RCRC, along with the California State Association of Counties (CSAC), the County Behavioral Health Directors Association (CBHDA), the County Health Executives Association of California (CHEAC), and the County Welfare Directors Association of California (CWDA), issued a joint letter to both State Senate and Assembly leadership opposing the Governor’s 2017-18 proposed budget item eliminating the Coordinated Care Initiative (CCI) and the In-Home Support Services (IHSS) Maintenance of Effort (MOE) cost sharing agreement.  Outlined in the letter are the major impacts of this change to the counties; most significant to RCRC member counties is the implications of shifting increased costs for IHSS services back to the counties.  RCRC continues to work with county partners to obtain data on the direct impacts to each county, but current estimates show an additional cost of $623 million to all 58 counties this upcoming fiscal year, rising to $1.6 billion in FY 2022-2023.  

CCI was established to more efficiently deliver care (including IHSS) to seniors and people with disabilities who are dually eligible for the State Medi-Cal program and the federal Medicare program.  With the passage of CCI in 2012, IHSS benefits were incorporated into the managed care delivery system in seven CCI pilot counties (none of which are RCRC member counties), and an MOE capping county IHSS costs was put in place for all 58 counties.  With the elimination of CCI, the IHSS MOE provisions are automatically repealed, and the counties’ share of the costs for the IHSS program will be reinstated to prior state-county sharing ratios.  This increased county share, 35 percent of the nonfederal portion of IHSS program cost, will be compounded by the minimum wage increase, the federal overtime requirement, and eventually paid sick leave.

The joint opposition letter can be accessed here.