State wants counties to pay more for in-home care

Heidi de Marco/ Kaiser Health News

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Gov. Jerry Brown is proposing shifting part of the burden of funding in-home care for low-income seniors and disabled people back to California's counties, a move that the state acknowledges would likely cause the localities "financial hardship and cash flow problems." The counties' statewide association warns that this could force them to slash spending on other programs or services.

The state's 58 counties are facing a collective $626 million annual hit under the governor's proposal, according to his budget blueprint. Since In-Home Supportive Services is a federal entitlement, counties must contribute their share. That means any cuts would have to come from other parts of counties’ budgets. 

"We cannot cut hours or turn people away at the door who apply," says Farrah McDaid Ting, legislative representative for the California State Association of Counties. 

The state assumed part of the counties' cost of running In-Home Supportive Services in 2012. There are some 500,000 Californians who use the program, which is funded with federal, state and county monies.

The move, part of an effort called the Coordinated Care Initiative, was "designed to be a program that would achieve cost savings," says H.D Palmer, deputy director of the state Department of Finance. But due to increased costs, the program is not sustainable, he says, and will be discontinued in the fiscal year that begins July 1.

Palmer points to several factors behind the rise in costs. 

He notes that around 100,000 additional people went on the program in the past five years. In addition, the extension of federal overtime protections to in-home workers pushed up costs, and now California is going to increase the statewide minimum wage.

While acknowledging that shifting the cost burden back to the counties will cause them "financial hardship," Brown's budget plan says the state is prepared to work with counties "to mitigate, to the extent possible, the impact of returning a share of the fiscal responsibility for [In-Home Supportive Services] to counties."

Counties are in danger of being "overwhelmed by these expenses," says Matthew Cate, executive director of the Association of Counties.

"We weren’t surprised" by Brown's proposal, says Cate, "but we were disappointed." To help counties manage the additional financial burden, he says the state should cover the cost of the increased state minimum wage and sick leave provisions implemented in the past five years, and "at least half the overtime."

In southern California, the most populous counties - Los Angeles, Orange and San Diego - "will all take really big hits financially," says Cate.

More than 200,000 people in Los Angeles County alone receive In-Home Supportive Services, according to the county's Department of Public Social Services. The county budgeted more than $600 million for provider services in the fiscal year that ended last summer.

Under the Coordinated Care Initiative, the state also took responsibility for collective bargaining with In-Home Supportive Services workers in seven counties: Los Angeles, Riverside, San Bernardino, San Diego, Santa Clara, San Mateo and Orange. The Initiative's demise would mean those counties would have to once again handle that task.

That could hit in-home support workers in the wallet, because the new costs will leave counties "very little to offer ... workers in the way of wages and benefits," says the Association of Counties' McDaid Ting.

The union that represents in-home caregivers will press to ensure that they "have the best wages and benefits that allow them a quality standard of living," according to SEIU Local 2015 Provisional President Laphonza Butler. "We will continue to work with the Administration and counties to make sure that is the case," she said in a statement.