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Board cautions against cuts to home-bound senior care


The Los Angeles County Board of Supervisors warned this week of catastrophic consequences, if the state rolls back funding for home care for low-income seniors.

The board voted unanimously to send a letter in support of an Assembly bill that would appropriate $650 million in state general funds to continue to make in-home support services available to Medi-Cal beneficiaries under the Coordinated Care Initiative.

The CCI is a pilot demonstration program in seven counties, including Los Angeles, Orange, Riverside, San Diego and San Bernardino. It is set to sunset July 1, under a legislative provision that required it to be cost-effective.

Gov. Jerry Brown has proposed programs that would continue services, but his budget proposal unwinds an agreement that caps county contributions to pay for those in-home support services.

If the CCI and cost caps are eliminated in the state’s final budget, it will cost Los Angeles County an estimated $220 million in the first year and more than half a billion dollars by fiscal year 2020-21, according to Supervisor Mark Ridley-Thomas.

The result would be “catastrophic,” and I don’t think that’s too strong a word,” Supervisor Kathryn Barger said.

IHSS helps low-income, blind and disabled individuals stay in their own homes, instead of being forced into nursing homes. Services include housecleaning, meal prep, laundry, bathing, paramedical services, shopping and grooming.

Supervisor Barger said there was no question about the need for home services. The issue is whether the costs will be shifted from the state back to county governments at a time of dramatic cost increases and an expanding demand for services.

“These are not individuals who can just be on their own,” Barger said, arguing that the state would end up paying more over time as individuals once cared for at home end up in hospital beds.

The state’s finance department has been warning for years that the CCI program wouldn’t be sustainable unless more low-income individuals enrolled to consolidate their Medi-Cal and Medicare coverage.

Eliminating duplicate costs was part of the legislative bargain struck, but too many people chose to opt out of dual-enrollment, department representatives said.

Only 10 percent of individuals receiving IHSS benefits in Los Angeles County are enrolled, less than half the lowest rate achieved by the other six counties, according to the latest data available.

Finance department representatives said Brown’s proposal was designed to continue IHHS care despite the end of CCI.

“The program will continue to provide these types of care, if the Legislature approves the governor’s proposal, said H.D. Palmer, the department’s deputy director for external affairs.

County CEO Sachi Hamai acknowledged that give-and-take, saying her office was “still trying to push back with the state.”

Hamai said severe cuts would otherwise be required in response to the rollback.

“It goes further than just the individuals that are receiving the care,” Hamai said. “It cuts across every department.” That could include cutting wages, overtime and sick leave negotiated by home care providers, who are set to benefit from minimum wage increases.