Justice In Aging and Laura Rath contributed to this post.
Even in the face of the State of California's fiscal challenges – Gov. Gavin Newsom’s $292 billion budget for 2024-25 assumes a $38 billion revenue shortfall – the proposed budget shows the administration’s commitment to the needs of older Californians.
We are very gratified that, in contrast to times of shortfall in the past, which led to severe cuts in programs for low-income and vulnerable older adults, this budget would preserve or even continue to improve many important services. So we urge the Legislature to make many aspects of the governor’s proposal a reality.
In 2009, in response to the Great Recession, the state cut payment rates to non-profits providing services, capped the number who could be served, and cancelled entire programs. Some of these cuts have only been restored in the last two years. The Alzheimer’s Caregiver Resource Centers, for example, were entirely defunded for 10 years until they were resurrected in 2020. (And unfortunately these do seem very likely to disappear once again.)
The budget the governor unveiled last month would preserve most older adult programs, such as the expanded Medi-Cal Assisted Living Waiver; the implementation of CalAIM (California Advancing and Innovating Medi-Cal, the state’s long-term commitment to make the state’s version of Medicaid more equitable, coordinated, and person-centered in part with new social supportive benefits); and the continuing expansion of Medi-Cal coverage for undocumented people. Along with maintaining the recent expansion of CalFresh (food stamps) and increased Supplemental Security Income/State Supplementary Payment (SSI/SSP) rates, the budget prioritizes care for those most in need. This is why Archstone Foundation joined our partners at Justice In Aging and many of the stakeholders involved in the Master Plan on Aging to send a letter to the Newsom administration and the Legislature urging them to remain steadfast against efforts to reverse recent progress in the state’s care for older Californians.
Maintaining Momentum for Our Priorities
Even in crisis, Archstone Foundation thinks it is vital to maintain focus on our long-term objectives and do what we can to maintain momentum and prepare for future opportunities. Our priorities include:
- Intense focus on the rollout of CalAIM to be sure it lives up to our hopes for low-income older adults who want to avoid institutionalization and the revolving door of hospitalizations and emergency room visits. It is early days for this new program, but the track record of such initiatives over decades is bad enough that we would be foolish to assume that it will just work itself out with more time.
- Vigorous work to obtain access to long-term care benefits for the “forgotten middle,” the families who are not (yet) so crushingly poor as to be on Medi-Cal but also not wealthy enough to pay all their health bills by themselves. We should be wary of what is happening, for example, in Washington. It will be a decade before that state sees its new universal long-term care insurance program as sufficiently funded to start paying benefits – saving the state nothing and only delaying the solution for an urgent need.
- More accurate, transparent, and candid efforts to create an effective workforce that can improve care for older adults and their families in all their glorious cultural, linguistic, geographic, and idiosyncratic diversity. This goal would be stymied by one part of the governor’s budget: It would delay a planned and well-deserved pay increase for the front-line workers doing the essential high-touch, low-tech care of people who can’t physically or mentally care for themselves. This is shortsighted given our immediate and acute shortage of direct care workers. Moreover, it is time to face the embarrassing fact that our workforce investments are failing broadly to move the needle. They have not yet ensured core competence or developed specialized skills (in dementia care, for example) in workers ranging from home care attendants to MD and PhD-level geriatric specialists.
- More support for unpaid family and friend caregivers. Successfully advancing the first three priorities would do much to address their burden, but the state and nation need to do more. Caring for each other in families, friendships, and neighborhoods is part of humanity at its best. We must collectively do what we can to make that work easier and less damaging to those who take it up – by creating easier access to training, more support, and some recognition of the vital economic contribution made by people caring for loved ones, despite being unpaid.
These are also some of the core priorities of the Master Plan for Aging, and the Foundation believes they deserve to be top of mind among state government leaders, agency staff, and other stakeholders – even if all that can be done for now is planning.
Health and Economic Security
The proposed budget would sustain some critical investments in health and economic supports for older adults made under previous budgets, including by eliminating the asset test for Medi-Cal beneficiaries and increasing the state’s grants under SSI/SSP, a joint federal and state program of cash grants to low-income older adults, individuals who are blind and persons with disabilities. (The federal government pays for the SSI portion and the state funds the SSP portion.)
Encouragingly, the Newsom budget would pay to continue implementation of Medi-Cal transitional rent and proposes to increase the numbers who could receive Assisted Living Waivers and Home and Community-Based Alternatives Waivers. We urge that the reform to the Medi-Cal share of cost program move forward on schedule on January 1, 2025.
Supporting Direct Care Workers
One aspect of the budget we find very disappointing is the proposed delay in implementing the pass-through wage increase for direct care workers paid for by Medicaid. Such wage pass-through programs have proven to be effective at boosting certified nursing assistant staffing in nursing homes, at least in the short term. Pushing off this pay increase would be egregious.
Long Term Services and Supports
Even in times of budgetary challenges, there are opportunities to collaborate to build a comprehensive long term care system. Recognizing the critical role played by a home and community-based care system, those efforts should focus on ensuring a well-coordinated home-based system for all Californians. Development of The Home and Community-Based Services gap analysis and roadmap, and the Long-Term Services and Supports (LTSS) Financing and Affordability Policy and Research Initiative, are critical to creating an affordable and equitable system that works for older Californians and people with disabilities. We know the lack of a universal LTSS system places additional strain and burden on families across the state.
Call to Action
We applaud the recent progress the state has made to improve care for its older population and urge the governor and the Legislature to take bold action during this year’s budget debate to ensure critical services and programs continue to meet the needs of California’s more than 6.5 million older residents.
Of highest importance, Archstone Foundation wants to make sure there is funding to: help CalAIM work well for our older adult population; encourage progress toward long term care insurance; support the critical workforce caring for older adults; and focus attention on the needs of caregivers.
