Not necessarily Care Tips, but Important California Policy Update

Remember, each state will have a different structure and ruling on how much support goes to caring for Alzheimer's patients.  Find out in your state!   
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------California Policy Update
January 2011

Governor's Budget Proposal
Governor Brown laid out his proposal for the FY 2011-12 budget.  With California facing a budget shortfall of approximately $25.4 billion, the Governor's budget proposal includes $12.5 billion in spending reductions, $12 billion in revenues (to be achieved by maintaining current tax rates for another 5 years - subject to voter approval in June), and approximately $1.9 billion in borrowing and tax shifts.  These proposals would close the $25.4 billion budget shortfall and create an additional $1 billion for a rainy day fund.

Good news:  The Governor is maintaining funding for the California Alzheimer's Disease Program and the Caregiver Resource Centers.  

As in the past, the Governor's budget does not identify cost increases in other areas of the state budget due to the following eliminations and reductions - these increases would primarily occur in nursing home and hospital expenditures in Medi-Cal, which are much more costly than home and community-based services.

The Governor proposes the complete elimination of:

• Adult Day Health Care, which would leave 27,000 beneficiaries without the vital services the program provides.
• Multipurpose Senior Services Program (MSSP), which provides case management services to elderly clients who qualify for placement in a nursing facility but wish to remain in the community.

In addition, the budget proposals include the following significant reductions:

$486.1 million in cuts to the In-Home Supportive Services (IHSS) program, which include:

• An 8.4% reduction in service hours:  This would implement an across-the-board reduction for all IHSS recipients, and would be in addition to the 3.6% reduction enacted in 2010-11.  The 8.4% reduction equates to a loss of 5 minutes of services per hour.
• Elimination of domestic and related services for recipients living with their provider:  Under this proposal, approximately 300,000 IHSS recipients living with their provider would no longer be eligible for domestic services (including housework, shopping for food, cooking, and laundry).  
• Requirement of physician certification for IHSS services:  Under current law, IHSS recipients must be assessed every 12-18 months by a county social worker to determine the types of services needed and the number of hours required.  This proposal would add to this process a medical evaluation, signed by a physician, that confirms IHSS services are being provided to those most at-risk of institutionalization.
• Elimination of state funding for county IHSS advisory committees:  Would eliminate the mandate for counties to establish advisory committees, which have been funded by the state.

Reductions to the Medi-Cal program, similar to those proposed last year:

• Placing monetary limits on durable medical equipment and supplies.
• Limiting prescriptions (except life-saving drugs) to 6 per month and doctor visits to 10 per year.
• Implementation of mandatory co-payments for Medi-Cal beneficiaries, including $5 co-payments for physician, clinic, dental and pharmacy services, $50 co-payments on emergency room services, and a $100/day and $200 maximum co-payment for hospital stays.

The Governor is also proposing significantrealignment of state services - most to the counties but some back to the state.  In 2012 he is proposing the following:

• Shifting of all responsibility for Adult Protective Services (APS) to the counties in which the counties would be given total flexibility and discretion in administering the program.
• In preparing for implementation of health care reform, he proposes shifting certainMedi-Cal services now administered by the counties back to the state in order to ensure better coordination of all Medi-Cal services - this would bring IHSS back to the state.