Tuesday, October 27, 2009

CDCAN: Counties warn of danger re: Nov. 1 cuts


SACRAMENTO, CALIF (CDCAN) [Updated 10/27/09  2:20 PM  (Pacific Time)  - Several counties – representing both urban and rural areas of the state – have sent official letters to the Schwarzenegger Administration warning of “chaos” for county workers and dire consequences for hundreds of thousands of people who receive and work in the In-Home Supportive Services (IHSS) program if new requirements passed in late July as part of the 2009-2010 revised State Budget, that included mandatory criminal background checks and fingerprinting of all IHSS workers (providers)  that are scheduled to go into effect November 1st, are not delayed. 

The counties have responsibility to administer and implement the program locally under rules, guidelines and direction provided by the Department of Social Services.  The Department of Health Care Services also plays a role in the IHSS program because it oversees the state’s Medicaid program (called “Medi-Cal”) and nearly all of the IHSS program is Medicaid funded. 

Counties said that more direction and information, including translated materials is needed from the California Department of Social Services – the state agency within the Schwarzenegger Administration that oversees statewide the IHSS program that serves over 450,000 children and adults with disabilities – including developmental – and people with mental health needs, the blind and low income seniors, enabling them to live in their own homes with the help of hundreds of thousands of support workers, before implementation of the new requirements can move forward.  Some of the counties warned of the possibility of unsafe conditions for thousands of IHSS recipients and potential lawsuits from both IHSS recipients and workers (providers) if implementation was not delayed. 

Bernadette Lynch, chief of Senior and Adults Services in the Sacramento County Department of Health and Human Services, in her letter to the Department of Social Services, wrote that Sacramento County was “…struggling to meet the November 1, 2009 start date as outlined by the state. In large part, this is due to delays in receiving necessary materials. [from the State] , saying that “…we have no translated materials with which to train the very diverse group of providers in Sacramento County…We do not have a list other than a draft of the criminal convictions that would bar an individual from seeking employment as a care provider….Other difficulties in implementation are caused by a lack of clarity in the requirements themselves.”  
She warned that the implementation problems “ …could result in recipients being left in unsafe situations or that a lack of providers may cause increased levels of institutional care.”

While recent federal court rulings in late June, and earlier this month  stopped two of the major budget reductions to the IHSS program that would have narrowed eligibility and reduced domestic and related services using a little known assessment scoring and ranking tool, and a reduction in state funding toward IHSS worker wages, other reductions – including the new requirements for background checks and fingerprinting of IHSS workers, elimination of the “share of cost buy-out” program – have either gone into effect or will go into effect November 1st.
Those new requirements were originally proposed by Governor Schwarzenegger – and subsequently approved by the Legislature controlled by Democrats in late July, as part of the package of spending cuts and other measures to close what was then a over $23 billion deficit.  The Governor signed the budget bills in late July which also included major permanent cuts to a wide range of health and human services including those impacting Early Start, regional centers, senior programs, Medi-Cal optional benefits and other services, mental health, community colleges and other areas of the state budget. 

The new requirements for IHSS workers and also new requirements for IHSS recipients are contained in ABx4 19 (“x4” stands for 4th special or extraordinary session) that contained provisions to combat fraud and abuse that Legislative Republicans and the Governor demanded be included as part of the budget agreement.  Some of those requirements were similar to legislation authored by State Sen. Abel Maldonado (Republican – Santa Maria).

Concerns Raised Focus of Budget Informational Hearing Wednesday
Those major concerns and problems being reported across the state on the implementation of budget reductions and policy changes to the In-Home Supportive Services (IHSS) program is the focus of a joint hearing of the Assembly Budget Committee and the Senate Budget Subcommittee #3 on Health and Human Services, is scheduled for Wednesday, October 28, 2009, at 1:00 PM at the State Capitol in Room 4202 [see CDCAN website at www.cdcan.us for agenda and previous CDCAN Report for details]

The IHSS budget reductions and program changes – along with major cuts to other health and human service programs including regional centers, Medi-Cal and other areas of the state budget - were made this year as part of the effort by the Legislature and Governor to close a budget gap of over $40  billion in February – and over $23 billion in July. 

County Officials Raise Major Concerns – Warn of “Chaos” and Legal Problems
Mary Goblirsch, branch director of Aging and Adult Services of the Monterey County Department of Social and Employment Services, after listing specific problems and concerns, wrote to the Department of Social Services that “…the manner in which implementation directions have been issued within the past month has created total chaos for IHSS recipients, providers , and county IHSS staff” and urged that the implementation date for the Provider Enrollment Requirements be delayed and that the Department of Social Services provide more clarification and specifics on outstanding issues.

Citing a criticism raised by several other counties of the confusion that they claim is caused by the lack of information from the State, Patrick Duterte, director of the Solano County Health and Social Services Department, writing to the California Department of Social Services said the department  “…has placed the County in an untenable position by requiring changes be made and providing incomplete and inadequate directions for implementation.  It is impossible for the County to provide responsible and thorough customer service to a critically important segment of our population under these circumstances.”

Echoing a concern raised by several other counties, Gary Andrews, deputy director of the Imperial County Department of Social Services, wrote of “serious concerns” that the county has with the November 1, 2009 implementation date of the IHSS worker (provider) requirements.  He cited that the state has not provided forms in languages other than English when “…our population (clients and providers) is approximately 75% Spanish speaking.  If we implement the use of these new forms on November 1, 2009, prior to having them translated into Spanish, 75% of our population will be signing statements under penalty of perjury that they may not completely understand.  This may be in violation of their civil rights and may undermine any prosecution effort in the future if fraud is committed.”

Linda Haugan, assistant county administrator for the Human Services Division of the County of San Bernardino,  concluded her letter to the Department of Social Services saying that the department “…has placed the County in an untenable position by requiring changes be made and providing incomplete and inadequate directions for implementation...the County is in urgent need of clarifications and answers regarding the unresolved issues”  and urged extension of the implementation date “…in view of the potential harm to IHSS customers”. 

Donna Clipperton, supervisor of the IHSS Public Authority of San Luis Obispo County, wrote to the Department of Social Services  that her county “…will not be able to implement the new provider enrollment mandates by the deadline,” because the county has not “…received all of the necessary directives that we need in order to proceed…have not been provided with all the materials needed for the mandated provider orientation, i.e., copies in Spanish,” and noted that “serious legal questions” regarding the new state requirements “have not been addressed”, saying there are conflicting statements on the new provider enrollment form that an individual with a record of “any” felony or a “serious” misdemeanor cannot be an IHSS worker.

Whew! Had enough yet? Stay tuned folks, this is only going to get lamer!

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