Bell Gardens resident Raquel Martinez said for almost three years she has relied on the program, which pays assistants to make sure they arrive safely to frequent appointments at the MLK Medical Campus.
Martinez, 65, is blind and has cancer. She said she would have trouble catching an elevator to find the right office without the help of her support worker. Her assistant also helps with everyday tasks like grocery shopping and housework, spending 21 hours a week caring for her.
“I needed a lot of help,” Martinez said in Spanish.
As budget cuts strain the state, California could end support for elderly, blind and other immigrants with disabilities who have relied on the state’s in-home support services program.
IHSS pays caregivers to help with everyday tasks like bathing, laundry and cooking, provide needed care like injections under the supervision of a medical professional, and accompany people to doctor’s appointments. The goal is to help people continue to live safely in their own homes, without having to go into a nursing home or suffer from lack of access to the care they need.
Gov. Gavin Newsom has proposed removing immigrants in the country illegally from the IHSS program, estimating it would save California about $95 million as the state faces a $44.9 billion budget deficit.
The proposed cuts have infuriated immigrant and disability advocates, who say the cuts are shortsighted and will put Californians in need of everyday assistance at risk, increase their risk of deportation and ultimately drive up costs for the state.
At a recent hearing in Sacramento, Ronald Coleman Baeza said it was “inexcusable” that Governor Newsom was proposing to “eliminate these services for residents for no reason other than their immigration status.”
“This is exactly what Donald Trump is playing,” said Baeza, managing director of policy for the California Pan-Ethnic Health Network. “Without IHSS, these people would need costly and preventable hospital and nursing home care, while their family caregivers would go unpaid,” perpetuating an “intergenerational cycle of poverty.”
In California, IHSS also applies to blind, disabled, and elderly people who are enrolled in Medi-Cal, California’s Medicaid program, which began with children and eventually expanded to cover all Californians and undocumented immigrants. State officials stressed that immigrants without legal status would continue to be covered by Medi-Cal even as the cuts take effect.
“The IHSS benefits for illegal aliens were an expansion of services,” H.D. Palmer, Treasury’s deputy director for external affairs, said in an email. “None of these solutions were created easily or lightly. The overall goal was to preserve core programs and essential benefits,” such as Medicare, “specifically Medicare services for both citizen and non-citizens.”
The California Department of Social Services said about 3,000 undocumented immigrants have been approved for IHSS benefits, and budget officials said more than 1,500 were receiving them as of the beginning of the year.
At a California Senate subcommittee hearing, a representative from the Department of Human Services said the state agency is working with the Department of Health Services to see what other benefits people who are removed from IHSS can receive “to mitigate the adverse impacts.”
Most of the victims receiving assistance are over 50, but aid groups say the program also helps children with disabilities who would otherwise have to live in institutions.
Advocates worry that if the cuts go through the Legislature, undocumented immigrants could lose their benefits as soon as July. The Department of Social Services says it will give people whose benefits will be cut at least 10 days’ notice. Martinez, who is undocumented, didn’t know IHSS was on the way until a reporter mentioned it.
Blanca Angulo, 62, who helps others through a local group for disabled migrants called Inmigrantes con Discapacidades, said the cuts to benefits would be a “big blow”.
“They don’t know what life is like for people with disabilities because they’ve never been in our shoes,” she said in Spanish, “so it’s very easy for them to take away these services without a second thought.”
Advocates said excluding people from the program could have ripple effects on their families, who are often the ones paid to provide care under the program. Anthony Wright, executive director of the consumer advocacy group Health Access California, called it a “double whammy.”
“Who will provide care if the caregiver loses their income and has to find other work,” he asked, “or continue providing care but then have no way to meet basic needs.”
Jose Villasana Moran, who lives in the Hollywood area, worries about what will happen to his family when the program goes away. His husband, who worked as an assistant restaurant manager, took a pay cut and now works as an IHSS caregiver for his 63-year-old mother, who is undocumented and has Alzheimer’s disease.
“My mom needs help 24/7,” Moran said. “We don’t know what to do. … We have to dress her, comb her hair, cut her nails, cook her food because she can’t cook anymore.”
Moran said putting her daughter in a nursing home would be a “last resort” even if they could afford it: Her late father required more care than they could provide and endured poor care in a filthy facility.
“I don’t want my mother to go through that.”
Being removed from the program meant that her husband would lose the income he had earned from caring for her mother. His caregiving hours were limited to 195 hours per month. Moran decided to somehow “take care of my mother together, even if we didn’t have money.”
But he worries that other vulnerable people who are in the country illegally will be left without help, forcing families to leave their homes to work and put themselves and others at risk.
Norma Garcia of Contra Costa County cares for her 67-year-old mother, who has dementia and requires full-time care through the IHSS program. If her mother is removed from the program and Garcia no longer receives payments for her care, “how am I going to buy food? How am I going to continue to pay my bills?” she asked.
“My spouse is working, but 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.”
Hager Dickman, a senior attorney at the seniors’ advocacy group Justice in Aging, called it a “really big inequality issue.”
“This law will force targeted individuals, including undocumented immigrants, to either seek institutional care or accelerate the impoverishment of their families,” Dickman said.
Critics also argue that the savings from removing undocumented immigrants from IHSS could be outweighed by the cost of putting more of them in nursing homes. Disability Rights California lawyers point out that the state estimates the average annual nursing home cost at $124,188, far exceeding the average cost of about $28,000 for people in the country illegally who are on IHSS.
“This seems to be a classic example of ‘a penny saved, a pound lost,'” Wright said. Even if only a small proportion were to go into care homes, “it would still increase costs because care in care homes is much more expensive.”
Dickman added that being forced into a nursing home risks losing any chance of obtaining legal status. “Public assistance” rules can block people from getting green cards or citizenship if the government finds they are likely to be “primarily dependent” on the assistance. Medicare benefits typically aren’t factored into such decisions, but they can be if they are placed in a facility for long-term care at government expense.
As things stand, Angulo said, many undocumented immigrants are already hesitant to use IHSS services for fear of possible consequences. “The laws are always changing,” she said in Spanish, “for better or for worse.”
At a recent hearing, a representative from the Western Law and Poverty Center warned that the advocacy group believes the cuts violate state and federal law, including the Americans with Disabilities Act, and is “considering its options for litigation.”
Palmer said Governor Newsom “respects that there are differences of opinion on many of these proposals and that other alternatives may be proposed as discussions with the Legislature continue in the coming weeks.”