Overview

The In-Home Supportive Services (IHSS) Program provides people who have disabilities or are over the age of 65 with in-home and personal care services to help them live safely in their own home or maintain an independent living arrangement. Services available are:

IHSS is often seen as an alternative to assisted living or nursing facilities. The program is funded by state, county and federal dollars. Personal care services can now be provided at the workplace as well.

Who Can Be Eligible for IHSS?

Any California resident, living in his/her own home, who is already eligible for Medi-Cal can be eligible for IHSS.

The four eligibility categories people with disabilities most often use to get on Medi-Cal are:

• SSI-linked Medi-Cal
• Aged and Disabled Federal Poverty Level Medi-Cal
• California’s 250% Working Disabled Program
• Aged, Blind, and Disabled Medically Needy Medi-Cal

See DB101’s Medi-Cal program description for more details on these categories.

Note that acute care hospitals, long-term care facilities, and community care facilities are not considered one’s “own home.” If you live in such a facility and meet the other IHSS eligibility criteria above, you may still be eligible for the program if you plan to live on your own in the future and can do so safely. If this situation applies to you, IHSS is required to go to your facility to do a needs assessment there before you are released.

The same resource limits that apply to SSI-linked Medi-Cal apply to IHSS (less than $2,000 in personal property for an individual; $3,000 for a couple—one home, one car used to get to medical appointments, and life insurance with a combined face value under $1,500 do not count as personal property).

Income rules for IHSS can vary depending upon which Medi-Cal category you are enrolled in.

Getting Started

• Call or visit your local county Medi-Cal office to complete an IHSS application. Once IHSS receives the application, a caseworker will be assigned to conduct a needs assessment.
• Needs assessment: Your caseworker will come to your home to interview you to determine if you qualify for IHSS. They will also ask you a series of questions about your mental and physical abilities to determine what tasks you can perform safely and what you might need help with. They will also evaluate your living and social situation.
• After the needs assessment, IHSS will contact you to let you know if you have been approved or denied. If approved, you will be notified of the services and number of hours authorized. If services are denied or you are not happy with the number of hours authorized, you have the right to appeal. The appeals procedure is outlined on the back of the notice you receive.

Your Responsibilities

You are responsible for hiring, firing, and supervising your care provider. If your county has contracted IHSS providers, you can hire them to provide you with the necessary services. You can also hire a friend, relative, neighbor or other care provider.

IHSS does not provide 24-hour (“round the clock”) care. If you need this kind of assistance, you will need to make other arrangements for your non-IHSS hours, such as through a Home and Community-Based Waiver (HCBW). To learn more about HCBWs, contact the Department of Health Care Services In-Home Operations at (916) 552-9105 (Northern California) or (213) 897-6774 (Southern California).

IHSS care provider wages vary from county to county. You and your care provider must submit timesheets for all services provided. The state will handle payment of your care provider(s) unless you are on advanced pay.

Advanced Pay

Advanced pay is a payment the state sends to you before your services are performed. Then you pay your care provider directly. To be on advanced pay, you must be considered “severely disabled,” meaning you require 20 or more hours per week in personal care services, meal preparation/clean-up, and/or paramedical services.

Some people receive In-Home Supportive Services free of charge. To qualify for no-cost IHSS, your countable monthly income (see calculation below) must be less than the SSI monthly benefit rate in California—$870 for an individual or $1,524 for a couple in 2008.

If your countable monthly income exceeds the SSI benefit rate, you can still receive IHSS services if you meet all other eligibility criteria. You must, however, pay for the amount in excess of the SSI benefit rate yourself. This is known as “share of cost”.

Determining Your IHSS Share of Cost

Use the following steps to determine your IHSS share of cost (if any).

Step 1: If you have monthly unearned income (for example, an SSDI benefit, a pension, dividends), subtract a $20 "General Income Exclusion" from it to calculate your countable unearned income. If you do not have unearned income, this exclusion is applied to any earned income.

Countable Unearned Income Calculation

		Monthly Unearned Income
	-	$20 General Income Exclusion
	=	Countable Unearned Income

Step 2: If you have monthly earned income (for example, wages), subtract a $65 "Earned Income Exclusion" from it (along with the remainder of the $20 "General Income Exclusion" that you have not applied to Unearned Income), along with any Impairment Related Work Expenses, and divide the resulting figure by two to find your countable earned income. If you have Blind Work Expenses, subtract them after you divide.

Countable Earned Income Calculation

		Monthly Earned Income
	-	$65 Earned Income Exclusion
	-	$20 General Income Exclusion (only if you haven't already applied it to unearned income)
	-	Impairment Related Work Expenses
	÷	2
	-	Any Blind Work Expenses
	=	Countable Earned Income

Step 3: Add your countable unearned income to your countable earned income to find your total countable income.

Total Countable Income Calculation

		Countable Unearned Income
	+	Countable Earned Income
	=	Total Countable Income

Step 4: Compare your total countable income to the 2008 SSI Monthly Benefit rate. If your Total Countable Income is less than that rate ($870 for an individual and $1,524 for a couple), you do not have a share of cost. If it is greater than the monthly benefit rate, you will have share of cost.

Example:

You qualify for IHSS but your total countable monthly income is $970. In this case, you would have to pay $100 per month for your IHSS services ($970 - $870 = $100). This is your “share of cost”.

Medi-Cal and IHSS Share of Cost

For IHSS recipients who are on the Medi-Cal Medically Needy program and have a share of cost, the state pays part of the share of cost so that you, the IHSS recipient, pays down to the SSI/SSP grant level ($870 for an individual, $1,524 for a couple) rather than down to the lower maintenance need allowance under the Medically Needy program ($600 for individuals, $934 for couples).

IHSS Programs

There are three standard programs by which consumers receive IHSS services. Each program has a different maximum number of hours allowed. This maximum depends on whether or not you are determined “severely disabled.” Your caseworker will make this determination during your needs assessment.

1. Medi-Cal Personal Care Services Program

The Medi-Cal Personal Care Services Program (PCSP) is available to people with full-scope Medi-Cal who fit into one of the following categories:

• an adult child who receives care services from a parent, or
• an adult who doesn’t have a spouse to provide services, or
• a child who doesn’t have a parent to provide services.

Severely and non-severely disabled people can receive up to 283 hours of service per month under PCSP, including protective supervision. Individuals receiving care under this program and their provider(s) should be sure to fill out a PCSP Provider/Enrollment Agreement form.

2. Residual Program

Unlike PCSP, the Residual Program is for people who are not eligible for full-scope Medi-Cal. The program provides a maximum of 195 hours per month, including protective supervision for non-severely impaired people. If an individual is severely disabled, a maximum of 283 hours per month is available.

3. IHSS Plus Waiver Program

The IHSS Plus Waiver Program is available if your provider is going to be paid in advance or if there is a restaurant meal allowance. It is also available if your parent or spouse is your care provider or if you have both a spouse/parent care provider and a non-parent/non-spouse care provider.

The maximum amount number of hours allowed under the Plus Waiver Program varies from 195 to 283.

How Services are Authorized

New regulations established guidelines regarding the amount of time allocated for certain IHSS services.

Important: If you can prove that you need more hours than what is listed above, you can receive them. If you live with a roommate or attendant, your services will be pro-rated.

Protective supervision hours will be authorized at 195 hours per month for non-severely impaired people and 283 per month for severely impaired people. Whether a person receiving 195 hours per month is entitled to more (up to 283) will depend on which IHSS program they are on.

Children can receive IHSS services if:

A parent can be the IHSS provider if:

• the parent quit a job or can’t get a full-time job because they must care for the disabled child; and
• no other suitable care provider is available; and
• the child is at risk of out-of-home placement or inadequate care.

If both parents live in the home, one parent may get paid by the IHSS program when the other parent is working, in school, sleeping, or disabled.

IHSS in the Workplace

Assembly Bill (AB) 925, also known as the Workforce Inclusion Act, allows for the use of IHSS personal care services to help obtain, retain, or return to work (see All-County Letter Number 04-43 for details). You can request to transfer IHSS hours to the workplace under the law but you cannot request additional hours specifically for use at the workplace.

IHSS services that can be performed in the workplace include meal preparation/clean-up, personal care services with the exception of routine bed baths and paramedical services.
IHSS hours cannot be used for assistance with college courses or vocational training.

To transfer IHSS personal assistance hours to the workplace, you must first contact your caseworker and specify the number of hours and services needed. If you are on the Medi-Cal Medically Needy program with a share of cost/IHSS share of cost and go to work, you should consider the Medi-Cal 250% California Working Disabled Program. This program allows you to earn up to $53,028 annually and still be eligible for full scope Medi-Cal. Rather than having a Medi-Cal share of cost, you will have a small premium to pay every month for your Medi-Cal and will not have an IHSS share of cost.

Sources

The following links are provided for those who want detailed information on Medi-Cal. For those looking for more general information, please go to DB101’s IHSS Resources Page.

The California Department of Social Services provides a variety of resources and information on IHSS. The Department’s All-County Directors Letter Number 04-43 provides details on the use of IHSS personal care services at the workplace.

The CSU Sacramento Institute for Social Research offers detailed information on IHSS in their IHSS Provider Handbook and Consumer Handbook.

The California Advocates for Nursing Reform provide a fact sheet and local phone numbers for information on IHSS services.

Protection & Advocacy, Inc. is a federally funded program that provides representation for consumers of public programs who are disabled. Their website includes information on IHSS and other benefit programs.