Periodically either the State or individual counties have attempted to mandate either "managed care" health services or home care through contracted service providers. The outcome is always the same: High costs and reduction in quality and quantity of services. When do we learn? Add another layer or two of corporate bureaucracy and profit and ya get more admin cost, and direct attention away from direct services. Apparently not yet. Inspired partly (or wholly) by the recent health care changes, California has gotten the federal go ahead to reinvent some wheels.
What's ironic in this is that California should by a model for other states, especially when it comes to in-home care services. Called in-Home Supportive Services, IHSS is NOT a low budget item. It will never be. As the baby boomers are becoming seniors and medical science is able to keep increasing numbers of permanently injured individuals alive -- and as long as we value helping people remain safely in their own homes and communities -- in home care will be in increasing demand. And as long as the economy languishes, the numbers needing IHSS will increase even more, because IHSS is a means-based program serving low-income seniors and disabled persons.
IHSS will never be a low budget item, but it is way less costly that the emergency rooms, hospital beds, and institutions that IHSS has kept us out of. Plus, most of YOU KNOW ME because of IHSS. You may not consider this an asset, but I consider knowing you all, well, gosh, what can I say? Some of you have even worked for me. :) This is what IHSS was established for: keeping persons with disabilities and seniors active members of our community.
But I've gotten side tracked. What the State is proposing is that those who are "dual-eligible", ie,. eligible for both Medi-Cal and Medicare, into mandated manage care. That's part 1. Part 2 is to move the whole of IHSS into the mix.
The original plan is a four county demonstration program of managed care for the target duel-eligible population. While many of us feel "been there, done that", there is a population that need a more management-based approach so finding good "managed solutions" would be of help. The key word is solutionS, plural! One approach will never, can never, fit diverse needs and abilities!
So, first of all, we want to keep the proven, cost-effective IHSS program for those of us who do well with a least invasive approach, and keep these care-giving jobs open to the great persons I've had the privilege of hiring through the years. I am not sick, I am physically limited. I am not (yet) mentally unable to direct my care and manage my life. I do both well. Like many, I do not want or need the government to incur the additional expense of replacing my caregivers with certified contract caregivers ... turning my home into an institution.
So, the petition we are seeking signatures for is calling for an IHSS "carve-out", to keep the present IHSS program as an option.
There is another aspect afoot. For some reason Governor Brown has proposed increasing the number of demo counties and fast-tracking a State-wide duel managed care mandate (including IHSS) within three years. The Legislative Analyst Office released its recommendation against this and calling for the four county demo with careful observation of outcomes, as there is no present evidence that managed care is either outcome or cost-effective.
I have not researched Brown's proposal, nor have I heard its status since the LAO report. I can speculate... The duel-eligible partnership with DC likely promises more Fed money. Cost-shifting has long been an issue, inspiring more costly, less effective approaches because "the Feds will pay more of the cost." This disregard for tax-payer money, and readiness to WASTE has to stop. As we are advocating the State level, I'm thinking another thing to do is to lobby DC to eliminate "cost-shifting" incentives.
Anyway, this is where we are at.. Thanks for signing and passing the petition on.
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