Two bills have been proposed to regulate an estimated one million unlicensed home health workers in California. The big questions are, how much regulation is needed, and how much that type of program will cost. One of the bills, AB 899 by Mariko Yamada (D-Davis), has looser requirements and is currently stuck in the Assembly appropriations committee.

The one more likely to make it to the floor is SB 411 by Curren Price (D-Inglewood), which would require background checks and care instruction for all home health care workers. It is expected to be taken up for a floor vote as soon as the end of January.

SB 411 is the one up for debate and possible amendment, according to Jordan Lindsey, director of policy and public affairs for CAHSAH, the California Association for Health Services at Home.

The big issue we’re facing [with SB 411] is the cost,” Lindsey said. “It’s a huge new program, which might be a lot to ask, given the budget constraints we’re going through.”

Last year’s estimate from appropriations was that the program would cost about $1 million to start up, and $8 million every year to run the background checks. But new analysis points to a cost of as much as $25 million a year, Lindsey said.

The bill passes some of the cost of the program on to home health care agencies and individuals in the form of licensing fees. “What it breaks down to is about $4,000 a year in licensing fees,” Lindsey said. “I think most of the agencies can do that. But then for every home health aide, it would be another $165 per aide per year.”

And if that turns out to be the cost, he said, that’s a significant burden to agencies. “Basically you’re paying $20,000 a year just to stay in business,” Lindsey said.

The bill, backed by the Service Employees International Union, has ramifications for labor unions as well as for consumer protection.

CAHSAH is pushing an amendment that abandons a complete online registry in favor of a system resembling Trustline, the state’s background check service for child care providers.