medical and IHSS IHSS eligibility within the nine days of termination.

However, we have since heard that from the administration that both the estimated number of individuals impacted by this proposal and the percentage of individuals expected to regain Medi Cal and thus IHSS IHS services, may be updated at the time of May revision.

So as such the estimated savings associated with this proposal, may also be expected to be updated at May revision.

Okay.

CWD. Carlos Marquez on behalf of the County Welfare Directors Association. Under this proposal, individuals would lose IHSS services whenever Medi Cal is discontinued. County staff report that people fall into residual for mostly procedural reasons such as incomplete paperwork and missed notices. We appreciate the department's engagement and the effort to design automation that may reduce county workload.

However, we maintain two outstanding concerns. First, the automation is not complete, and additional needed changes are not yet confirmed. Second, automation changes alone do not adequately address the risk of service disruption. Counties are committed, to preventing the loss of Medi Cal and IHSS. Even short gaps in healthcare and in home support services come with serious consequences to health and safety.

These impacts are amplified in rural areas where geographic isolation, provider shortages, and limited infrastructure already strain access to care. Rural IHSS recipients often face limited Internet access, mail delays, and transportation challenges, for example.

To preserver to preserve continuity of care, CWDA recommends additional safeguards to strengthen the legislature's response to the governor's proposal, including targeted funding for counties to assist with Medi Cal Redeterminations and rapid reprocessing, added CMIPs functionality, including automatic reinstatement of an IHSS provider when Medi Cal is restored, and advance reports to our staff identifying IHSS recipients with upcoming Medi Cal Redeterminations for additional outreach.

We welcome additional discussion with the administration and the legislature as well as our consumer advocate partners on these safeguards to prevent gaps in care. Thank you.

Thank you.

Every month, a couple of thousand IHSS recipients are moved automatically from federally funded IHSS to state funded, IHSS residual program because they did not fill out their medical redetermination paperwork on time. These individuals may not realize that they're in medical or that their IHSS is a medical service. They may have difficulty reading their mail or responding to it and may require additional time to find someone to help them.

And when their Medi Cal is terminated, they may not know how to appeal on time or may not be aware that they can keep their IHSS under the policy of aid paid pending while appeal while they appeal and finish the redetermination process. Removing IHSSR is a safety net for these individuals saves the state money, but it does nothing to remove the administrative burdens and hurdles that cause IHSS recipients to lose their medical at redetermination and necessitated the safety net to begin with.

The state could, in fact, save the same amount of money by simply helping the subset of IHSS recipients that require the IHSS, our safety net, to not lose their medical coverage. For example, CDSS, together with the Department of Health Care Services, can add a notice together with medical redetermination paperwork, informing IHSS users of the risk to IHSS of not filling out the paperwork on time.

The department can work together to issue a notice about the risk to IHSS together with a Medi Cal termination notice of action. CDSS can provide clear language at the top of its IHSS notice about how to receive aid paid pending an appeal, which would preserve federally funded IHSS services. And the department can add reading and responding to mail as a reimbursed IHSS service to the subset of individuals who require it.

We have provided this committee with proposed trailer bill language that takes these preventative steps aimed at helping IHSS participants maintain their Medi Cal and IHSS, access aid paid pending when they don't, and add additional support to remove barriers with reading and responding to mail. We urge you to consider this alternate strategy, which addresses budgetary concerns by ensuring California maximizes its federal matching without impacting IHSS recipients access to care. Thank you.

Thank you so much. Director, so currently there's no statutory limit on how long an IHSS recipient can remain on the residual program. And so, does that mean like they never have to get back on Medi Cal? And then we just paid for it continuously on the residual program?

So I wanna be clear that there are different populations in the residual program. For example, there are individuals in the residual program who receive state funded medical, state only funded medical by design as a state as a matter of state law. There's no time limitation on their presence in the residual program so long as they are eligible for state only Medi Cal. They're eligible for the residual program.

It's a little confusing to say that there's no time limit on individuals remaining in the residual program because they lost Medi Cal due to their redetermination.

They're not eligible to be in the residual program in the first place. So no, there's no time limit on their placement in it because they are not actually eligible to be in it.

They're not eligible? They're not eligible at all.

So there's no time limit in state law because state law doesn't allow for them to be served. If they're not. Through the residual program. If they're not eligible for Medi Cal, they lose their IHSS.

So they, I'm struggling. I know I understand. I'm sorry, director.

So the the Medi Cal and IHSS automation systems are not the same. So we have over time, originally IHSS was not a benefit of Medi Cal. As time proceeded and IHSS became a medical benefit, eligibility for IHSS is now aligned with eligibility for medical. However, when you lose your medical because you don't complete the redetermination process, you get terminated on the Medi Cal side in their automation system from Medi Cal. On the IHSS side, it's not automatic.

The counties have to manually

How do we do it?

Terminate your IHSS eligibility until you restore it. Hopefully, if you are still eligible.

Ninety days hopefully.

Yes. You have ninety days to restore it. But as soon as you lost your Medi Cal, you also should lose your IHSS. But it is a manual process and it is not happening consistently across the state.

So some do it? Individuals yes. Some do. Individuals automatically fall to residual because they're not eligible for medical and federal funding. And the only other place in our automation system for them to be is in the residual program.

They're not eligible to be there if they've lost their Medi Cal until they get their Medi Cal restored. It's just that the county has not yet taken the manual step of removing them.

Okay. Okay. And of the people that we see and I know we're going to get updated numbers. Is it going to be less than 10,000 or more than 10,000? I did the opposite.

Less or?

Go ahead, Kia. Sure. Trying to further advise.

So we are looking at we are updating the looking at that and updating that. And, well, you'll see here.

Do we know if it's less or high? We know but we're not saying.

So, I think it's fair. I I don't deal in estimates. Everybody knows I don't talk about money, but we see three

You're in a budget hearing, ma'am.

I know. I know. I was trying not to but we see about three to 6,000 people falling off of Medi Cal every month for this reason. So that's the the universe.

Falling out of Medi Cal. Yeah. So meaning For what reason? They for failure to, oh, redetermination. Yeah.

Yeah. And so that's the universe. So we see that every every month that happens, we get a file from

But not everyone has IHSS.

No. Those are just IHSS.

Oh, those are just Oh.

Yeah. So those are that so it's around 6,000 people now per month that did not complete their paperwork for on the medical side. And now, they've lost their medical eligibility and now they're falling into residual.

So it's about three to six. About 6,000.

Okay.

So it's six about 6,000? In the different individuals per month. Yes. Correct. Alright.

And so the 10,000 was annually? How do we? That's very off.

I'm not, I can't speak.

But I can say though that the majority of those folks cure their Medi Cal within the ninety days. And we're actually seeing the most of them cure within thirty days.

Uh-huh.

Because and we and we know this anecdotally because if they didn't, the residual program would be off the charts in growth. Right? It's not. It's staying around the same. So the majority of folks who lose their Medi Cal are regaining their Medi Cal within that that ninety day cure period and that's what we're seeing.

I think they're updating the estimates based on some of that information. I couldn't speak to whether it's gonna what how it's gonna impact the savings.

It sounds like it's gonna be a drastically higher number. If if it's 6,000 per month and the average was 10,000 that are gonna be impacted. I mean, and the number was 10,000.

I think this might be a better conversation after you've seen, the numbers in the May revision. Because I think we've also, looked at revising how we did the estimate based on, more information being available. Okay.

I just wanna also emphasize though that the difference is that while individuals are being served in residual even though they're not eligible for it, they're being served there. We are paying general fund only for those services. Right. We

And if they regain medical eligibility, we cannot go back and claim the federal funding. Instead, if they are not served in residual, if they are terminated as, it is designed under state law, and they regain their eligibility within a few days within ninety days, we go back to the feds and we can claim that federal funding retroactively for that time. So we are losing that federal funding by serving them And

don't give any more.

during that time, do they get to still have their IHSS hours? They do still have IHSS but not medical because Okay. So, if this were to move forward, an individual would get kicked off of medical. In that moment, lose their IHSS hours. But the but the provider will still be able to provide services to the recipient?

If they cure their Medi Cal and become eligible again for Medi Cal, we can still pay for those hours.

They do have to become eligible again for Medi Cal.

I mean, I think that's true. It's retroactive. You they get retroactive pay. You're still asking a low income IHSS provider to provide care for free. Right.

So in that moment, they wouldn't get. Pay until that money comes back.

Right. And and I think this is why our position is that the state

And it could be a whole month of no pay.

Right.

Or three months of no pay. Yeah.

And they don't necessarily get back pay. If they're cut off both services, that provider had if they don't notify the consumer, which I've had a friend this last year happened to. The not only are they cut off their medical, they cut off IHSS and then and they're not told about it till a later date where the provider has already provided services and ineligible for pay.

But but they do get back pay?

Not not if they've been cut off until they reinitiate their service.

But when they reinitiate, they get the pay the they get the pay of the services that were already provided.

Yes. They can't but does it always happen?

How do you get the payback? It's a good question.

So so the way it works today in in counties that are doing this work. So the file comes through from DHCS. It says this person's losing their Medi Cal save. They got it June 1. So the counties goes in and they terminate IHSS effective June 1.

The person gets a notice of action from DHCS, from the medical side of the house. They get a notice of action from from the IHSS side of the house. So what happens is is when that person cures their medical, we get notice of that. And we send a task to a social worker that says, hey, this person's medical was restored.

Then the the social worker is supposed to go back in and retroactively based on that medical eligibility, it should go back to the date they were terminated as long as within the ninety days.

And then the social work goes back and and resends that termination of IHSS and puts it back into place as of that date of termination. And so the the social workers and that's why we're trying to automate a lot of this because you can imagine it's a lot of work going, calling somebody and letting somebody, you know, and working all of that part out.

So that and then once they resend that termination, the recipient gets another notice of action that says your your services have been restored. Here's your hours. And that's the process today.

And and right now, but right now, we're just paying under the residual. Everyone goes into the residual.

Not everyone. Some counties are doing the manual work to terminate people's eligibility for HSS when they also terminate their eligibility for Medi Cal. So we do not have consistency statewide because there is no statewide program that is supposed to be serving people in this way. Our direction to the counties is manually terminate eligibility. It is not happening consistently across the state.

So in many places across the state, people are being served an IHS residual and there are varying lengths of time. Before the county then completes that manual work. It's not consistent, because again it's not a policy. It's it's just what's happening.

So at various points, people do eventually get terminated from IHSS if they have lost their Medi Cal. It depends when the county catches up to that manual work. We are also proposing to automate the reinstatement. So it would no longer depend on a social worker. To go into actually going in to reinstate. So this would become an automatic.

If you lost your Medi Cal, you automatically lose IHS. But if you regain your Medi Cal, you also automatically regain

Where's the Automation gonna go in.

Upon approval of the proposal. So the automation has been completed. It's something that we've had, waiting. We we have not deployed it.

What is automation part of the TBL? I I didn't see the automation. So what do you mean upon approval? What's approval?

So once this proposal is approved, we can turn the automation on.

The information technology system is already ready to

do this. We are Okay. Waiting on, yeah. Sorry.

Are you able to share if you have any information on the counties that already do this proposal that the department is proposing? And if you have any background on the providers that are working without the pay until the federal back pay comes in.

Yep. Tiffany White in SEIU California. The workers will work no matter what. They will show up each and every time and they work. Oftentimes, they do get the back pay, but to just as an agent's point, they can work one month to three months without the pay and then they have to get reimbursed.

And you can only imagine the hardship of an individual that has to wait that time in order for it to get reimbursed. I'm not sure on the data by county but

Uh-huh. Our workers will This is a random random question. If they go into our program, I know the federal can't reimburse us. Is there a loan we can give to the counties to pay and then they get and we get that back while providers are paying, working for free. Is there a creative way that we can give money to a county and collect that back once the Federal Government kicks in?

I'm just trying to find, just to not have people pay for work for free. I understand. I I understand the proposal. I get the proposal. It's just the people that are working for one to three months for free.

They get back pay but in that meantime. Yeah. Are there creative ways It was a random I don't even know if that's legal. I don't even know. But I'm just like, is it just do they need a loan for the time being?

I don't correct me if I'm wrong, department. But I don't think that there's anything like that, like, that exists. But if the legislature is interested.

I just I don't know. I just if we get them if we get the money back

I think part of the challenge here is that we don't know for sure exactly which recipients will cure

their medical medical eligibility within the ninety day period and which will not. So if we that that doesn't mean that we couldn't as a state, if the legislature and governor agreed to it, decide that we were gonna take on the risk of paying either way.

We could stress that.

Whether or not federal funding ultimately comes depends on whether or not the redetermination projects. Process ultimately does get completed and we don't really know that on day one or 30 necessarily.

Right.

And I think to add just a little bit to that too. I think the data right now shows that, the majority of people cure within the thirty days. So there's also this sort of like cost effectiveness, efficiency, you know, that has to be kind of considered if. Okay. Yeah. But under okay.

Yeah. Go ahead. Under the auto terminate proposal, would we still get a ninety day grace period that's consistent with Medi Cal?

So I believe that would still be a cure period. Right?

There would be a still they would there would be an IHSS cure period of ninety days equivalent to Medi Cal's.

Okay. IHSS eligibility eligibility and Medi Cal eligibility are in tandem under current state law and policy. So any period of time in which you could cure your Medi Cal eligibility would also apply to the IHSS program as a service of Medi Cal.

Can I do, yes, Michelle?

Thank you. I my biggest concern about this is is when you're looking at how you're engaging the consumers who's had their, Medi Cal or their Cutoff and That's my next question. Language issues. There's there's, you know, there's a visual divide with a lot of those. People are blind.

They're getting notices of paper. There's other barriers to them being notified in a timely manner or or they just don't get it at all because they've moved or other issues or they have another agency who's doing that renewal paperwork for them. And so, it that's where my concern is is with this proposal and I would I would once again ask you to reject. Thank you.

Director, to kind of to to that point, DHCS is working on, updating information that is being sent out to their Medi Cal consumers, HR 1 changes. Have we talked to them to include a notice that if you lose Medi Cal, you will also lose IHSS? I know that's one of the requests.

Yeah. We have engaged DHCS already. So this is a request and things that we've talked about many times over the years. So we're, they are very amenable to adding that language to their notices. They're recognizing that.

And they're making a lot of changes on their side for the redetermination process itself. So they were very amenable to adding that language. Same for us on our side adding additional language to our NOAA messages to make it more clear to folks On, what it means. Like, why they lost their medic you know, you lost your Medi Cal. Now IHS is a benefit of Medi Cal.

So they'll get two notices that say the same thing. So that's also in we we took that away.

And from from my knowledge, can you address a little bit what Michelle brought up in concerns of the, the way we share information with people? Sure. Sure. So we do issue notices of action in all of

our threshold languages. Okay. So that's English, Spanish, Armenian, Chinese. We're in the process of expanding to an additional five. Okay.

And Medi Cal also provides notices of action in 19 languages. So they're much based on their threshold languages. As far as blind and visually impaired individuals, we do have, different solutions for that for people that they opt into. So we do issue braille notices. We issue large font notices.

We issue electronic notices on a CD or whatever type of media that person requests. So that they can plug into their own systems and and have their system read that notice to them. So we do have those types of things already in place for our noticing.

And before I get back to you, Michelle, I know one of the proposals is I don't know if it's just as an agent's proposal on having that be a coverage. Was it a provider proposal? No. Just kidding. Reading mail.

Reading mail.

Reading mail. This is for the two mail for the Oh, reading mail. Yes. Yeah.

Maybe a minute here. A provider providing these services, why do we need to add reading mail as a service if that's a need? For If

I have 2,000 for 70

Can I get Let me get my question out first?

Sorry. Sorry for the re

If a providers are to care for the needs and then the media need is perhaps reading, why there why does there need to be an added requirement to that be pro as service?

Static task. Transfer to that or Alright. I mean the yeah.

The IHSS program specifically reimburses for services for which the individuals are eligible. So we outline based on what we were talking about before, the functional index tells our need, the hourly task guidelines. Those hourly tasks are prescribed in terms of what it is that we will reimburse for. Okay. And reading mail is not currently a service that you could claim time Okay.

That you have, completed and that it would be reimbursable under the IHSS program.

Okay. Thank you. And then I'll come to you, Michelle.

I think also keeping in mind what the day of a provider looks like. They come into the home, they do a particular task and then they go to the next they they often have more than one consumer that they're working for. And so adding a that as a service is very important. It's not just about reading the mail. It's about helping with responding to it.

So receiving IHS medical redetermination paperwork, for example, would require down and assisting the individual for a significant amount of time in that particular week with responding to that mail. K. Michelle?

Yeah. When I do my medical review, I actually go to the local medical office and have them help me do the paperwork. But for our blind consumers and stuff like that, they're still getting a lot of their stuff in in a in a way that they can't they can't access. They're getting paper in the mail.

And then because there's no requirement for with IHSS for them to be read to, they they're getting paper notices that that they can't respond to because they don't have access to somebody who can read for them.

Okay. Okay. Thank you. Director, I had a question. I'm gonna shift here.

I had a question on I know you gave an update on the CFCO. The action that we did last year. You you mentioned, should I wrote it down? You mentioned the backlog that you're seeing from the counties.

I think my question was, when do we anticipate I think you said like once they address the backlog, it'll be back to normal. Like when do we anticipate

that backlog being addressed? So the the backlog, the overdue reassessments that we started with in, July 2025 was about 24,000 reassessments that were overdue. And in March 2026, we were down to about 5,000. So that gives you a sense of the magnitude of how much they have already worked through the backlog. And that's why the overdue reassessments I had noted decreased by about 79%.

So we are a good chunk of the way through already.

Okay. And Department of Finance, are we on track to the for the full savings? You know, CWDA note, notes or county yeah, counties note, that given the significant progress and timely processing of it, we might not get the full savings we anticipated. So if or maybe director you have that.

I was just gonna say, the the savings are also would materialize to the extent that we are no longer penalized by the Federal Government and there are no penalties to pay. Okay.

What's that?

I would just say

I invoked your name so go ahead.

I think it's important just to make sure the trade off is understood and we don't think it's, transitory. In fact, I don't know that, that director Troy has asserted that that they're certain, that the backlog or or that the, the trade off that we've described for you, which is that intakes have suffered while counties have refocused their staffing on CIVCO reassessments. That's just that's not the that's a theory. Right? That's entirely a theory whether there's a a backlog that will ultimately level out.

What we know is that the program's growth continues to increase, that our intakes are going to ultimately when we're able to get them in a timely manner, they're going to result in more clients, both Cisco and Non Cisco consumers. And we also know that our caseloads per social worker, about 350 to 500 depending on the county. So the fundamentals haven't shifted. And we don't think that the the trade off that you're seeing today, which is intakes have suffered significantly.

The top 15 counties that have been able to reduce their SIF code, backlog, also are the worst in terms of intake timeliness.

We don't think that's transitory. We think that's gonna continue because of the fundamental growth drivers within the program. The lack of staffing and chronic underfunding of the admin of the program.

How often are we evaluating that trend if it's going down? Deputy director.

With regards to applicate intakes or all of it?

Well maybe but the director mentioned you know, we're a good chunk in the way of addressing the the backup.