Fee would prevent cuts in in-home care for elderly, disabled

August 5, 2010

By Daniel Weintraub

The Democratic proposal to draw more federal money to California by raising the income and car taxes while lowering the sales tax has received a lot of ink this week. But a smaller and possibly less controversial idea to draw down more federal money to stave off cuts in home care for the elderly and disabled is also moving forward, with little fanfare.

This proposal is modeled after similar plans already in place for intermediate care nursing homes and homes that care for people with developmental disabilities. The idea is to impose a fee on the industry, and the money raised by the fee is then matched by the federal government. The state, in turn, returns the fee money to the people paying it. The payers come out even, but the state pockets the match from the feds. That windfall can be used to boost services, or, as is the plan in this case, reduce the need for cuts.

This roundabout scheme might seem a bit dodgy, but it has worked in the past for nursing homes and the developmentally disabled, and several other states have used it for in-home supportive services.

Advocates for the disabled and the unions representing in-home workers believe that such a fee could generate $150 million to $200 million for California.

The budget conference committee this week approved the concept while also repealing cuts to the program that were enacted last year but have been put on hold by the courts.

The cuts that might be avoided if the plan works would be a reduction in the state share of in-home care workers’ wages, to $9.50, and eligibility restrictions that eliminated all in-home services for people who had a “functional index” rating below 2 on a scale of 1 to 5, and eliminated domestic services for people with a rating below 4.

A rating of 1 on the scale means the person can perform a function independently. A 4 means the person can perform the function with assistance and a 5 means the person cannot perform the function, even with assistance.

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