A person is eligible for IHSS who is a
(1) Currently receives SSI/SSP benefits[1].
(2) Medically needy aged, blind or disabled.
(3) Meets all SSI/SSP eligibility criteria, except for
income in excess of SSI/SSP eligibility standards.
(4) Meets 94 SSI/SSP eligibility criteria including
income, but does not receive SSI/SSP benefits.
(5) Was once eligible for SSI/SSP benefits, but became
ineligible because of engaging in substantial gainful activity, and meets all
of the following conditions:
(a)
The individual
was once determined to be disabled in accordance with Title XVI of the Social
Security Act (SSI/SSP)
(b) The individual continue to have the physical or mental
impairments which were the basis of the disability determination
(c) The individual requires assistance in one or more of
the areas specified under the definition of "severely impaired
individual"
(d) The individual meets
applicable share of cost obligations
(MPP 30-755.1)
(6) Is participating in one of
Eligibility is determined at the time of application,
at twelve month intervals, and anytime information is received about changes in
the individual's situation. MPP
30-755.21. An IHSS recipient has
responsibility to report any change of
eligibility status to the
You meet the financial eligibility requirements for
IHSS if you receive SSI. If your income is too high to be eligible for any SSI,
you may be eligible for IHSS with a share of cost representing the difference
between your other income less $20 and the applicable SSI/SPP grant level. Please refer to Chapter 6 for more
information about meeting your share of cost.
Also, it may be possible for you to be eligible for
zero share of cost Medi-Cal (and thus, zero share of cost IHSS) under the A
& D FPL program, the 250% Working Disabled Program, 1619b, or the Pickle
Program For more information about the A
& D FPL program, go to: http://www.pai-ca.org/pubs/524401.pdf
and http://www.pai-ca.org/PUBS/545001.pdf,
http://www.healthconsumer.org/medical-cal.overview.pdf
Generally, your personal property may not
exceed $2,000 for an individual or $3,000 for a couple. Personal property that is not considered in
determining your resources includes the home you own and in which you live and
one automobile needed for transportation to medical appointments or work.
If an applicant is an alien permanently residing legally in the
If a person receiving IHSS is absent from the state for 30 days or longer, it is
considered to be a possible change of residence that may affect eligibility. If
a person leaves or is leaving the state for 30 days or longer, the
If you meet the presumptive eligibility criteria, and
you meet the other eligibility criteria, you can receive IHSS under PCSP or the
IPW program immediately on an interim basis if you have yet to establish
Medi-Cal eligibility. The presumptive
eligibility means you do not have to wait until a final decision is made on
your Medi-Cal eligibility before your IHSS can start. If, after you start receiving presumptive
Medi-Cal, you are told you are not eligible, you can appeal and continue
receiving IHSS (and Medi-Cal) during your appeal. The presumptive eligibility criteria for
Medi-Cal are the same as those for SSI[2].
Under the IHSS-R, a disabled applicant’s eligibility
for IHSS may be presumed if the applicant is not employed and has no
expectation of employment within the next 45 days, and if in the county's
judgment the person appears to have a mental or physical impairment that will
last for at least one year or end in death. MPP 30-759.31, MPP 30-759.8; MPP 30-761.11.
No. Not any longer. Under the old system, if you applied for IHSS
and were found eligible under the IHSS-R (residual) program, you automatically
were found eligible for Medi-Cal. Now if
you are one of the few people only eligible for IHSS under the original
residual IHSS program, you will separately apply for Medi-Cal. The application will be handled by a County Medi-Cal
eligibility worker, not by a
Before, if you applied for
IHSS covered by Medi-Cal and you were not already a Medi-Cal recipient, the
Before, if you qualified for
IHSS with a share of cost you received only one notice of action about your
share of cost under the IHSS program.
Now you will receive two notices of action: one notice of action will come from the
Medi-Cal program to tell you your share of cost under the Medi-Cal ABD MN
program; another notice of action will come from the IHSS program to tell you
your share of cost as a recipient of IHSS.
The IHSS share of cost is the amount you have to pay (or incur an
obligation to pay) after the state pays the difference between the Medi-Cal
maintenance need level and the higher applicable SSI/SSP grant level. DHS ACL 05-21; DSS ACL 05-05.
Medi-Cal program rules allow applicants to request
Medi-Cal coverage for the three months prior to the month of application, if
the applicant incurred a cost for a covered health care service in that
retroactive month.
One of the requirements of Medi-Cal’s three-month
retroactivity provisions [22 CCR §50197, §50148] is that the recipient actually
receives health care services in the retroactive month. This requirement means the services must have
been actually received. An unmet need
supported by a subsequent assessment would not qualify for Medi-Cal
reimbursement. In addition, because the
PCSP program reimburses recipients directly for services received and paid for,
proof of payment must be provided in the form of cancelled checks or such
similar proof as DHS may require. No
reimbursement will be made unless the recipient provides a statement of
necessity from a medical provider.
Although it has not yet been made explicit, there is a
presumption that the three month retroactive eligibility rule also applies to
the IPW program because it too is a Medi-Cal program. Retroactive eligibility under the IHSS-R
program is limited to the date of the application for IHSS services.
IHSS recipients under both
the PCSP and IPW programs must not have their cases terminated solely because
the recipient is terminated from SSI/SSP.
Medi-Cal benefits may not be
terminated for recipients if their termination is based upon the discontinuance
of their SSI/SSP eligibility (other than individuals discontinued due to death
or incarceration.) The law requires,
except in certain cases, that the counties evaluate every Medi-Cal case set for
termination for possible eligibility on any other basis before any action to
terminate Medi-Cal eligibility is taken. Craig v. Bonta (ACL 03-03)
This law is inapplicable to
persons receiving services under the IHSS-R Program because those individuals
would not be eligible for SSI/SSP in the first place.
A person’s “own home” is
defined as the place in which an individual chooses to reside. An individual’s “own home” does not include
an acute care facility, skilled nursing facility/intermediate care facility,
community care facility, or board and care facility. A person receiving an SSI/SSP payment for a
nonmedical out-of-home living arrangement is not considered to be living in his
or her own home. MPP 30-701(o)(2).
Yes. Under the Community Care
Facilities Act, any facility, place, or building that provides care and
supervision or that accepts residents who demonstrate a need for care and
supervision must be licensed.
If the person with a
disability is living with a spouse, the spouse or anyone else may be the paid
IHSS provider of nonmedical personal care services (see category 4 on the
enclosed worksheet form) and paramedical services. If the spouse leaves full-time employment or
is prevented from obtaining full-time employment because no other suitable
provider is available and, as a result, there is a risk of inappropriate,
out-of-home placement or inadequate care, the spouse also may be paid to
provide protective supervision and to accompany the disabled recipient as
necessary to medical appointments. If
the spouse is not able or available, these and the other IHSS services may be
provided by others. "Not available"
includes time when the spouse is out of the home because of work or for other
necessary reasons, or when the spouse is sleeping or meeting the needs of other
family members. MPP 30-763.4
a. Personal care services (bathing, toileting, dressing, feeding, assistance with ambulation, etc.).
b. Related services (meal preparation, planning and cleanup, laundry, food shopping).
c. Paramedical services if prescribed by a doctor (injections, catheters, tube feeding, suctioning).
d. Protective Supervision (24-hour monitoring and supervision to prevent injury). See Chapter 5 for further information.
• Not routine child care or supervision.
• Must show difference between disabled child and other children of same age.
e. Assistance with travel.
MPP 30-763.454
Theoretically, if the parents are not IHSS providers, they can be authorized at least 8 hours per week of respite when parents are shopping, doing errands, or doing other things for the family.
a. When disabled and low-income (receipt of SSI means automatic eligibility)
b. If income too high for SSI, may qualify with share of cost[3].
c. If parents are out of the house working, school, training[4].
d. If parents are unable to provide care due to disability or illness.
e. If parents are sleeping or caring for other family members.
MPP 30-763.44
a.
If the parent quit a full-time job or can't get
a full-time job because he or she must care for the disabled child,
b. If no other suitable care provider is available (willing and able), AND
c. If services are not received, the child will be at risk of out-of-home placement or inadequate care.
MPP
30-763.451
IHSS regulations impose
additional requirements on parent providers for minors when there are two
parents in the household. MPP
30-763.453. Under the regulations, a
parent may receive a payment for as an IHSS provider under a two parent
household only when all of the following conditions are met:
(1)
the parent
provider leaves, or is prevented from obtaining, full-time employment because
no other suitable provider is available and the inability of the parent
provider to provide services may result in inappropriate placement or
inadequate care,
(2)
the non-provider
parent is unable to provide the services because he/she is absent because of
employment or in order to secure education, or is physically or mentally unable
to provide the services, and
(3)
If the
non-provider parent is unable to provide the services due to employment or
educational purposes, payment shall be made to the parent provider only for
services which are normally provided during the periods of the non-provider
parent’s absence as indicated above.
There have been reported
cases where this regulation has been ruled invalid because it exceeds the scope
of the statute, which only requires that rule (1) above be met. The cases reason that if the legislature
intended to deny payment for services to a child to a parent in a two-parent
family, the legislature would have inserted language so providing.
No. Age
cannot be a controlling factor in determining whether a particular personal
care or related service should be authorized. The sole IHSS service limited in this respect
is protective supervision, where it is authorized “only as needed because of
the functional limitations of the child.”
“The starting
point for interpretation of a statute is the language of the statute
itself. Absent a clearly expressed
legislative intention to the contrary, that language must ordinarily be
regarded as conclusive.”
No. The
only limitations regarding IHSS provision for individuals under 18 years old
are found at MPP § 30-763.454. While
this regulation does, indeed, omit domestic services, it specifically includes provision of related
services at subsection (a). Perhaps the
county is confusing its actual term “services related to domestic services”
under the statute (
Only if your
circumstances fall within the description of what the legislature defined as
the expected parental responsibility towards the care of a child with IHSS
needs. That definition requires parents to care for their children unless the
parent provider leaves, or is prevented from obtaining, full-time employment
because no other suitable provider is available and the inability of the parent
provider to provide services may result in inappropriate placement or
inadequate care.
No. Payments will not affect a child’s SSI because this is considered exempt income under SSI rules. POMS SI 01320.175. When IHSS rules changed to allow Medi-Cal funding for parent providers under the IPW, these payments became income and property exempt under all of the State’s Medi-Cal programs for IHSS provided to children under 21. (ACWDL 05-29, 06-04, 06-19). However, receiving these payments still may affect the family’s welfare grant.
Yes. Respite services from the regional center are different from IHSS. You should be able to receive IHSS, including protective supervision, without losing any respite hours. Call DISABILITY RIGHTS CALIFORNIAif the regional center tries to cut your respite because you receive IHSS.
Yes. IHSS is not just for people with physical or developmental disabilities. People with psychiatric disabilities may also qualify if they need help in order to live in their own home1 or in the home of a relative.
Here are some of the reasons why a person with a disability may need help through IHSS or personal care services in order to live in their own home or in the home of a relative or friend:
a. Need for “prompts”2 to get up in the morning and go through tasks such as bathing, grooming, dressing, taking medication, eating. Prompts and assistance in sequencing are terms to describe the help people need in starting a task and in going from one step to another. Because of a person’s disability or the side effects of medication, the person may not be able to do that consistently without someone present to step them through the process.
b. Similarly, “prompts” may be needed to assist the person in going through the various tasks leading to going to bed at night.
c. Preparation of meals which a person may not be able to do consistently and safely alone.
d. Reminders to eat and drink water.
e. Shopping, cleaning, laundry, menu planning.
f.
Accompaniment to medical and mental health appointments because
the person cannot safely drive due to the disability or side-effects of
medication, or because the person has problems following through on
appointments without assistance.
g. Need for monitoring and intervention as “protective supervision” because a person may see a harmless, benign situation as one which is personally threatening and one which the person believes requires a response which could cause self injury. In such a case the person may need his attention diverted or redirected, help to see there is no threat, or action to prevent injury.
Workers from the County Welfare Department who process applications for IHSS or personal care services work primarily with people with physical disabilities (in a wheelchair or can’t do things because of severe arthritis) or cognitive disabilities (mental retardation or a senior with Alzheimer’s). They are not used to applications from people with psychiatric disabilities. That means the county worker will need more help from you and the people helping you in order to understand why you need attendant care help in your home. You will need a letter from your psychiatrist or the social worker at the clinic you go to or the psychologist you see or your case manager -- or anyone else who helps you and knows your needs. The letter should explain the following:
a. The things you need help with and the kind of help you need.
b. Why you need that help because of your disability. For instance, the psychiatrist or social worker or psychologist you see can explain that your medications plus your disability make it hard for you to get up on time and go through the other morning steps without help.
c. How not getting the help you need could mean you are not able to continue living on your own in your own home or hotel room or apartment.
d. How not getting the help you need could make your condition worse. For instance, without help in getting up regularly every day and in keeping your apartment in order, your day-to-day life could feel chaotic and lead you into a crisis. Without help in providing structure and order in your life, you are at risk of a crisis which could even mean a visit to the emergency room.
If you or the people helping
you run into problems getting the attendant care services you need, call
Protection & Advocacy at 1-800-776-5746.
Ask for an appointment with an Advocate.
The right of people with psychiatric disabilities to get the IHSS or
personal care services they need to live in their own home is a priority with
us.
Social services staff must explore
alternative IHSS which may be available from other agencies and programs to
meet the needs of the recipient. MPP §30-763.61.
While counties may offset the total number
of hours authorized to you due to alternative resources, counties are required
to consider your alternative resources when assessing your overall need. MPP §30-763.273. This could make a difference in you being
categorized as “severely impaired” instead of “non-severely impaired.”
If a need for services is
assessed and authorized, then with certain exceptions, an individual can
legally be paid to perform the services.
Any individual who could legally be paid to provide IHSS services can
volunteer not to be paid to provide those services. Regulations require counties to obtain a
signed Voluntary Services Certification Form from individuals who agree to
render voluntarily any compensable services. (ACL 00-28)
If an organization provides a
portion of the authorized service, it must be considered as an Alternative
Resource rather than a provider.
Organizations are funded by other sources and therefore, cannot be paid
via the receipt of IHSS funds.
No. Regional center clients may not be denied
IHSS because they receive supported living or independent living services
funded by the regional center. Regional
center funded services that support consumers in their own homes, such as
supported living and independent living services, which are different from or
in addition to IHSS, cannot be used as a basis to deny eligibility for or
reduce the number of hours of IHSS at any time. (ACLs 98-53 & 98-79.)
The county may not deny
eligibility for or reduce the number of hours for IHSS to regional center
consumers who receive interim emergency regional center funded services, which
are similar to IHSS, on the grounds that the regional center services are
“alternative resources,” if the regional center reports that the regional
center funded services are being provided until IHSS begins, and the interim
regional center services will end when the county begins funding IHSS. The county must fund IHSS back to the date of
application, unless the interim services have been provided at no cost to the
consumer.
Both IPP’s and ISP’s should
clearly state which services are interim emergency services that the regional
center will fund until IHSS begins and which are supported living or
independent living services that the regional center will continue to fund.
No, EPSDT should not be
considered an alternative resource, and IHSS/PSCP authorized recipient hours
should not be reduced because the recipient receives EPSDT services. EPSDT provides supplemental services that are
prescribed by medical professionals who established the medical necessity of
the services, which is considered distinct from IHSS/PSCP services. (ACL 02-43E.)
Yes. You can get both. If you are currently getting the maximum
number of IHSS hours, these hours cannot be reduced if you get some in-home
help through MSSP. If you are not
getting the maximum number of IHSS hours, any in-home help through MSSP will
not affect your IHSS hours. (ACL 03-11.)
Yes. You can be served under all three
programs. If you are currently getting
the maximum number of IHSS hours, these hours cannot be reduced if you get some
in-home help through MCWP and CMP. If
you are not getting the maximum number of IHSS hours, any in-home help through
MCWP or CMP will not affect your IHSS hours. (ACL 04-16.)
Maybe. There have been reported cases where counties
have denied eligibility for IHSS because the recipient is receiving a
specialized foster care rate payment.
The case decisions require the county social workers to conduct needs
assessments of the clients and then determine what services the basic and
specialized foster care rates benefits are intended to cover before reducing or
denying IHSS services based on alternative resources.
AAP provides a cash benefit to families that
adopt special needs children. The
purpose of AAP is to remove financial barriers to adoption of children who
would not otherwise have the security and stability of permanent homes, while
simultaneously achieving substantial savings to the state in foster care costs
by reducing foster home care. The amount
of the cash benefit is based upon the needs of the child and the circumstances
of the family. The latter term includes
“the family’s ability to incorporate the child into the household in relation
to the lifestyle, standard of living, and . . . the overall capacity to meet
the immediate and future plans and needs, including education, of the
child.” But AAP benefits are not
earmarked to pay for any specific service.
Pursuant to a court order, VA Aid and Attendance payments cannot be counted as income or treated as an alternative resource. (Clift v. McMahon)
Yes. All IHSS recipients are eligible to transfer
a portion of their current authorized service hours to the workplace if they
choose to do so. This includes
recipients in all three modes of service delivery for IHSS Residual/PCSP/IPW.
The personal care services are limited to those that are currently authorized for you in your home and those services are to be utilized by you at your place of employment to enable you to obtain, retain, or return to work. Authorized services you use at your work must be services that are relevant and necessary in supporting and maintaining your employment. Work place services shall not replace any reasonable accommodations required of your employer by the Americans with Disabilities Act or other legal entitlements or third-party obligations. Cal.
In addition, income and
resource limits under all IHSS programs have not changed, so income you make
could affect your program eligibility.
If your earnings affect your eligibility or cause you to have a share of
cost, counties should evaluate your eligibility for the Medi-Cal 250% Working
Disabled Program (WDP) or other Medi-Cal coverage. The 250% WDP allows an individual to earn
countable income up to 250% of the federal poverty level while still
maintaining eligibility for Medi-Cal benefits.
(ACL 04-43.) For more information
about the 250% WDP, please refer to: http://www.healthconsumer.org/cs032WorkingDisabled.pdf
Additional IHSS hours may be
authorized under a Home & Community Based Waiver (HCBS) for persons who
would otherwise qualify for care in a nursing facility or subacute nursing
facility. If you qualify, you can receive
more IHSS hours even if you are already receiving the maximum 283 per month to
reduce your unmet need. Also, you do not
need to be authorized for the maximum amount of hours (195 or 283) in order to
receive WPCS.
You may receive WPCS if: (1) You have been approved by DHCS to receive services through a HCBS Waiver for persons who would otherwise require care in a nursing facility;(2) You have doctor's orders that specify that you require waiver personal care services in order to remain in your home;(3) You choose to receive waiver personal care services in order to remain in your home.(4) Your waiver personal care services and all other waiver services do not exceed the fiscal limit established under the HCBS Waiver.
(ACL 03-24)
For more information about
qualifying for supplemental waiver personal care services, go here: http://www.pai-ca.org/pubs/539201.htm. If you are temporarily in a hospital or
nursing facility, your providers of supplemental waiver services will be paid
for up to 7 days.
4 A person who receives the SSI out-of home
board and care rate does not qualify for IHSS. This is considered to be
nonmedical out-of-home care. The SSI board and care rate includes care and
supervision for that individual. MPP
30-701(o)(2); MPP 30-763.72.
[2]
[3] See if the child would be eligible for zero share of
cost Medi-Cal under the A & D FPL program or through institutional deeming
under one of the state’s HCBS Waiver programs, particularly the DD Waiver if
the child is a regional center client.
[4] Exception: Under PCSP, a non-parent
provider may provide services to an institutionally deemed child even if the
parent is present in the home. (ACL 00-83;
1 “Home” may include an apartment you share with other people or a hotel room. You are not eligible for IHSS or personal care services if you live in a board and care or residential facility. However, these services may help you move from a board and care to your own apartment or hotel room.
2 “Prompts” and “Cuing” and “sequencing”
are physical and verbal interventions to overcome a disability barrier to
beginning a task, to going through the steps necessary to complete a task, to
following the correct sequence in completing tasks or a task. Functional limitations that provide a basis
for finding a mental impairment for purposes of qualifying for SSI include
“[d]eficiencies of concentration, persistence or pace resulting in frequent
failure to complete tasks in a timely manner. . . .” This is from one of the “B” criteria under
mental impairment listings 12.01, Appendix 1, Subpart P,