Citing California’s budget deficit, the Democratic governor wants to save around $613 million in state funds by delaying pay increases for a year for about 150,000 disability care workers. The state will forgo an additional $408 million in Medicaid reimbursements, reducing funding by over $1 billion.

Some lawmakers say this decision will increase staff turnover and vacancies, leaving thousands of children and adults with disabilities without critical services at home and in residential facilities. Disability advocates warn it could violate the Lanterman Act, California’s landmark law that says the state must provide services and resources to people with disabilities and their families.

Newsom is “breaking a promise,” says Felisa Strickland, 60, who has been searching for more than a year for a day program for her 23-year-old daughter, Lily, who has autism and cerebral palsy. “It’s creating a lot of physical and mental health problems for people, and it’s a lot of undue stress on aging parent caregivers like myself.”

Disability care workers, known as direct support professionals, provide daily, hands-on caregiving to help children and adults with intellectual and developmental disabilities, such as autism, cerebral palsy, and epilepsy, remain independent and integrated into their communities.

In California, more than 400,000 people with disabilities need accommodation, and this population, along with seniors, is increasing. It’s unclear how big the worker shortage is because the state hasn’t released workforce data. As the demand for these workers grows generally, experts predict a shortage of between 600,000 and 3.2 million direct care workers by 2030.

Advocates say California pays most providers from $16 to $20 an hour, which meets the state’s minimum wage but falls short of what some economists consider a living wage. In 2021, the state committed to raising wages after identifying a $1.8 billion gap between the rates received by nonprofits that contract with the state to provide care and the rates deemed adequate.

Thus far, the state has provided around half that total, most of which has gone to raising wages and benefits. Workers had been expecting one more increase of $2–$4 an hour in July until Newsom proposed a delay.

Also, nonprofits say California has made it harder to compete for workers after raising wages in other service and health industries. Newsom approved a $20 minimum wage for fast-food workers that went into effect in April, and he struck a deal last year with unions and hospitals to begin raising health care workers’ wages to a minimum of $25 an hour.

Ricardo Zegri says Taco Bell would pay him more than the $19 an hour he makes as a disability care worker in a supervisory position.

“Every paycheck, it’s a discussion at home about what bills we need to prioritize and whether it’s time to start looking for work that pays more,” says Zegri, who works a second job as a musician in the San Francisco Bay Area.

Newsom wants to preserve key health initiatives, including the state expansion of Medi-Cal to low-income immigrants regardless of legal status, and CalAIM, an ambitious $12 billion experiment to transform Medi-Cal into both a health insurer and a social services provider. However, the rate delay for providing disability care is the largest savings in the Health and Human Services budget as Newsom and legislative leaders look to cuts, delays, and shifts in funding to close a deficit estimated between $38 billion and $73 billion.

Dozens of legislators from both parties are asking Newsom and legislative leaders to preserve the increase. Assemblymember Stephanie Nguyen, a Democrat from Elk Grove, signed a letter supporting the raise. Although lawmakers are negotiating with the administration, she says reversing the decision to delay the pay boost is unlikely. Everybody “has to take a hit somewhere,” Nguyen says.

Krystyne McComb, a spokesperson for the Department of Developmental Services, says that even though the state would lose federal matching funds this year, it would resume drawing funds when it reinstates the plan in 2025.

The department did not respond to questions about how it plans to retain workers and fill vacancies.

Newsom’s proposal risks a collapse of the disability service system, which would violate the Lanterman Act and make the state vulnerable to lawsuits, says Jordan Lindsey, executive director of the Arc of California, a statewide disability rights advocacy organization.

Families say the state has already fallen short of the services they need. Strickland quit her job to care for Lily, the Santa Barbara mother, says. “It’s not reasonable to expect someone to care for somebody else 24 hours a day, seven days a week,” she says.

Lily graduated from high school and, in 2022, completed a program that prepares youth with disabilities to transition into adult life. She had been looking forward to joining a day program to make new friends but has yet to find a spot. And due to a shortage of workers, Lily receives only four hours a week at home with a provider, who is paid around $16 an hour.

When Lily hangs out with the provider, her demeanor changes to the happy person she used to be, Strickland says.

“The system is already in crisis,” she says. “There are tons and tons of people that are sitting at home because there’s nowhere for them to go.”

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Previously, PCAFC was only available to eligible Veterans who served on or after Sept. 11, 2001. This expansion opens the program to eligible Veterans who served after May 7, 1975, and before Sept. 11, 2001.

PCAFC provides caregivers of eligible Veterans with resources, education, financial assistance, health insurance, beneficiary travel, peer support and more. The program is a cornerstone of VA health care, ensuring that Veterans get the world-class care they deserve and that caregivers get the comprehensive support they need.

“For the first time, eligible Veterans of all service eras can participate in the VA’s Program of Comprehensive Assistance for Family Caregivers,” says Deputy Secretary of Veterans Affairs Donald Remy. “We recognize the critical role family caregivers play in caring for Veterans, and through this expansion, we’re able to ensure that family caregivers of all eligible Veterans have access to the comprehensive support they deserve.”

This is the second expansion of PCAFC, and it will expand access to the program for tens of thousands of Veterans and their family caregivers. The first expansion of PCAFC began in Oct. 2020, as part of implementation of the VA MISSION Act of 2018. PCAFC has added approximately 20,000 active Veteran and family caregiver participants during the past two years.

Earlier this month, VA announced an interim final rule that will extend PCAFC eligibility for legacy participants, legacy applicants and their family caregivers, by three years to Sept. 30, 2025. Legacy Participants or Legacy Applicants are Veterans and their family caregivers who participated in PCAFC prior to Oct 1, 2020.

Learn more about the PCAFC expansion and VA’s Caregiver Support Program, reach out to a local CSP team or call our Caregiver Support Line at 855-260-3274 Monday through Friday, 8 a.m. to 10 p.m. ET, and Saturday, 8 a.m. to 5 p.m. ET.

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Specifically, this new rule will extend program eligibility for legacy participants, legacy applicants and their family caregivers, by three years. A legacy participant is a Veteran or servicemember who was participating in PCAFC as of Sept. 30, 2020, and a legacy applicant is a Veteran or servicemember who applied for PCAFC before Oct. 1, 2020, and was accepted into the program on or after Oct. 1, 2020.

“We will stop at nothing to make sure Veterans and their caregivers get the support they need and deserve, and this extension is a key part of that effort,” said VA Deputy Secretary Donald M. Remy. “As I’ve said before, trust is earned, it’s not given. We hope we can earn the trust of Veterans and caregivers through our continued efforts.”

“This extension allows us to continue supporting this cohort of Veterans and caregivers, while VA separately conducts program improvement initiatives aimed at ensuring the Program of Comprehensive Assistance for Family Caregivers addresses the unique needs of Veterans of all eras and their caregivers,” said VA Caregiver Support Program Executive Director Colleen M. Richardson, Psy.D. “Moving forward, we will continue to examine ways to improve this program and make sure it delivers for Veterans and their caregivers.”

PCAFC is a key part of VA’s Caregiver Support Program. PCAFC offers enhanced clinical support for family caregivers of eligible Veterans who incurred or aggravated a serious injury in the line of duty on or before May 7, 1975, or on or after Sept. 11, 2001, and meet other eligibility criteria. Benefits under PCAFC include education and training, respite care, counseling, technical support, a monthly stipend and access to health care through the Civilian Health and Medical Program of the Department of Veterans Affairs and certain travel expenses. VA is on track to expand PCAFC eligibility to include eligible Veterans of all service eras effective Oct. 1, 2022. More information about this program can be found here.

For any questions about caregiver support or the PCAFC, please contact local VA facility Caregiver Support Program teams or the Caregiver Support Line (toll-free at 855-260-3274). Find your Caregiver Support team using the facility locator.

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This applies to all Veterans and family caregivers participating in the program; additionally, VA will not discharge or reduce stipends based on a reassessment.

“President Biden has made clear ‘because Veterans are the backbone, the spine of who we are as a country,’ we have a sacred obligation to care for them, their families, caregivers and survivors,” said VA Deputy Secretary Donald Remy. “Although we’ve come a long way in supporting caregivers through the Program of Comprehensive Assistance for Family Caregivers, we have much more work to do. In our effort to uphold our sacred obligation to families of Veterans, VA continues its review of PCAFC to ensure department requirements and procedures meet the needs of caregivers and Veterans participating in the program.”

Facility Caregiver Support Program staff will however continue to initiate reassessments for Veterans and family caregivers for certain purposes, such as when a Veteran or caregiver requests to be considered for an increase in stipend level or if there is evidence of an increased need for personal care services. VA will also continue to conduct wellness visits. Appeal and review options for those who disagree with a PCAFC determination remain the same.

Visit VA’s reassessment updates for more information or contact your local CSP team with any additional questions.

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This extension applies to Veterans who were participating in PCAFC before Oct.1, 2020, individuals who applied for PCAFC before Oct.1, 2020 and those who were accepted into the program after Oct.1, 2020. 

The extension will provide VA an additional year to conduct required reassessments of this cohort.

PCAFC offers enhanced clinical support for family caregivers of eligible Veterans who incurred or aggravated a serious injury in the line of duty and meet other eligibility criteria. Benefits under PCAFC include education and training, enhanced respite care, counseling, a monthly stipend, CHAMPVA (if eligible) and certain travel expenses, among others. 

All legacy participants, legacy applicants and their family caregivers will be reassessed based upon the new eligibility criteria resulting from the Final Rule which became effective Oct. 1, 2020. 

“During this one-year period, approximately 19,800 legacy participants, legacy applicants and their family caregivers will be reassessed.,” said VA Caregiver Support Program Executive Director Colleen M. Richardson, Psy.D.

The department will initiate a large-scale effort to complete reassessments for this cohort. This effort will begin within the next several weeks.

The earlier VA conducts reassessments, the sooner it will be able to assist with discharge planning for PCAFC participants who do not qualify under the new eligibility criteria. Discharge planning may include engaging the Veteran and family caregiver in other services to include participation in the Program of General Caregiver Support Services, which provides caregivers with education, training, peer support mentoring, coaching and self-care courses.

Questions about PCAFC should be directed to local VA facility Caregiver Support Program staff or the Caregiver Support Line, tollfree at 855-260-3274. Find your Caregiver Support team or Caregiver Support coordinator using the facility locator.

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