CHA Blog

The recently proposed budget cuts, particularly those to the In-Home Supportive Services (IHSS) program, will disproportionately affect immigrants and communities of color. Of those people enrolled in IHSS, over 49% of them speak a language other than English at home.

IHSS provides assistance to seniors and individuals with disabilities that enables them to live safely in their home instead of a nursing home. Yet with the proposed budget cuts, over 404,000 seniors and people with disabilities will be cut off from these important benefits. Immigrants and people of color are more likely to live at home and use their IHSS benefits  for personal assistance care (such as help with bathing and eating) than live in a nursing home. In contrast, however, the majority of nursing home patients are white. As over 60% of IHSS recipients aged 65 and older are people of color, the state’s proposed cuts will have a greater, more devastating impact on these communities and their families.

As stated in a recent article from the National Senior Citizens Law Center (NSCLC) on the proposed IHSS cuts, no good alternatives exist for ethnic elders affected by these cuts.  Most people would rather live at home than be isolated and pay the high cost of a nursing home. Also, statistics show that ethnic elders often receive lower quality care in nursing homes than white elders, further contributing to the gap in health disparities and health care equality. In addition, California does not have enough nursing home beds to house all the people who will be cut off from their IHSS benefits if the proposed cuts go through. This means that people who are not able to pay for or find a nursing home for their required assistance with dressing, bathing, preparing food, etc, will be left to fend for themselves. The results can be devastating to ones health, quality of life, or even their ability to live. 

These proposals only offer short-term ‘budget relief’ and would most likely cause a health crisis and undermine the stability of thousands of families who currently care for their vulnerable and elderly immigrant parents and grandparents.

For more information on the proposed cuts, see our recent article:

• Governor Proposes $9 Billion in New Massive Cuts; Entire Programs Targeted for Elimination

For updated information on the California budget, see:

• California Department of Finance
• California Disability Community Action Network
• Health Access
• California Budget Project

This article was edited in part from NSCLC’s article, California Budget Cuts Target Ethnic Elders.

As the Obama Administration is asking Congress to put together a health care reform package by October 2009 to revamp our $2.5 trillion U.S. health care system, much conversation, debate, and research is taking place in Congress. Reuters recently published a good summary article on what’s happening in health care reform in the Senate, House of Representatives and several special interest groups. 

Click here to read the article.

Yesterday June 15th, the Budget Conference Committee of the California Legislature made some severe cuts based on the Governor’s proposals, yet they also largely rejected full-scale eliminations of programs, such as Healthy Families. 

Today June 16th, the Budget Conference Committee will complete its work focusing on proposed cuts to human services, education, higher education, and general government. 

Several big issues to be discussed under human services include the Governor’s proposed cuts he made in May to In-Home Supportive Services, Supplemental Security Income/State Supplementary Payment (SSI/SSP), several Department of Aging programs, community care licensing, and the Cash Assistance Program for Immigrants (CAPI). 

The Budget Conference Committee’s actions, however, are not final. The full Assembly and State Senate must give their final approval to any budget choices that the legislative leaders and the Governor make – which is predicted to happen before the end of this month. 

Below is a summary of some of the budget decisions made yesterday, Monday June 15th, according to Health Access: 

• A $1 billion cut in Medi-Cal as part of the Governor’s flexibility and stabilization negotiations with the federal government.
• A $70 million cut to Healthy Families, which would establish a waiting list for children to receive coverage, unless other sources of funding or donations were made. (For example, last year, the First Five Commission provided $17 million to Healthy Families to prevent a waiting list from being established, but this year’s proposed cuts present a significantly bigger funding gap.)  Without additional assistance, a $70 million cut could mean that no new children can enroll in  the Healthy Families program for an extended time, denying well over 200,000 children coverage.
• The rejection of the elimination of Medi-Cal coverage for legal immigrants, both legally residing and those with PRUCOL status.
• A 30% cut to state funding of community clinic programs.
• A $35.5 million cut for AIDS and HIV programs (as opposed to the proposed $80 million cut), both education and prescription drug service programs.
• A $26.5 million reduction in Adult Day Health Care Centers, as opposed to a full elimination as the Governor and the Republicans on the committee supported (which would’ve reduced state spending by $170.5 million). The proposed compromise would cap the use of ADHCs to 3 days a week, among other provisions.
• A smaller cut to small and rural hospitals that what the Governor proposed.
• A near 50% cut, rather than complete elimination, of the state’s poison control system.

Below is a summary of some of the specific proposed cuts on the agenda for discussion today, according to CDCAN’s 6/16 Alert:

• Community Care Licensing – Governor’s proposal to eliminate state funding for this program. (reduction would total over $19 million in state general fund spending)
• In-Home Supportive Services Share of Cost Buy-out – Governor’s proposal to reduce spending and limit who can participate in the buy-out program (reduction would total over $41 million in state general fund spending)
• In-Home Supportive Services Domestic & Related Services – Governor’s proposal to limit domestic and related services to only persons with a functional index ranking of 4.0 or higher  (reduction would total over $53 million in state general fund spending)
• In-Home Supportive Services Cost Containment- Governor’s proposal to make ineligible for any services under IHSS, persons with a functional index score (different from functional index ranking) 2.99 or lower; would provide for some services under IHSS but not domestic and related services for persons with a functional index score between 3.0 and 3.99.  Would make no changes for persons with functional index scores of 4.0 or higher.  “Functional index score” is the average of the activities of daily living that each person on IHSS is assessed by their county social worker.  A person is “ranked” in each of the activities of daily living.  (Reduction would total over $705 million in state general fund spending.)
• In-Home Supportive Services State Funding for Worker/Provider Wages – Governor proposed reducing the state’s funding (participation) for IHSS worker wages to a maximum of $8 an hour – the state minimum wage, plus 60 cents for health benefits, effective October 1, 2009. (Total reduction would be over $161 million in state general fund money.)  This would impact currently 46 counties who pay higher than the minimum wage.  This proposal would be a further reduction to state funding of IHSS worker wages, which, unless reversed by the Legislature or stopped by legal action, is scheduled to be reduced to $9.50 per hour (plus 60 cents for health benefits) effective July 1, 2009.  That action was previously approved by the Legislature as part of the 2009-2010 State Budget passed in February.  
• In-Home Supportive Services Integrity Initiative – Governor’s proposal that would result in reduction in IHSS due to increased fraud and abuse efforts. (Reduction would total over $32 million in state general fund spending.)
• In-Home Supportive Services Public Authority Administration – Governor’s proposal to provide for a $699,000 increase due to caseload and other related adjustments for the 2009-2010 State Budget year.  
• Multipurpose Senior Services Program (MSSP) – Governor’s proposal to eliminate the program.
• Linkages Program – Governor’s proposal to eliminate  this program. (Reduction would total over $13 million in state general fund spending.)
• Senior Community Based Services Programs (Including Alzheimer’s Day Care Resource Center, Brown Bag, Respite Purchase of Services and the Senior Companion Program) – Governor’s proposal to eliminate these programs. (Reduction would total over $4 million in state general fund spending.)
• Supplemental Security Income/State Supplementary Payment (SSI/SSP) – Governor’s proposal to reduce SSI/SSP grant levels to the lowest amount allowed by the federal government, effective October 1, 2009 (reducing grants for individuals to $830 per month and couples to $1,407 per month).  Grants were already reduced due to suspension of cost of living increases on May 1, 2009 and June 1, 2009. The 2009-2010 State Budget passed in February also included a 2.3% reduction to the SSI/SSP grant level, effective July 1, 2009 (lowering grants to $850 for individuals and $1,489 for couples).  That grant level will be lowered further on October 1, 2009 if this new proposal by the Governor is approved.  (Reduction would total over $264 million in state general fund spending.)
• Cash Assistance Program for Immigrants (CAPI) – Governor proposed elimination of this state funded program that provides similar SSI/SSP level grants to over 10,000 persons with disabilities, the blind and seniors who are legal immigrants but do not qualify for SSI/SSP due to federal law changes in 1996.  (Reduction would total over $85 million in state general fund money.)
• California Food Assistance Program (CFAP) – Governor’s proposal to eliminate this program which provides food stamp benefits to legal immigrants not eligible for the federal food stamp program.  (Reduction would total over $33 million in state general fund spending.) 

For more information on the California state budget, see:  

• Our article, Governor Proposes $9 Billion in New Massive Cuts; Entire Programs Targeted for Elimination
• Alert updates from health-access.org and cdcan.us

Information in this article is edited in part from Health Access’ and CDCAN’s budget update alerts, 6/16/09.

Nearly half a million elders living alone in California cannot make ends meet, lacking sufficient income to pay for a minimum level of housing, food, health care, transportation and other basic expenses, according to a policy brief by the UCLA Center for Health Policy Research and the Insight Center for Community Economic Development. This number jumps to over 1 million when adding in elders living with family members.

The research for the brief, “Half-Million Older Californians Living Alone Unable to Make Ends Meet,” is based on 2007 data, the last time comprehensive, statewide data was collected. But the numbers of affected seniors are likely to be even higher today as the current recession deepens and as systemic budget cuts in health care and other social service programs are in place for July 1, 2009, with more pending approval of the Legislature. 

The brief includes county estimates of the percentage of economically vulnerable seniors. Those estimates show that elder economic insecurity is a problem in both more and less affluent counties: The 2 counties with the highest elder economic insecurity are Imperial and San Francisco. 

The findings in the policy brief are based on the Elder Economic Security Standard Index (Elder Index) for California, a tool that measures the actual cost of basic necessities for older adults in each of California’s 58 counties. The Elder Index is viewed by many as a more accurate measure of economic security than federal poverty level (FPL) guidelines, a standardized national estimate that does not take into account the cost of living in high-cost states such as California. 

Among the findings in the brief:

Most older renters can’t make ends meet

Older renters were more than twice as likely to be economically insecure as those who owned their homes and had paid off their mortgages (70.4 percent of older single renters were insecure, compared with 34.4 percent of homeowners without mortgages). 

Latino elders at risk 

About 3/4 of Latino elders who lived alone, and almost half of those who lived with only a spouse, could not cover their basic costs of living. 

Women at risk

Older women accounted for 72% of all older Californians who lived alone. Those women were more likely than older men to be unable to cover their basic needs (53.5% of women, compared with 44% of men). 

The very old at risk

A majority of all single elders aged 75 or older were economically insecure, regardless of ethnicity. More than 90% of female single renters aged 75 and older who were Latino or Asian had incomes below the Elder Index, as did 2/3 of all white single renters and 85% of all African American single renters aged 75 and older. 

FPL indicates only half of what is needed

In 2007, the nationwide federal poverty level (FPL), used to determine eligibility for public assistance, was $10,210 for a single adult living alone. According to Elder Index calculations, however, the average minimum income needed by a single older Californian who rented was $21,011.

With so many elders already at risk and unable to make ends meet, the current budget cuts will only exacerbate this situation.

Read our recent article on California’s state budget for more info and how the cuts will affect our state’s elders and people with disabilities.

On June 3, 2009, Bonnie Burns, Training and Policy Specialist, testified on the need for greater consumer protections, standardization of policies and regulation of long-term care (LTC) insurance products and marketing practices. Her written testimony also includes a detailed discussion on Partnership policies and the unique situation and precautions needed in regulating and marketing a state-endorsed product.  Client case studies and highlights on rate increases from 2 major players in the LTC insurance industry, Conseco and Penn Treaty Network America, are discussed as well. 

Senator Herb Kohl (D-WI) chaired this hearing entitled “Boon or Bane: Examining the Value of Long-Term Care Insurance.” Policymakers are investigating the role LTC insurance could play in financing our country’s growing LTC needs, as the strain of the recession affects both consumer and government budgets, and the gap between the long-term care services people require and the public and private programs to cover those services is growing wider. About 6 million people currently have LTC insurance. 

The 4 other people who testified in this hearing were: Diane Rowland, Executive Vice President, Henry J. Kaiser Family Foundation; Sean Dilweg, Insurance Commissioner, Wisconsin Department of Insurance; Carol Cutter, Chief Deputy Commissioner, Indiana Department of Insurance; and Thomas Stinson, President, Genworth Long-Term Care.

• Read Burns’ testimony, Gambling on Consumer Ignorance: Comprehensive Consumer Protections and Regulatory Scrutiny Are Required To Protect Purchasers of Long-Term Care Insurance Products. 
• View the archived webcast of the hearing and other presenters testimonies posted on the Senate Special Committee on Aging’s website.

For more information on long-term care (LTC) and LTC insurance, see the LTC section of our website.