Last Thursday, Governor Newsom released California's proposed 2019-20 budget. The budget includes a number of proposals to improve health care and social services in California including initiatives to increase affordability and access to health care, a permanent restoration of the 7% In-Home Supportive Services (IHSS) hours reduction, investments in housing and programs to reduce and prevent homelessness, and permanent funding for the SSI cash-out "hold harmless" programs. The budget strongly signals the Governor's intention to strengthen California's communities through increased investments in programs on which Californians rely. The proposal falls short, however, of the Governor's campaign commitment to affirmatively and aggressively advance the needs of California's older adults. Given the $21 billion surplus in the 2019-20 budget, we believe California can and must do more to serve the older adults in our communities, especially those living in or near poverty.

As acknowledged in the budget proposal, the number of adults aged 65 and older is growing, and by 2030 older adults will represent more than 20% of the population in California. Today, one in five older Californians – a total of 1.1 million - lives in poverty, the highest rate of senior poverty of any state in the nation. Meanwhile, another 775,000 older adults struggle day-to-day because they have too much in income or resources to qualify for most public programs, but not enough to meet their most basic needs, including housing, food, and medication.

On the campaign trail, Governor Newsom pledged his support for creating and investing in a plan to address the needs of California's older adults. Given where we are now and where we are headed, we strongly urge the Governor to honor his campaign commitment and take aggressive action to address the needs of the millions of older adults in California today and in the future. Below we have outlined key provisions in the budget for low-income older adults, and where more investment is urgently needed to ensure older adults can age with justice.

Health Care and Medi-Cal

Access and Affordability. The budget proposal contains three major initiatives to increase access and affordability to health care for Californians: (1) it expands Medi-Cal to young adults 19-25 regardless of immigration status; (2) it increases subsidies for individuals between 250%-400% of the federal poverty level (FPL) who purchase insurance through Covered California, and it expands eligibility for subsidies to individuals between 400-600% FPL; and (3) it reinstates the individual mandate in California. These initiatives are important steps to move California toward universal health coverage. However, to ensure equal access to health care coverage for individuals age 65 and older, the Governor should eliminate the Medi-Cal senior penalty, which disqualifies older adults for Medi-Cal at a lower income threshold than younger adults. We also encourage Governor Newsom to expand Medi-Cal coverage to include California's undocumented older adults.

Whole Person Care Programs. Additionally, the budget proposal includes $100 million of one-time funding that can be used across multiple budget years for the Whole Person Care programs. These programs, which focus on Medi-Cal-eligible individuals who are experiencing homelessness, are high utilizers of emergency systems, or have chronic conditions, have shown the potential to effectively coordinate health, behavioral health, and social services. We believe this is a wise investment in improving health outcomes for eligible older adults in our communities.

Value-Based Payment. Finally, the budget funnels $180 million to a value-based payment program established through Medi-Cal managed care plans that gives providers incentive payments for meeting certain measures aimed at improving care for high-need populations.  The Governor proposes that the program focus on behavioral health integration, prenatal/post-partum care, and chronic disease management.  We call on Governor Newsom, in implementing this program, to specifically consider one of California's highest need populations – those individuals dually eligible for both Medicare and Medi-Cal – to ensure this expansion improves the delivery of Medi-Cal services to those most in need. Efforts like these would follow on the heels of important steps California has made in the past to integrate care to this population.  

Home and Community-Based Services

IHSS Restoration. The most significant investment in home and community-based services in the Governor's budget proposal is the permanent restoration of the 7% reduction in IHSS hours that was originally enacted when the State was suffering through the recession. While the restoration had been temporarily restored for the last three years through the Managed Care Organization (MCO) tax, the tax is set to expire on June 30, 2019. We commend the Governor for recognizing the importance of the IHSS program for helping older adults and people with disabilities remain at home and in their communities, as well as for not tying continued funding of IHSS to the unreliable MCO tax.

Other HCBS. We urge the Governor to broaden investment in home and community-based services by continuing the California Community Transitions program, which provides assistance to help older adults and people with disabilities move out of nursing facilities back into our communities; increase the rates for the Multipurpose Senior Services Program, (MSSP) which supports some of the state's most frail older adults so they can live at home; and to increase the Assisted Living Waiver slots available for those who need to live in a more supported setting.

Supplemental Security Income (SSI)

SSI Cash-Out. The budget proposes to make permanent the "hold harmless" programs created in last year's budget as part of the repeal of SSI cash-out, which was the policy that barred SSI recipients from receiving food assistance through CalFresh. The repeal of cash-out would have caused some low-income households to lose their current CalFresh benefits if SSI income were included in the CalFresh determination. Thus, then Governor Brown and the Legislature agreed to create two "hold harmless" programs to backfill the loss of CalFresh benefits for these households, but only provided two years of funding. With this budget, Governor Newsom would make the "hold harmless" funding permanent.

State Supplementary Payment (SSP). Unfortunately, the budget does not restore the cuts made during the Schwarzenegger Administration to the SSP, which is the state-funded supplement to the federal SSI benefit. This $77 per month recession-era cut to the SSP benefit pushed many people who rely on SSI to meet their basic needs into poverty, where they have remained. While California's economy has recovered from the recession, the seniors and people with disabilities who rely on SSI/SSP benefits have not. The surplus California enjoys today is in large part due to the cuts in benefits Californians with the lowest incomes have suffered. The Governor should act to finally restore the value of the SSP and lift all seniors in California out of poverty. As a part of the Californians for SSI coalition, Justice in Aging will continue pushing to restore the SSP.

SSI Advocacy. The budget proposes $25 million in ongoing funding for the Housing and Disability Advocacy Program (HDAP), which previously received one-time funding of $45 million over three years. HDAP provides matching funds for counties to provide comprehensive services including housing support to people who are likely eligible for SSI, while they apply for disability benefits. The program addresses the need for comprehensive services in order to reduce homelessness and ensure long-term stability for people with disabilities who are experiencing homelessness.

Conclusion

The Governor's proposed budget takes tangible, much-needed steps to reduce poverty in California, but falls short of taking steps targeting the unique needs of older adults in particular. We look forward to working with the Governor to honor his commitment by pursuing additional solutions aimed at supporting older adults in our communities.