Stanislaus County leaders concerned about costs of in-home support program

Stanislaus County officials are upset about a state plan to shift rising costs of In-Home Support Services to counties.

Gov. Jerry Brown’s recent budget proposal would shift about $625 million in IHSS costs to counties, with Stanislaus County’s share of the costs jumping from $11.2 million this year to $17.1 million next budget year. The costs are projected to keep rising from there, and counties say they can’t afford it.

IHSS caregivers (often family members) are paid around $10 an hour to take care of disabled people in their homes and assist the elderly with cooking and cleaning so they can continue living independently. California’s multibillion-dollar program, funded by federal, state and local dollars, supports close to 470,000 severely disabled and elderly people who otherwise would be placed in care facilities at greater expense.

Jody Hayes, assistant executive officer for Stanislaus County, told supervisors Tuesday that the fiscal impact of IHSS will grow exponentially in the next five years. Starting a year ago, labor standards required payment of overtime to IHSS workers, who are also eligible for paid sick days and payments for taking clients to medical appointments.

In addition, the state will raise the minimum wage to $15 an hour by the end of 2022, further driving up costs of the program.

Statewide, the IHSS caseload grows every year due to demographic factors and the aging population. Stanislaus County, which had 6,000 cases in July, expects its program will increase to 7,000 cases by mid-2018.

Hayes said that IHSS costs will grow faster than projected increases in funding. The program for Medi-Cal recipients is one of the services funded by 1991 realignment, a state and county fiscal arrangement that gave vehicle license fees and sales tax revenue to counties for health and social-service programs.

County leaders are opposing the state’s cost-shifting plan, following Supervisor Kristin Olsen’s advice to send a formal letter to Sacramento.

Board Chairman Vito Chiesa criticized a legislative proposal for counties to defer IHSS costs to a loan program if those costs are not covered by increases in realignment funding. Counties would be allowed to pay the costs over time, but Chiesa fears IHSS will ultimately take funding from other social services, such as mental health and foster care, and could eventually impact the county general fund, which pays for law enforcement and other local services.

Chiesa said he’s not comfortable with carrying the costs on the books when the county has limited control over program expenses.

Chiesa also expressed concern about previous investigations that revealed fraud and abuse in the county-administered program. According to the county, the results of investigations between 2009 and 2012 showed that fraud was far too common.

Inspectors checking a random sample of 223 cases found fraud in more than half of them. Of the 296 cases referred or flagged for investigation in 2010, fraud was uncovered in 70 percent of those cases, and more than 80 percent of the flagged cases the following year were deemed fraudulent, resulting in people being removed from the program or a reduction in service hours.

Supervisor Jim DeMartini, who rode along with inspectors, said that lying about disabilities and income was a common thread.

“A lady said she needed help to get out of bed and when we pulled up to the house she was doing yard work,” DeMartini said. “There are more people getting paid for In-Home Support Services than the county has employees.”

The United Domestic Workers union took issue with the county’s fraud investigations, saying caregivers’ rights were violated.

Sandy Yoppini of Keyes, who cares full time for a 23-year-old daughter with Down syndrome, said the county needs to take a harder look at its intake procedures if it’s concerned about fraud.

She said she’s saddened to see aspersions cast on a program that supports a better quality of life for people with disabilities.

Yoppini noted that IHSS workers endured a 7 percent cut in hours as the county dealt with a budget crunch after the recession. She said many parents can’t work if they care for a disabled adult child, and they should not apologize for getting paid to care for a family member.

The program ensures that people with disabilities and the elderly are not isolated in gloomy care facilities where there are risks of abuse, Yoppini said.

“If people were not able to be providers for this program, then people with disabilities and the elderly would not have the option of remaining in their homes,” she said.

This story was originally published March 9, 2017 at 2:04 PM with the headline "Stanislaus County leaders concerned about costs of in-home support program."