Sunday, July 31, 2011

In California, state lawmakers have made deep cuts to health, social services; safety net gone for many disabled or elderly people

From the Los Angeles Times:

Cynde Soto (pictured) dreads the arrival of yet another benefit notice.

Her cash assistance has been cut four times in two years. State medical coverage is getting more expensive and no longer includes dental care or podiatry. And the in-home help she needs to take care of basics has been cut by about 20 minutes a day.

"That doesn't sound like a lot to people but … I'm a quadriplegic," said the 54-year-old Long Beach resident. "I can't even scratch my own nose."

Faced with years of recession-driven budget shortfalls, state lawmakers have made deep cuts to health and social services. The reductions, including a round that took effect this month, translate into sizable state savings but are sharply scaling back the safety net for California's most vulnerable residents: the elderly, the disabled and the poor.

Since mid-2008, more than $3 billion has been sliced from CalWorks, the state's welfare program for nearly 600,000 families with children, according to an analysis by the California Budget Project, a nonpartisan think tank. Another $3 billion has been cut from Medi-Cal, which provides health coverage to about 7.5 million Californians. And $4.6 billion has been cut from the Supplemental Security Income program, which supports nearly 1.3 million elderly and disabled people with little or no other income.

The cuts are reversing longstanding policy priorities and eroding the ability of public agencies to cope with a growing and aging population, advocates for low-income families say.

More than a billion dollars has been slashed for childcare, job training and other services that have helped hundreds of thousands of unemployed Californians reenter the workforce since a Clinton-era overhaul of the national welfare system imposed strict limits on benefits in 1996.

"We've gone back on the social compact of welfare reform," said Jean Ross, the California Budget Project's executive director.

Because those programs are stretched, welfare recipients with small children have not been required to participate in workforce preparation activities since 2009, increasing the number of exempt families by about 60,000, according to the County Welfare Directors Assn. of California.

"We have a lot of people we're telling to sit at home," said Michael Herald, a lobbyist for the Western Center on Law & Poverty. "We have fundamentally distorted the program in recent years because of the budget crisis."

Programs that help the poor, the elderly and the disabled stay healthy and independent have also been hit, undercutting local, state and federal efforts to keep the needy away from high-cost emergency rooms and institutionalized care.

"You've got the most vulnerable people in society getting hit with multiple cuts," said Frank Mecca, who heads the welfare directors association. "The same person gets hit over and over."

Soto is paralyzed from the shoulders down but does not let that keep her from doing advocacy work for people with disabilities at a Los Angeles independent living center. Using her mouth, she can operate a computer trackball and type numbers into a phone with a Popsicle stick. Several times a week, an aide helps her into an electric wheelchair so she can take the train to work.

Most of the $800 she earns a month goes toward work expenses, including paying someone to feed her lunch. She has relied on $723 a month in SSI to cover rent and utilities. In July, the state reduced its portion of the grant for single beneficiaries like Soto to the federal minimum, shaving $15 from her income.

The same month, the state began charging Medi-Cal beneficiaries copayments of $5 for prescriptions, $50 for emergency room visits and up to $200 for hospital stays. Soto has five prescriptions and went to the hospital four times last year. "That can really add up," she said.

But the cuts that worry her most are those to the In-Home Supportive Services program, which is paying for about nine hours of care a day. The two women who have been assisting Soto for more than a decade have told her they will have to look for other jobs if their hours are cut again. Without them, she fears she would have to go into a nursing home.

"Oh, my gosh. That's no way to live," she said. "I wouldn't be able to continue working. I would lose my quality of life.... I think I would rather just die."

State lawmakers said tough choices had to be made because of the size of the budget shortfalls, which totaled tens of billions of dollars. Health and human services account for about a quarter of state spending.

Last month, Gov. Jerry Brown signed another "painful budget" with deep cuts to services after losing a bid to win enough Republican votes to extend temporary taxes. Republicans said the taxes were a drag on the struggling state economy.

Among the cuts taking effect this month is an 8% reduction to CalWorks grants for low-income families. A single mother with two children living in Los Angeles County now receives a maximum $638 a month. If the mother has been on the program for more than four years, her portion of the grant will expire Aug. 1, and the family will be left with $516 a month. Previously, adults could receive cash aid for five years.

A Times analysis shows that the maximum monthly payment for a family of three has fallen to just 41% of the federal poverty level, compared to 55% before welfare reform began in 1996.

Margarita Romo, a 61-year-old widow from Pasadena with two children at home, says she is careful about money and reluctant to complain about benefits.

"That's not me," she said. "I find I always have enough for food, for rent." But the thought of managing with the latest cuts, she said, makes her "sick."

Romo's household income is being hit on two fronts: the reductions in CalWorks and SSI payments, which they receive to help care for a child with Down syndrome. Her older children say they want to help. But one has a child of her own; another has been looking for work for months; and the third had to drop out of college to pay a $2,000 emergency room bill because he had no insurance.

"We worry about her, all of us," said eldest daughter Marisol Salcedo, 23, who is studying engineering. "We give her money, but later on it's one of us borrowing $20."

Federal programs, including food stamps and job subsidies, helped ease the impact of some state cuts, said Caroline Danielson, a fellow at the Public Policy Institute of California. But the subsidies were temporary and food stamps can't be used for rent or utilities.

In addition to affecting beneficiaries, the state cuts are eroding the ability of counties to provide quality services, Mecca said. Even before the current recession, state funding to administer services was not keeping pace with inflation. Many counties have had to reduce staff even though caseloads are growing.

Mecca's association estimates the cuts have left the state short about 1,280 child welfare workers and 465 adult protective services workers, who investigate elder abuse and neglect.

"We know that we're not responding to all the calls that we should be," Mecca said. "You just can't."

The Los Angeles County Department of Public Social Services has lost about 1,500 employees since 2007, said Director Philip L. Browning.

"I don't see us ever getting back to the level of staff that we have had," Browning said. "I think we're going to have to do things smarter." Among adjustments the county has made is taking benefit applications online.

The Medi-Cal cuts and the elimination of state funding for community clinics have reduced access to healthcare, , said Anthony Wright, executive director of Health Access California, a consumer advocacy group. And he said the problem could get worse if the state wins a legal fight to cut reimbursement rates for Medi-Cal service providers.

The combined cuts have left many families hard-pressed to manage day-to-day needs.

Carlos Garbutt, a 45-year-old database manager from Riverside, gets up before dawn to make breakfast for his 74-year-old mother, Nubia. He wakes her by gently stroking her cheek, then bathes and dresses her and carefully styles her curly dark hair. She has Alzheimer's and Parkinson's disease. Garbutt has been able to continue working because the state has paid for her to attend a day care program at Loma Linda University Medical Center and receive 126 hours a month of in-home care. But, the latest state budget could upset this arrangement.

The state's Adult Day Health Care program are being eliminated, and it is not clear what alternatives will be provided. That leaves Garbutt wondering whether he can continue to care for his mother at home.

"I want to be part of her journey," he said. Although his mother no longer speaks, he said, "I'm able to see when there is a glimmer of a smile or when she enjoys her meal... Those are gifts that will live on."