California could boot thousands of immigrants from program that aids elderly and disabled

THOUSAND OAKS, CA - APRIL 15: Kim Ballon a Ventura County In Home Support Services (IHSS) care provider attends to Marjorie Williams, 84, at her Thousand Oaks home as California does little to track safety of health care workers during the coronavirus Covid-19 pandemic. Ballon is worried about a lack of protective gear though she regularly cares for elderly clients, helping them bathe and multiple tasks. (keep as a silhouette) Thousand Oaks on Wednesday, April 15, 2020 in Thousand Oaks, CA. (Al Seib / Los Angeles Times)
An In-Home Supportive Services care provider helps a client at her home in Thousand Oaks. Proposed budget cuts would close the IHSS program to unauthorized immigrants. (Al Seib / Los Angeles Times)

In Bell Gardens, Raquel Martinez said she has relied for nearly three years on a program that pays an assistant to help her make it safely to her frequent appointments at the MLK Medical Campus.

Martinez, 65, is blind and has cancer. If she did not have the help of her support worker, Martinez said, she would struggle to navigate the elevators and find the right office. Her assistant also helps her with groceries and other daily tasks such as housekeeping, she said, tending to her 21 hours a week.

"I was in need of a lot of help," Martinez said in Spanish.

As budget cuts squeeze the state, California could cut off such assistance to elderly, blind or otherwise disabled immigrants who have relied on the state's In-Home Supportive Services program.

IHSS pays assistants who help people with daily tasks such as bathing, laundry or cooking; provide needed care such as injections under the direction of a medical professional; and accompany them to and from doctor's appointments. It aims to help people remain safely in their own homes, rather than having to move into nursing facilities or suffer without needed care.

Gov. Gavin Newsom has proposed cutting immigrants in the country illegally from the IHSS program, estimating it would save California nearly $95 million as the state stares down a $44.9-billion budget deficit.

The proposed cut has outraged groups that advocate for immigrants and disabled people, which argued it would be a shortsighted move that would jeopardize Californians who need day-to-day support, put them at increased risk of deportation and ultimately drive up costs for the state.

At a recent hearing in Sacramento, Ronald Coleman Baeza called it "indefensible" for Newsom to propose "to eliminate these services for a population for no reason but for their immigration status."

"It's right out of Donald Trump's playbook," said Baeza, managing director of policy for the California Pan-Ethnic Health Network. "Without IHSS, these individuals will need costly and preventable hospital and nursing home care, and family caregivers will go without pay," perpetuating "a generational cycle of poverty."

Read more: 'We'll end up on the streets': L.A. caregivers for elderly, disabled push for higher pay

In California, IHSS is open to blind, disabled and aged people on Medi-Cal, the California Medicaid program. Medi-Cal has expanded over time to include immigrants here illegally, beginning with children and eventually covering Californians of all ages. State officials emphasized that if the cut goes through, immigrants without legal status would remain eligible for Medi-Cal.

"The IHSS benefit for the undocumented population was an expansion of services," H.D. Palmer, deputy director of external affairs for the Department of Finance, said in an email. "None of these solutions were made easily or lightly. The overall goal was to maintain core programs and base benefits" such as Medi-Cal, "in particular, Medi-Cal services regardless of citizenship status."

The California Department of Social Services said nearly 3,000 immigrants without legal status had been authorized for IHSS. Budget officials said more than 1,500 were receiving such benefits as of earlier this year.

At a California State Senate subcommittee hearing, a Department of Social Services representative said the state agency was working with the Department of Health Care Services to see what other benefits people being jettisoned from IHSS might be able to access "to mitigate any negative impacts."

Most of the affected people getting such assistance are 50 and older, but the program also serves children with disabilities who might otherwise need to live in facilities, advocates said.

Advocates fear that if the proposed cut is approved by state lawmakers, people in the country illegally could lose such support as soon as July. The Department of Social Services said it would issue notices at least 10 days in advance to people being cut off. Martinez, who is here illegally, hadn't heard that IHSS could be yanked away until a reporter mentioned it.

Blanca Angulo, 62, who helps others through the local group Inmigrantes con Discapacidades — Immigrants with Disabilities — said rolling back the benefits would be "a terrible blow."

"They don't know the life of a disabled person because they're not walking in our shoes," she said in Spanish. "So for them it's very easy to take away these services without thinking about it."

Booting people from the program could also have reverberating effects on families, advocates said. In many cases, relatives are the ones being paid to provide care under the program. Anthony Wright, executive director of the consumer advocacy group Health Access California, called it "a double whammy."

If a caregiver "loses income and has to potentially find other work, then who does the caregiving?" he asked. "Or they continue the caregiving, but then they have no means to meet basic needs."

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In the Hollywood area, Jose Villasana Moran worries about what losing the program would mean for his family. His husband took a pay cut from working as an assistant manager at a restaurant to serve as the IHSS caregiver for his 63-year-old mother, who is here illegally and has Alzheimer's disease.

"My mom needs help 24/7," Moran said. "I don't know what we will do. ... We have to dress her. We have to comb her hair, clip her nails, make her food because she cannot cook anymore."

Putting her in a nursing home "would be the last resort," if they could even afford it, Moran said. His late father had needed more care than they could provide and had endured shoddy care at a dirty facility, he said.

"I would not want my mom to go through that."

Being jettisoned from the program would mean losing the income his husband had been receiving for her care, now capped at 195 hours a month, he said. Moran was determined that somehow, between the two of them, "we're going to try to take care of my mom, even if we don't have the money."

But he fears other vulnerable people who are in the country illegally may be left alone without help, putting themselves and others at risk, "because family members are forced to leave the house and work."

In Contra Costa County, Norma Garcia has been attending to her 67-year-old mother, who has dementia and needs constant care, through the IHSS program. If her mother is cut off from the program, and Garcia is no longer paid to care for her, "how am I going to buy food? How will I keep paying the bills?" she asked.

"My spouse works, but it's not enough," she said in Spanish. Finding another job outside their home in El Sobrante is impossible when her mother needs so much help, Garcia said.

"I can't leave her alone for even a minute."

Hagar Dickman, a senior attorney with the advocacy group Justice in Aging, called it "a really big inequity issue."

"It forces a targeted population, which is the individuals who are undocumented, to either seek institutional care ... or to increase impoverishment of their families," Dickman said.

Critics also argue that any savings from ejecting people here illegally from IHSS could be outstripped by the expense of putting more of them into nursing facilities. Attorneys with Disability Rights California pointed out that the state has estimated a nursing home costs an average of $124,188 annually — far more than the average cost of roughly $28,000 for people in the country illegally on IHSS, they said.

"This looks like a classic example of 'a penny wise, a pound foolish,' " Wright said. Even if only a fraction move into nursing homes, "it would still cost more money, because nursing home care is so much more costly."

Dickman added that being pushed into a nursing facility could put immigrants at risk of losing their shot at legal status. Under the "public charge" rule, people can be blocked from getting a green card or citizenship if they are likely to become "primarily dependent" on government aid. Medi-Cal benefits do not usually factor into those decisions — but they can if someone is institutionalized for long-term care at government expense.

As it stands, Angulo said many immigrants here illegally are already afraid to use IHSS services for fear of possible consequences. "The laws are always changing," she said in Spanish, "for good or for bad."

At a recent hearing, a representative of the Western Center on Law & Poverty warned that the advocacy group believes the cuts would violate state and federal law, including the Americans with Disabilities Act, and said it was "exploring litigation options."

Palmer said Newsom "respects that there will be disagreement over many of these proposals, and that other alternative approaches may be put forward in the weeks ahead as discussions with the Legislature continue."

Read more: Newsom boosted California’s public health spending during COVID. Now he wants to cut it

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This story originally appeared in Los Angeles Times.