The “Coordinated Care Initiative” is one of those uber-wonky, densely complex, acronym-laden pieces of governmental policy that may affect millions but only a handful of folks even profess to understand.
And they may not have to even try to understand it, because Gov. Jerry Brown wants to give it the boot after a half-decade.
As CCI was envisioned and partially implemented, the poor, disabled and aged — or all three — in seven large counties receive coordinated medical, institutional and/or in-home care via different federal, state and local programs, including Medi-Cal and Medicare.
CCI was to be a one-stop-shop approach that would, it was believed, make life easier for recipients while saving taxpayers’ money. And if it worked out, it would be extended statewide.
However, the implementing legislation contained an escape clause allowing the governor to cancel CCI if it proved not to save money for the state. And Brown’s proposed 2017-18 budget does just that, while urging that some aspects remain in effect.
Brown’s in-house bean counters say that instead of saving money for the state, it’s costing substantially more, mostly because of fast-growing, $10 billion “In-Home Supportive Services.” IHSS provides attendants for the infirm in their homes, supposedly offsetting what would otherwise be very expensive institutionalized care.
IHSS has exploded to cover hundreds of thousands of Californians with hundreds of thousands of attendants, often their own family members, who are unionized. Under CCI, a state agency was to negotiate labor contracts for IHSS workers, rather than local authorities.
The share of IHSS costs paid by counties was capped by the CCI, and the state’s share was open-ended, which hit the state budget hard thanks to former President Barack Obama’s decree that IHSS workers could get overtime pay, and the state’s decision to raise minimum wages.
Dropping CCI does not require legislative approval, and if Brown follows through with it, IHSS labor contract negotiations would shift back to local agencies, and counties’ share of IHSS costs would jump by an estimated $623 million a year, growing to $1 billion in the future.
County officials are howling about the cost shift, saying it could force them to cut other health and social services to cover IHSS costs. The Legislature’s budget analyst, Mac Taylor, says that canceling CCI should lead to a reconfiguration of the 1991 “realignment” of state and local health/welfare services.
Meanwhile, returning IHSS pay negotiations to the local level affects one of organized labor’s biggest achievements — the unionization of home aides under former Gov. Gray Davis.
It meant 350,000 more dues-paying unionized workers, and union officials had hoped that CCI would eventually lead to one set of negotiations at the state level, where their political clout could obtain substantial raises for workers now barely receiving minimum wages.
Instead, much to their dismay, they may have to resume costly and laborious negotiations with county officials feeling a big financial pinch.
Dan Walters is a political columnist for The Sacramento Bee.