AB 675

Bill Subjects

Abstract

(1) Existing law provides for the Medi-Cal program, which is administered by the State Department of Health Care Services, under which qualified low-income individuals receive health care services. The Medi-Cal program is, in part, governed by, and funded pursuant to, federal Medicaid program provisions. Existing law provides for the federal Medicare Program, which is a public health insurance program for persons 65 years of age and older and specified persons with disabilities who are under 65 years of age. Existing law, the Coordinated Care Initiative (CCI) , requires the department to seek federal approval pursuant to a Medicare or Medicaid demonstration project or waiver, or a combination thereof, to establish a demonstration project that enables beneficiaries who are dually eligible for the Medi-Cal program and the Medicare Program to receive a continuum of services that maximizes access to, and coordination of, benefits between these programs. Existing law requires, with some exceptions, Medi-Cal beneficiaries who have dual eligibility in the Medi-Cal program and the Medicare Program to be assigned as mandatory enrollees into Medi-Cal managed care health plans for their Medi-Cal benefits in counties participating in the CCI. Existing law conditions implementation of the CCI on whether the Director of Finance estimates that the CCI will generate net General Fund savings, as specified. Existing law, with certain exceptions, specifies those provisions of law that are within the scope of the CCI, including those relating to the demonstration project described above, to become inoperative if this condition is not met. Existing law establishes the county-administered In-Home Supportive Services (IHSS) program, under which qualified aged, blind, and disabled persons are provided with services in order to permit them to remain in their own homes and avoid institutionalization. Existing law requires, as part of the CCI, Medi-Cal long-term services and supports, including IHSS, to be covered services under managed care health plan contracts and to be available only through managed care health plans to beneficiaries residing in the CCI counties, except as specified. This bill would provide that the provision conditioning implementation of the CCI on the above-described estimation by the Director of Finance shall not apply to the requirement that IHSS be a covered service available through managed care health plans in CCI counties, and would continue IHSS as a covered service available through Medi-Cal managed care health plans in those counties. The bill would make conforming changes to related provisions. (2) Existing law permits services to be provided under the IHSS program through the employment of individual providers, a contract between the county and an entity for the provision of services, the creation by the county of a public authority, or a contract between the county and a nonprofit consortium. Under existing law, any public authority created under the IHSS program is deemed to be the employer of in-home support services personnel within the meaning of the Meyers-Milias-Brown Act, which governs local employer-employee relations. Existing law also provides that any nonprofit consortium contracting with a county is deemed the employer of in-home supportive services personnel for the purposes of collective bargaining over wages, hours, and other terms and conditions of employment. Existing law, as part of the CCI, establishes the California In-Home Supportive Services Authority, referred to as the Statewide Authority, and requires the authority to be the entity authorized to meet and confer in good faith regarding wages, benefits, and other terms and conditions of employment with representatives of recognized employee organizations for any individual provider who is employed by a recipient of supportive services, as specified. Existing law establishes the In-Home Supportive Services Fund within the State Treasury. Existing law requires that moneys in the fund be made available, upon appropriation by the Legislature, to the Statewide Authority for the purposes of funding its functions. Existing law establishes, as part of the CCI, the In-Home Supportive Services Employer-Employee Relations Act, which serves to resolve disputes regarding wages, benefits, and other terms and conditions of employment between the Statewide Authority and recognized employee organizations providing in-home supportive services. Under the act, the Statewide Authority is deemed to be the employer of record, for purposes of collective bargaining, of individual providers of in-home supportive services in each county, as specified. This bill would provide that the provision conditioning implementation of the CCI on the above-described estimation by the Director of Finance shall not apply to the provisions establishing the Statewide Authority, the provisions establishing the In-Home Supportive Services Fund, and the IHSS Employer-Employee Relations Act. (3) Existing law requires the state and counties to share the annual cost of providing in-home supportive services, with the state paying to the county 65% of the nonfederal cost and each county paying 35% of the nonfederal cost. Notwithstanding that provision, existing law requires all counties to have a County IHSS Maintenance of Effort (MOE) and requires counties to pay the County IHSS MOE instead of paying the nonfederal share of IHSS costs, as specified. Existing law provides that the County IHSS MOE base year is the 2011–12 state fiscal year and requires the County IHSS MOE from the previous year to be annually adjusted by an inflation factor of 3.5%. Existing law conditions the IHSS MOE requirement on the above-described determination by the Director of Finance. This bill would provide that the provision conditioning implementation of the CCI on the above-described estimation by the Director of Finance shall not apply to the IHSS MOE requirement. The bill would make conforming changes in related provisions. This bill would appropriate $650,000,000 from the General Fund to the department for the purpose of continuing to make IHSS available to Medi-Cal beneficiaries pursuant to these provisions.