While on the national front ADAPT has been waging its campaign against the institutional bias in Medicaid that keeps nursing homes flush and disabled people unnecessarily captive in them, Governor Schwarzenegger would like to eliminate California’s In Home Supportive Services program (IHSS) turning back the clock.
The state-only funded IHSS program is a pioneer project that has for over 20 years provided workers for significantly disabled persons to allow us to remain in our homes and communities rather than be shuffled off to some rat infested nursing home.
The Governor’s destructive plan has been fought back at every turn by thousands of disabled persons and the home care workers unions who have pounded the pavement around the state capitol building and linoleum of state office building over the past 6 months to see that our state funded program remains in tact. Protestors have clogged the hallways of legislators’ offices. Many have made grueling all night trips to Sacramento to come out en masse to stop him in his tracks.
Backing down on one front Gov. Schwarzenegger seeks to obtain a federal Independence Plus Waiver to draw down federal financial participation for the program. (Medicaid “Home and Community-Based Services” Waivers make up the overwhelming bulk of community-based long term care expenditures. States have focused on using the Waiver to expand community services. Total Waiver expenditures for 2003 were $18.6 billion, up from $16.3 billion in 2002, up from $12.7 billion in 2000, and up from $8.2 billion in 1997. This means that in the past seven years there has been an increase of 129% in community based expenditures. In the past four years there has been nearly a 47% increase.)
However, the latest proposed trailer bill language put before the legislature gives the Schwarzenegger Administration discretion to fully or partially implement the waiver, meaning that services to consumers could be terminated via emergency regulation or simply by an all-county letter.
The governor plans to save money regardless. There is no money for services but surprise!
The proposal now at hand is to fund the salaries of state workers whose job it will be to cut back disabled people’s hours of service. The governor requests money to fund 18 two-year, full time staff positions for a new IHSS “Quality Assurance Initiative Bureau” to implement a “Quality Assurance Initiative.”
The proposed Initiative is a frontal assault projected to score annual programmatic savings of up to 10%.
The Initiative is based upon the premise that the lack of staff training and effective quality control systems has resulted in over-assessment of hours. There is no recognition that these same deficiencies may have resulted in any under-assessment of hours. Therefore, “quality assurance” is a complete misnomer. The initiative is intended to score programmatic savings by restricting the number of hours authorized.
The stated proposed activities of the “Quality Assurance Initiative Bureau” are designed to assure that consumers receive only the services to which they are entitled, that systems are tightened to control costs, and that program fraud is identified and prevented. These activities are projected to result in annual savings of $246 million!
An estimated 3,000 recipients would lose their protective supervision hours under the Initiative.
The governor also plans to save money by short changing the IHSS workforce. The May Revised Budget maintains the proposal to reduce state participation in provider wages and benefits from $10.10 per hour to the state minimum wage of $6.75 per hour, effective October 1, 2004. The state would continue to provide its share of cost up to $9.50 per hour for wages and 60 cents per hour for benefits through the expiration date of existing collective bargaining agreements. Thereafter, counties would either have to reduce provider wages or backfill the lost state monies with county funds.
Cash-strapped counties can ill afford to restore the lost state share of provider wages and benefits. Local governments are taking a $1.3 billion hit in the budget year. In addition, evidence abounds that prior state funding reductions have already substantially eroded the counties’ safety net.
The anticipated result is that provider wages will be drastically reduced and access to quality IHSS services will be severely impacted.
Meanwhile blow after blow, wave after wave, activists and the SEIU workforce have ardently followed Joe Hill’s words “Don’t Mourn, organize.”
Due to the governor’s refusal to raise taxes on rich people who have greatly benefited from economic activity over the past 10 years, next year’s budget forecast portends more of the same. A 1% tax on the income of people making over one million a year in California could resolve the problem in a New York second.
Marta Russell Los Angeles, CA http://www.martarussell.com