One of the programs with much to lose in this year’s budget fight is In-Home Supportive Services, which already has undergone major cutbacks as the strapped state grapples for funds.
But much more than state money is at stake: A potential IHSS reduction in $225 million to the program would have ripple effects.
IHSS is a state and federal Medicaid program that allows disabled and the elderly to be cared for at home in place of being institutionalized or put in convalescent care. There are currently 425,000 people who receive care-related services from IHSS.
But IHSS is not just funded by the state, which only cover’s 32.5 percent of the program. Fully half of IHSS is covered by the federal government, while the remaining 17.5 percent is covered by local county governments.
It’s a three-legged stool: Cut one leg, and the others must be cut proportionately.
“If state funding is reduced, it will also reduce federal and county funds,” said Oscar Ramirez, spokesperson for the state Department of Social Services.
The federal government participates in a system of matched funding with the state. This means that the federal government will partially fund programs or projects with a requirement that the state and local governments step up and provide money, too.
When certain services are eliminated in the IHSS program, not only does the state gain general fund savings, the federal budget will also receive savings. California counties will accrue savings for their general funds. In the end, the combined reductions mean less funding for IHSS.
Gov. Brown has called for the elimination of domestic and related care services for most IHSS patients who live with their care-providers, as well as a 7 percent cut to IHSS hours in addition to the 3.6 percent cut already in place.
The California Budget Project reports that approximately 254,000 individuals could be affected by elimination of domestic and other care services hours.
According to Rebecca Malberg, director of Home Care at Service Employees International Union and United Heath Workers West, the proposed cuts would mean every client that depends on this service would lose 7 percent of their hours.
“And any [careworker] who had a client living with them, they would lose hours they get for what’s called domestic services, which are things like cleaning, bill preparation, laundry,” Malberg said. “It would put people in jeopardy of falling, of malnutrition, and other events that could lead to hospitalization and nursing home treatment.”
The Legislative Analyst’s Office estimated that federal and county funds total $575 million and is the matched funding to the state’s $225 million . In order words, as much as $800 million in state, federal and county funding could be taken out of IHSS if the governor’s proposed cuts for IHSS go through.
However, this scenario is off the table for the moment. The state Assembly and Senate have rejected cutting domestic and related care as well as the additional 7 percent cut to wages across the board.
What will likely happen, observers say, is the state will extend a 3.6 percent across-the-board reduction in hours to IHSS. Originally scheduled to sunset at the end of June, the 3.6 percent cut is seen as mild compared to deeper cuts that Gov. Brown called for in his budget proposal. This will save the general fund $58.9 million.
The state is currently pursuing additional federal funding through the federal Affordable Care Act. If California qualifies, the federal government could shoulder 56 percent of IHSS cost, instead of the50 percent it currently funds, offsetting costs to the state’s general fund.
Malberg said that people in her union are really passionate about having legislature understand why IHSS is so vital.
“We believe any cut to the program is people losing valuable hours of service… so when [IHSS] is threatened with massive cuts, the people who depend on this program to live and who know their quality of life would be remarkably different if they did not have this program,” Malberg said. “And year after year, they have been forced to fight off cuts to this program.”