A yearlong battle between the state and home care workers came to a head this month, with the state rescinding an unpopular policy and the governor vetoing a bill preserving the programs in their current form.
The union covering home care workers says Gov. Bruce Rauner is trying to dismantle programs for seniors and people with disabilities, but the governor says he’s trying to control costs and move to a better system.
Home care services in Illinois consist of two state-funded programs – one through the Department of Aging which focuses on senior citizens in poverty, and another through the Department of Human Services focusing on people with disabilities. Through those programs, the state pays caregivers to help seniors and people with disabilities live on their own instead of in more expensive nursing home care.
Caregivers in Illinois are represented by the Service Employees International Union, giving them collective bargaining abilities with the state even though many are private individuals who don’t work directly for state government.
Combined, the two home care programs cost the state about $1.5 billion in Fiscal Year 2015, the most recent fiscal year with a complete budget, prompting Rauner’s administration to examine the programs closely for ways to control costs.
The dispute over home care began last year, when the Rauner administration proposed changes to the “determination of need” score, known as DON, used to measure how much help someone needs in order to continue living on their own. Rauner wanted to raise the eligibility threshold for services, a move which advocates said would have cut services for an estimated 34,000 people and forced many into nursing homes or even into homelessness.
Rauner’s initial bid to raise the DON score threshold stalled, and the governor now says he doesn’t want to raise it, but the battle isn’t over. On July 29, Rauner vetoed House Bill 4351, which among other provisions would have fixed the DON score threshold in place until the federal government adopts a new measurement tool. Rauner called HB4351 “well-intentioned,” but he raised concerns that the legislation would have restricted the state’s ability to move away from institutional care and prevented implementation of a new program. The governor noted in his veto message that a previous law passed in
2012 already set the stage to increase the DON threshold, although doing
so would also require federal approval.
Rauner hopes to create a new Community Reinvestment Program (CRP) program adding to the current home care programs, a move which he says would save the state $200 million during the next fiscal year. Veronica Vera, spokeswoman for the Illinois Department of Aging, says CRP would be an addition – not a replacement – to the existing programs. It would split Medicaid and non-Medicaid clients into two camps, allowing the state flexibility in how services are offered.
The DON score battle was only part of the dispute over home care. At the start of 2015, a federal rule from the U.S. Department of Labor required overtime pay for home care workers, and in May 2016, the Illinois Department of Human Services attempted to control costs by limiting overtime use and requiring home care recipients to hire multiple assistants to split up hours instead of having an individual assistant work more than 40 hours per week. Assistants who worked more than 40 hours in a week without justification could have been defunded, effectively kicking them out of the program.
Marianne Manko, spokeswoman for DHS, says the policy didn’t decrease how many hours of service a person in need received, and it didn’t ban overtime. She says that besides controlling overtime costs – which totaled $4.9 million between Jan. 1 and June 30 – the policy was meant to prevent individual assistants from working extremely long days with no down time or vacations.
On July 21, a Kane County court ordered DHS to halt enforcement of the overtime policy until a formal administrative rule was established. Shortly thereafter, a Chicago-based disability rights group threatened to file a class-action lawsuit against the state seeking to strike down the state’s overtime policy. DHS rescinded its policy before the lawsuit was filed, saying it would reestablish the limit as an administrative rule. DHS said in a press release its policy had cut overtime costs in half and had “increased much-needed community capacity” to provide services.
Gail Hamilton, a personal assistant for a senior citizen in Springfield says the state’s overtime policy forced vulnerable people to hire assistants who hadn’t yet earned their trust.
“If you’re in a position where you’re told your caregiver can only work 40 hours a week, but you get 72 (hours of service),” Hamilton said, “you’ve got to find somebody to cover those other 32 hours.”
Contact Patrick Yeagle at pyeagle@illinoistimes.com.
Correction: This article has been changed from the version that appeared in print to reflect that the CRP concept is an addition – not a replacement – for the existing home care programs. The article has been further changed to reflect that no providers were kicked out of the program, although some did receive disciplinary notices.
This article appears in Aug 18-24, 2016.
