in-home supportive services (ihss)

Presented by:
Maria F. Iriarte, Managing Attorney
A special thanks to National Senior Citizens Law Center for allowing us to
use some of their slides
What is IHSS?
• IHSS is the largest publicly funded, non-medical
service to help people with disabilities remain in
their homes.
Who is Eligible?
• On Medi-Cal;
• California resident;
• Living in own home;
▫ Otherwise eligible applicant who:
Is living in a facility;
Wants to live on his/her own;
Can safely live on his/her own; and
Undergoes a needs assessment.
What Types of IHSS Services Are Available?
▫ Domestic Services
 (cleaning; sweeping; dusting; taking trash out, etc.)
▫ Related Services
 (meal preparation; meal planning and cleanup; laundry; including
ironing and putting items away; food shopping.)
▫ Personal Care Services
 (assistance with feeding; dressing; grooming; bathing; toileting; bowel
and bladder, getting in and out of bed.)
▫ Accompaniment to Doctor
 (or to alternative sources of services such as a day program.)
▫ Paramedical Services
 (injections; range of motion exercises, etc.)
▫ Protective Supervision
 (monitoring a cognitively or mentally impaired individual to safeguard
from injury or hazard.)
When Are Children Eligible to Receive
IHSS Services From Non-Parent?
• When disabled and low-income.
• If income too high for SSI, may qualify with
share of cost.
• If parents are out of the house working, school,
training, or
• If parents are unable to provide care due to
disability or illness, or
• If parents are sleeping or caring for other family
When Can A Parent Be Paid As An IHSS
• If the parent quit job or can't get a job full-time because
he or she must care for the disabled child, AND
• If no other suitable care provider is available (willing and
able); AND
• If the child is at risk of out-of-home placement or
inadequate care.
• If both the parents live in the home, one parent may get
paid when the other parent is working, in school,
sleeping, or disabled.
• Payments will not affect child’s SSI, but will affect
family’s welfare grant or Medi-Cal eligibility.
What Happens When I Call the Social
Services Agency?
• A Social Worker will request:
▫ Information about your needs to remain living
safely in your home.
▫ Information about your finances to determine
• A social worker will schedule a visit to your
home to conduct a needs assessment.
When Are Needs Assessments Performed?
• When person applies for services.
• Every twelve months thereafter.
• Whenever the county has information that the
recipient’s physical/mental condition or living
social/condition has changed.
Assessing Need
• Social worker makes an assessment of what your
need for in-home care is using:
▫ Available medical Information.
▫ Face-to-Face home visit:
 Recipient’s physical/mental Conditions.
 Living/social Situation.
 Time-For-Task Guidelines.
▫ Recipient’s statement of Need.
▫ Other Information Necessary and Appropriate to Assess
How Services are Authorized
• Using assessment information, time-for-task guidelines
and rankings, the social worker determines the amount
of authorized services.
• “Time-For-Task” Guidelines:
▫ Set ranges of time that can be authorized for services: Meal
preparation, Meal cleanup, Bowel and bladder care, Feeding,
Routine bed baths, Repositioning, Bathing, oral
hygiene/grooming, Dressing, Transfer, Care and Assistance with
prosthesis, Routine menstrual care, Ambulation, Domestic,
Laundry, Food Shopping and Other errands.
▫ Social worker must document tasks that might require more or
less time than the guidelines, and the reason for the increase or
▫ Keep a log of your daily care needs so that you can explain why
you need more time.
How Services Are Authorized (cont’d)
• Rankings: as part of the assessment for services the
county determines the person’s ability to complete
certain tasks. The county then gives a “functional index
rank” from “1” to “6” for each of the tasks.
▫ General Standards (Rankings):
1. Functioning is independent, and person is able to
perform the function without human assistance but
might have difficulty in performing the function, but
the completion of the function, with or without a
device or mobility poses no substantial risk to
person’s safety.
How Services Are Authorized (cont’d)
Able to perform a function, but needs verbal assistance,
such as reminding, guidance, or encouragement.
Can perform the function with some human assistance
including, but not limited to, direct physical assistance from
Can perform a function, but only with substantial human
Cannot perform the function with or without human
Paramedical services needed.
Note: not every ranking is always used in assessing a
specific area of need, ie. Laundry only uses ranks
Preparing for an Assessment
• Read the Disability Rights California IHSS Self-Assessment Packet.
• Fill out the Disability Rights California IHSS Self Assessment
Worksheet. Do this before the in-home assessment.
• Talk to your/child’s health care provider(s).
• Remember you/child is not authorized hours based on the basis of
diagnosis or disability alone, but upon disability related impairments
that prevent you/him/her from performing these task on your/his/her
• Always try to have friend, family member or other person present to
witness the face-to-face assessment.
• Think about the types of assistance your /child needs on the worst
Quick Facts about IHSS Cuts
• 2009 and 2011 proposed cuts
▫ 3.6% in 2009
• Oster v. Lightbourne lawsuit
• Oster Settlement
Oster Settlement- IHSS Reductions
• When: July 1, 2013
• Where: Statewide
• What: 8% reduction in IHSS hours
▫ Contingent on court & legislative approval of Oster
▫ 4.4 % + 3.6% (prior cut) = 8%
▫ Reduction will decrease to 7% (7/1/14)
Advice for IHSS consumers to minimize
• Can apply 4.4% cut to unmet need (see next slide)
▫ Protective supervision hours don’t count as unmet
▫ Make sure unmet need is accurately assessed!
• Consumers can choose how to apply cut to
▫ YES: tell provider about how to apply cut to hours.
▫ NO: county SW does not need to know how hours will
be cut.
• Consumers on waivers administered by In-Home
Operations should contact IHO to try to increase
waiver personal care hours to make up for lost
need for
Unmet Need
Maximum IHSS Hours
283 hour/month
maximum for
severely disabled
IHSS recipient
(unmet hours for
supervision don’t
320 Total Assessed Need(320 x 0.08) = 294.4
Still gets maximum IHSS after Extra 4.4% Cut
Consumers may be able to get
reassessment, but cannot appeal cut
• Consumers will get Notice of Action prior to
extra 4.4% cut.
• No right to appeal solely based on extra 4.4%
cut (unless there is a math error).
• BUT consumer can request reassessment if
medical needs or circumstances change
▫ Settlement agreement clarified: no need for new
medical certification form or doctor’s note.
Coordinated Care Initiative
• When: 1/1/2014
• Where: 8 Counties
• What:
▫ Mandatory Medi-Cal for all SPDs, including
persons on Medi-Cal and Medicare (Duals)
▫ LTSS integration
▫ Cal MediConnect
Coordinated Care Initiative: Where
Los Angeles
San Bernardino
San Diego
San Mateo
Santa Clara
Coordinated Care Initiative: What
CCI Change
Mandatory Medi-Cal
Managed Care
Duals and previously excluded SPDs
must enroll in Medi-Cal Managed Care
LTSS Integration
LTSS added to Medi-Cal Managed Care
Plan benefit package: IHSS, Community
Based Adult Services (CBAS);
Multipurpose Senior Services Program
(MSSP); Nursing Facility
Medicare Integration
(Cal MediConnect)
For duals, passive enrollment of
Medicare benefits into same MC plan

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