Health Policy Fact Sheet April 2012 Hidden in Plain Sight: California’s Paid Medi-Cal Caregivers Are Vulnerable Geoffrey J. Hoffman and Steven P. Wallace I n 2009, an estimated six million caregivers in California provided care to a family member or friend with a long-term illness or disability.1 Of these caregivers, a significant tenuous economic situation of paid Medi-Cal caregivers with incomes less than 200% FPL is reflected in food insecurity rates that were twice those of unpaid caregivers (31% versus number —450,000 persons—were paid for 15.4%). Of those with incomes less than 300% the care they provided. Nearly two-thirds of FPL, paid Medi-Cal caregivers were the most these paid caregivers, or 290,000, aided a likely to depend on food stamps (14.1%). family member or friend receiving Medi-Cal Across all income groups, they were the least (paid Medi-Cal caregivers).2 Many of these likely to own their own home (49.6%). paid Medi-Cal caregivers more than likely worked for California’s In-Home Supportive Paid Medi-Cal Caregiver Work Unstable Services (IHSS) program. Despite being Paid Medi-Cal caregivers were the most likely compensated, paid caregivers—and paid of all groups to be at their job for a short period Medi-Cal caregivers in particular—fared of time, suggesting a high client turnover. much worse on a number of economic Among paid Medi-Cal caregivers, 15.7% were security indicators. at their current job for less than one year and only 17.5% had been at their job for more than Paid Caregivers Economically Insecure 10 years. Close to one-third of both unpaid Paid Medi-Cal caregivers had the highest rates caregivers and employed non-caregivers of poverty: they were most often at less than reported being at the same job for more than 100% of the Federal Poverty Level (FPL) and 10 years (Exhibit 2). at near-poverty (100-199% FPL; Exhibit 1). This publication contains All paid caregivers had the next highest Job instability is compounded by poor access data from the California poverty rates, while non-caregivers and unpaid to health care. Paid Medi-Cal caregivers were Health Interview Survey caregivers were more likely to have incomes almost twice as likely to have no health (CHIS), the nation’s largest above 300% FPL.3 Over half of paid Medi-Cal insurance as non-caregiving adults (30.7% state health survey. caregivers (57%) and almost half of all paid versus 17.8%), and 38% of paid Medi-Cal Conducted by the UCLA caregivers (49%) had poverty or near-poverty caregivers used a health clinic or health center Center for Health Policy as their usual source of care (Exhibit 2). The incomes. Research, CHIS data gives other groups were more likely to use a doctor’s a detailed picture of the office as their usual source of care. Paid Medi- The average monthly income for paid Medi-Cal health and health care caregivers was $1,970, compared to $4,222 for Cal caregivers were also more likely to delay needs of California’s large caregivers who were not paid for the assistance getting a prescription (17%) or medical care and diverse population. Learn more at: they provided (Exhibit 2). Paid Medi-Cal (23%) compared to adult non-caregivers (8% www.chis.ucla.edu caregivers averaged 43 hours of care per week, and 13% respectively). Among paid Medi-Cal or approximately $11 per hour, accounting caregivers whose usual source of care was for additional work many caregivers do. The a clinic, 30% reported delays getting prescriptions and 31% reported delays getting 1 Caregivers provide assistance with bathing, taking medications, household chores, transportation, and other medical care. activities care recipients can no longer do for themselves. 2 In comparison, an estimated 5.7 million California adults Paid Medi-Cal Caregivers At Risk were unpaid caregivers and more than 21 million were not engaged in caregiving. The demand for paid caregivers will grow 3 All paid caregivers include paid Medi-Cal caregivers. rapidly as the population ages. The already Read this publication online 2 UCLA CENTER FOR HEALTH POLICY RESEARCH fragile economic circumstances of caregivers Data Source: 2009 California Health Interview Survey are jeopardized by pending and proposed cuts Author Information: Geoffrey J. Hoffman is a to state programs. These paid Medi-Cal graduate student researcher at the UCLA Center for caregivers lack job stability and have limited Health Policy Research. Steven P. Wallace is resources, especially if they should become sick associate director of the UCLA Center for Health themselves. Reduced funding for programs Policy Research and professor of Community Health affecting seniors and caregivers, such as Adult Sciences at the UCLA School of Public Health. Day Health Care and In Home Supportive Acknowledgements: The Service Employees Services, will likely add to the burdens already International Union supported the analysis faced by California’s paid caregivers. reported here. Exhibit 1 Federal Poverty Level of Paid/Unpaid Caregivers and Non-Caregivers in California, 2009 56% 52% 33% 30% 27% 26% 23% 24% 20% 16% 18% 18% 18% 14% 14% 13% 0 - 99% FPL 100 - 199% FPL 200 - 299% FPL 300%+ FPL Paid Caregivers of Medi-Cal Recipients All Paid Caregivers Non-Caregivers Unpaid Caregivers Note: The poverty threshold in 2009 was $10,956 for an individual and $21,954 for a family of four. Source: 2009 California Health Interview Survey Exhibit 2 Economic Characteristics: Paid Caregivers of Medi-Cal Recipients, Unpaid Caregivers and Non-Caregiver Adults in California, 2009 Paid Caregiver of Medi-Cal Recipient Unpaid Caregiver Non-Caregiver Estimated population (x 1,000) 294 5,719 21,244 Employment % % % Time at main job Less than 1 year 15.7 10.6 8.8 1-9 years 66.8 52.6 59.2 10 or more years 17.5 36.7 32.0 Finances % % % Respondent’s earnings last month ($) 1,971 4,222 4,127 Food insecurity (if income <200% FPL) 31.0 15.4 13.8 Receive food stamp benefits (if income <300% FPL) 14.1 10.7 9.2 Home Ownership % % % Own 49.6 64.7 60.3 Rent 46.3 31.1 35.9 Other 3.8 4.2 4.1 Health Services % % % Uninsured 30.7 17.9 17.8 Place for usual source of care Doctor's office 58.2 71.0 67.6 Clinic/health center 37.5 26.3 29.7 ER/Other 4.4 2.1 2.6 Delay getting prescription in past year 17.4 12.7 8.3 Delay medical care in past year 22.7 22.0 13.1 Notes: Data are from the 2009 California Health Interview Survey and are weighted. Percentages may not total 100% due to rounding. FS2012-1