The $5.5 billion-a-year program that provides in-home, personal care to more than 444,000 Californians doesn’t effectively track its own payroll and has failed to conduct annual studies to estimate the level of overpayments and fraud, according to a Senate investigative report. The program, which relies in part on the honor system in its billing, also is hamstrung by an antiquated system that delays the flow of crucial information for months, the study says.
The report, prepared by the newly created Senate Office of Oversight and Outcomes, was commissioned by the Senate Human Services Committee. The report targeted compliance with 2004 legislation, part of the state’s Budget Act, that sought to tighten up the guidelines governing the quality and finances of the In-Home Supportive Services program, which is run by the state Department of Social Services.
The IHSS challenged the findings in the Senate study. “Virtually every element of SB 1104 (the 2004 legislation) is in place — just as the legislation requires,” said Lizelda Lopez, deputy director of the state Department of Social Services, which oversees IHSS.
Among the findings in the Senate report:
–The state has not “developed comprehensive or measurable ways to validate the delivery of services. The program operates essentially on an ‘honor system,’ which presumes that a recipient’s signature on a worker’s time card is sufficient verification of services.”
–The timecards, about 400,000 submitted every two months, only list hours worked, but do not list details of service. They are in paper format, which slows processing.
–Even though a social worker’s authorization is theoretically needed, the IHSS workers perform other, non-authorized tasks, often at the direction of their clients.
–In cases of fraud, many counties conduct investigations themselves, rather than rely on the state, “which does not routinely collect data on the number and disposition of IHSS fraud cases statewide.”
–Despite the requirements of the 2004 legislation, the state has not conducted annual “error-rate” studies as a tool to root out potential fraud. Two studies, limited in scope, have been conducted in the past five years.
–The Department of Social Services is required to conduct regular “data matches” with the state’s Medi-Cal program, but “only one such check has been completed by the administration as part of a four-county error-rate study.”
Lopez said the Senate study was “inaccurate and misleading …to suggest in its executive summary that the IHSS changes required in SB 1104 have not been implemented by the administration.” She noted that of 15 tasks required under the legislation, all but two were completed.
IHSS serves low-income people whose assets are worth less than $2,000, excluding their house and car, and are aged, blind, disabled or 65 years of age or older. Nearly two-thirds of IHSS workers are related to their clients, a 50 percent increase since 2000.
According to a separate report by the Office of the Legislative Analyst, the IHSS cost per-case is about $13,000 for 2008-09. Much of that increase has been handled by federal funding; although the state’s share also rose, from $527 million to about $1.9 billion this year. In dollars, IHSS has grown about 253 percent, and about 13.4 percent this year, the LAO reported.
The program is intended to provide care to people in their homes rather than in an institution, and emphasizes meeting the needs of daily living. Evaluation of a client’s services is assessed by a social worker.
Prior to 1999, workers providing the services to IHSS clients were paid the minimum wage. After 1999, state legislation created a mechanism to allow unionization and collective bargaining. About 376,000 workers receive paychecks from IHSS, ranging from $8 per hour in rural counties to $14.68 per hour in Santa Clara County. The state authorizes up to $12.10 hourly. In counties where the locally negotiated wage level is above that amount, the difference is picked up by the counties. The workers, whose duties include providing non-medical help such as shopping, cleaning, bathing and transportation, are hired and fired by their clients. A number of IHSS workers are members of the Service Employees International Union.
IHSS, which has doubled its client load during the past decade, is expected to grow by nearly 8 percent during the next five years. The program is financed by a mix of money: The federal government picks up half the tab, or $2.7 billion; the state pays about a third, or $1.8 billion, and the counties pick up the remaining 18 percent, or $1 billion.