Title
Health and Human Services Agency recommending the Board approve and authorize the Chair to sign a Letter of Support in endorsement of the County Welfare Directors Association of California advocacy for the budget request of $51,000,000 of State General Fund for one-time bridge funding for In Home Supportive Services Administrative Costs for the Fiscal Year 2024-25.
FUNDING: State General Fund.
Body
DISCUSSION / BACKGROUND:
IHSS is a county-administered program that ensures eligible older adults, blind, and/or disabled individuals remain in their homes and receive consumer-directed assistance with activities of daily living to avoid costly institutionalization. As of December 2023, over 750,000 older adults and persons with disabilities were authorized to receive in-home care from nearly 600,000 trusted IHSS caregivers in California.
There is an increasing demand for IHSS as California’s population ages. Adults ages 65 and older are projected to reach 25 percent of the State’s population by 2030. The recent expansion of the Medi-Cal program to include full coverage for undocumented adults will enable even more older Californians to access home-based care to live safely in their homes and communities, but also will create further demand for IHSS services. Unfortunately, IHSS staff caseloads in most counties are very high and continue to grow. County IHSS staffing relies on a combination of state funding and federal Medicaid matching funding to meet federal and state program mandates. Funds are administered through the California Department of Social Services (CDSS) but the funding falls short due to inaccurate estimation of the actual number of people IHSS serves and the cost of staffing. In 2017 and 2018, CDSS, in consultation with county human services agencies and CWDA, updated the budget methodology to fund county administrative activities associated with the IHSS Program. However, that updated methodology never fully funded actual IHSS worker costs from the beginning due to decisions to exclude some costs. The resulting funding shortfall has grown ever since because there are no cost adjustments provided. Furthermore, not all IHSS administrative workload is counted, as administrative funding is not provided if an IHSS application does not lead to an applicant actually receiving services. This is the case even if the applicant is assessed and approved for services but is unable to find a provider. Counties receive no administrative funding despite county employee time being spent on these applications.
This has led to counties consistently not being fully funded to meet the increasing population and demands of the IHSS Program. Higher worker caseloads, which will continue to grow without more funding for additional staff, are likely to impede access to IHSS. As a result of inadequate funding for IHSS staff, many counties are under a Quality Improvement Plan for not meeting federal and state mandates which can lead to withholding of enhanced federal funding to the State.
CWDA is asking counties for their support in advocating for the budget request of $51,000,000 of State General Fund for one-time bridge funding for FY 2024-25, and associated implementation of language to the California State Budget Bill language requiring CDSS to work with CWDA and counties during the FY 2024-25 to update the existing IHSS administration budget methodology to take effect in the FY 2025-26. $51,000,000 is the amount that counties are currently overspending their statutorily required share of cost in an attempt to keep up with the mandated administrative requirements. Providing bridge funding while counties, CWDA, and CDSS work to update their budget methodology is consistent with the approach used to update recent county administrative allocations for CalFresh and CalWORKs. HHSA is recommending the Board approve this Letter of Support to bolster CWDA’s advocacy of this budget request, particularly during this difficult budget year.
ALTERNATIVES:
Should the Board decline to approve this recommendation, HHSA IHSS Program would have difficulty meeting the needs of those older adults, blind, and disabled individuals needing assistance with activities of daily living to remain in their homes. Higher worker caseloads for County staff contributes to the inability to recruit and retain staff and meet the needs of an increasing elderly and vulnerable population.
PRIOR BOARD ACTION:
N/A
OTHER DEPARTMENT / AGENCY INVOLVEMENT:
N/A
CAO RECOMMENDATION:
Approve as recommended.
FINANCIAL IMPACT:
There is no financial impact associated with this agenda item.
CLERK OF THE BOARD FOLLOW UP ACTIONS:
1) Clerk of the Board to obtain signature of Chair on one (1) original Letter of Support; and
2) Clerk of the Board to return one (1) Chair signed Letter of Support to HHSA Contracts Unit at 3057 Briw Rd, Suite B.
STRATEGIC PLAN COMPONENT:
Healthy Communities
CONTACT:
Olivia Byron-Cooper, MPH, Director