As a response to a $72 million shortfall, Sacramento County officials proposed on September 16 an over $1 million funding reduction to In Home Support Services (IHSS), a program that provides home care for the disabled and elderly. According to the county proposal, the reduction, "will leave [IHSS] with 52 case-carrying social workers for over 21,000 cases."

The $1 million cut would only save the county roughly $490,000. The remainder of the lost funds would come from the elimination of $515,000 in attached federal monies.

According to Laura McCasland, Communications Officer at the Sacramento County Deptartment of Health and Human Services, a last-minute infusion of state resources has restored the federal monies and likely saved IHSS from dramatic cuts, although reductions will leave the program with less than 63 positions to oversee 21,000 cases.

The IHSS program compensates caregivers with an hourly wage -- $10.40 per hour in Sacramento County -- for providing home care to disabled and elderly persons. The purpose of the program is to help vulnerable Californians remain safely in their homes while saving resources that may otherwise be spent on institutional care.

According to the California Department of Social Services, "Nearly 60 percent of IHSS providers are family members of recipients."

Some, including Governor Schwarzenegger, have argued that IHSS is rife with abuse, a claim that has been substantiated by a March 23 Sacramento County grand jury report.

The grand jury found that, "At its best, [IHSS] is a dysfunctional system plagued by upper management who refuse to make meaningful changes or even look into matters that will be beneficial to the truly needy people [IHSS] is pledged to support. ... The lack of fiscal controls and oversight at IHSS has made it an easy target for those who are greedy."

The grand jury report has led to the creation of a multi-agency District Attorney task force that is currently investigating fraud at IHSS.

Supporters of IHSS, however, are suspicious of the grand jury's claims. "Have you ever seen anyone being prosecuted for fraud? No. Where are the prosecutions if there is fraud?" said Human Services Specialist George Raya, in an interview with the Sacramento Press.

Official statewide investigations into IHSS have been generally supportive of the program.

Earlier this year, allegations of IHSS misuse prompted the California State Senate to order the Senate Office of Oversight and Outcomes (SOOO) to examine the program. On March 24, SOOO issued its report on IHSS, which found strong, but qualified, support for the program. While the report did criticize the program's inability to verify timesheets completed by caregivers, the report "found general consensus that [IHSS] saves taxpayers money in nursing home costs and improves the lives of its vulnerable beneficiaries."

In the July budget revision, the state government reduced funding for the program by $263.5 million. These reductions, which were a response to a $62 billion state deficit, will "limit the provision of IHSS services to the neediest consumers," according to a California state budget report issued by the Governor's office.

Responding to program criticism, budget-related changes include the implementation of "rigorous anti-fraud efforts," according to the report. They will require that all providers attend an orientation and be fingerprinted and subject caregivers to civil penalties if they falsify timesheets.

The California Department of Social Services reports that on Nov. 1, program reductions will result in 36,000 individuals currently covered by IHSS losing care coverage while approximately 97,000 see a reduction in care.

IHSS's future is uncertain, as it is largely tied to the status of California's state and county budgets, but supporters argue that cuts to the program create greater societal costs in the future. "It saves pennies, but it costs pounds later," said George Raya.

The Legislative Analyst's Office has reached a similar conclusion. A report issued by the organization on April 14, 2008 found that the IHSS program costs $12,406 per enrollee, while the comparable cost of a Medi-Cal skilled nursing facility was $57,182.