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Receive a presentation on the In-Home Supportive Services Program
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Published Notice Required? Yes ____ No _X _
Public Hearing Required? Yes ____ No _X _
DEPARTMENTAL RECOMMENDATION:
Health and Social Services and the County Administrator’s Office recommend that the Board of Supervisors receive a presentation on the In-Home Supportive Services Program (IHSS) as requested by the Board of Supervisors.
SUMMARY:
During the September 13, 2016 Board of Supervisors meeting, the Board requested a presentation on the IHSS Program including an overview of the program’s purpose and how it was established, how services are paid, and who pays for the services.
IHSS is a California Medi-Cal Program established to provide services that allow certain individuals to remain in their homes rather than in an out-of-home facility. The program includes income eligibility and health certification requirements. Staff in the County’s Older and Disabled Services (ODAS) Bureau within the Public Health Division of Health and Social Services process applications and determine eligible service hours.
The program is paid through a combination of federal, State, and County funds and the share of costs for each has been modified over the history of the program. Prior to FY2012/13, the share of cost was approximately 50% federal, 32.5% State, and 17.5% County. In FY2012/13, Maintenance of Efforts (MOEs) were established with all counties based on each county’s FY2011/12 paid service hours. Under Solano County’s MOE, the County’s most recently calculated share of cost (FY2015/16) was approximately 10.4%. Continuation of the MOE is dependent on the success of the State’s Coordinated Care Initiative (CCI), an initiative to move IHSS services to a managed care model. Each year, the State evaluates the progress of CCI in the 7 pilot program counties.
FINANCIAL IMPACT:
The cost to prepare this report is included in Health and Social Services and the County Administrator’s Office FY2016/17 approved budgets.
DISCUSSION:
The current IHSS program evolved out of the 1950’s Attendant Care Program which was established to enable elderly and disabled consumers who needed assistance to remain safely in their own homes. In the 1970’s the Homemaker Chore Program was added to the Attendant Care Program to provide personal care services and the expanded program is now the IHSS Program. IHSS is a California Medi-Cal program that is funded by a combination of federal, State, and County funds. The purpose of the program is to provide services so that individuals may remain in their homes rather than in an out-of-home facility. To be eligible, individuals must reside in the United States and California, be over 65 years of age; or disabled, including disabled children; or blind; and provide a Health Care Certification Form signed by a physician. IHSS applications and the determination of services and service hours are coordinated through the ODAS. In some cases, the eligible individual may be required to pay a share of costs.
Individuals may be authorized to receive up to 283 hours per month of services. Provider travel time and waiting time are now included in calculating hours. Once a recipient is authorized to receive service hours, the recipient is responsible for hiring his/her provider/s and is considered the employer of the provider/s for the purpose of hiring, supervising, and firing his/her provider. The IHSS Public Authority coordinates a provider caregiver registry, provider and consumer training, and is the employer of record for purposes of collecting bargaining to set provider wages and benefits. Payroll of providers is primarily administered through the State. Providers complete time sheets, mail them to a State processing facility, and receive their pay and a new time sheet from the State processing center. Staff within ODAS assist with payroll issues and the processing of exceptions when payroll corrections are necessary. In 2015, Fair Labor Standards Act overtime rules were implemented for IHSS Providers for hours over 40 hours per week with paid provider hours capped at 66 hours per week.
In FY2012/13, as part of the State budget, MOEs were established for counties based on each county’s FY2011/12 IHSS paid service hours. The MOE’s increase by 3.5 percent annually beginning in FY 2013/14 plus a share of any wages and benefits subsequently negotiated at the county level. In Solano County, the FY2011/12 service hours were 3,388,044. For FY2015/16, Solano County paid service hours were 5,867,593. Hours are projected to increase to 6,573,037 in FY2016/17 based on the current projections formula.
Prior to the MOE, the majority of IHHS costs were funded by a share of costs of approximately 50 percent federal, 32.5 percent State, and 17.5 percent County. For FY2015/16, under the MOE, the share of costs were 54% federal, 35.6% State, and 10.4% County. Continuation of the MOE is tied to the success of the State’s CCI, an initiative to create a managed care system. CCI “success” is evaluated annually by the State and currently involves 7 out of the original 8 pilot counties.
Two additional factors, the passage of SB 1234 which expressed legislative approval of the California Secure Choice Retirement Savings Program; and the dismantling of State operated developmental centers may have future impacts on the IHSS Program. The Secure Choice Retirement Savings Program may include IHHS providers under certain conditions which will require identification of an employer of record to administer the program. The closing of the developmental centers could result in an increase in authorized hours if individuals previously living in developmental centers return to a home-based environment or an increase in other services, such as behavioral health services.
ALTERNATIVES:
The Board could choose not to receive the presentation; however, this is not recommended as an overview of the IHSS Program was requested by the Board.
OTHER AGENCY INVOLVEMENT:
The California State Association of Counties assisted in the preparation of the presentation. Reference materials provided by the California Department of Social Services were used for research purposes in the preparation of the presentation.
CAO RECOMMENDATION:
APPROVE DEPARTMENTAL RECOMMENDATION