The California Department of Social Services (CDSS) has issued an All-County Letter (ACL) to implement Telehealth Reassessment Options for In-Home Supportive Services (IHSS).

Due to COVID-19, California declared a state of emergency which authorized the IHSS program to conduct assessments and reassessments over phone or video call. This authorization ended when the state of emergency ended on February 23, 2023

On May 1st, 2024 the federal government approved State Plan Amendments that authorize the Telehealth Assessment Option for the IHSS programs.

Telehealth Reassessment Options will allow reassessments by phone or video call for any IHSS recipients who choose to participate and are determined eligible by county staff. To be eligible recipients must have stable care needs, have received an initial in-person assessment, and one in-person reassessment. In-person reassessments are the default and participants must opt-in to telehealth reassessments. Recipients cannot have consecutive telehealth reassessments unless there is a State of Emergency.  Recipients will be reevaluated for eligibility before every telehealth reassessment.

All counties must implement the Telehealth Reassessment Option sixty days after completing computer system changes. Counties can choose to begin implementing this option after the publication of this letter, However, counties must manually research cases to determine eligibility and can use scheduling and assessment practices used during the COVID-19 pandemic. Recipients who have not had an in-person reassessment due to COVID-19 must receive one before using the Telehealth option.

Recipients must be able to independently use the technology required for telehealth or have someone assist them. This ensures that they can fully participate in the reassessment. In-person assessments must be conducted every other year and telehealth cannot be used for quality assurance or program integrity home visits.

To qualify as having “stable care needs” the recipient must meet 10 criteria at the time of reassessment. First, telehealth recipients must be 19 years of age with minors being ineligible due to changes in need of care. A minor who turns 18 must have one in-person reassessment after their birthday to qualify. Second, recipients cannot have had any incidents involving Adult Protective Services or other similar agencies. Third, there can be no documented concerns about health or safety and no suspicion of fraud in their case. Fourth, recipients cannot have been hospitalized or admitted to an overnight facility for 24 hours nor had multiple ER or urgent care visits in the last 3 months. Fifth, the recipient must not have had a gap in provider services in the last six months ensuring that needs are being met. Counties can use the 60-day no-activity report to identify cases that have gaps in provider services. Sixth, they must not have changed residence since the last reassessment. Seventh, they live with others when in need of assistance with memory, orientation, and judgment (MOJ), or they live alone and do not need assistance. If they have rank 2 or 5 in MOJ and live with others, they must have access to additional resources and support and are determined to have stable care needs. A recipient who lives alone should be rank 1 and not require any assistance with MOJ or need additional assistance. Eighth, the recipient cannot have an authorized representative who directs all care needs. Ninth, the recipient must not require assessment or reassessment for protective supervision. Finally, 10th, the recipient must not have complex paramedical needs. If a recipient has management through another program that helps stabilize them but does not meet all the criteria above, they can receive an exception as it pertains to stable care.

During a State of Emergency, recipients of impacted countries can receive telehealth reassessments regardless of stable needs criteria. When conducting a reassessment, the county is expected to fulfill documentation requirements for completion of an annual reassessment. The recipient must be in their home environment for the reassessment regardless of whether they are participating in the telehealth option. If a country cannot visually assess the recipient and their environment during the telehealth reassessment, they must ask questions to obtain the same information they would have during an in-person reassessment and document it. All standard forms are still required and original signatures are needed on forms that require it. When doing assessments with recipients with language or communication barriers the county must ensure the recipient’s comfort and provide translation services.  (ACL 24-72, October 8, 2024.)

Severely impaired In Home Supportive Services (IHSS) recipients can receive an advance payment for their monthly authorized IHSS services and pay their providers directly.  Recipients who get advance payment must submit reconciling timesheets by the end of the month.  If the recipient fails to submit a reconciling timesheet within 45 days of the issuance date of the advance payment, there is a rebuttable presumption that the unreconciled amount is an overpayment.  Counties should help recipients with reconciliation.

Counties should determine which part of the advance payment is an overpayment because of failure to reconcile.  Any portion of an advance payment that is not used to purchase IHSS services is an overpayment.  If timesheets are not reconciled, but the county determines that the advance pay amounts were used to purchase IHSS services, there should not be an overpayment and the county can consider the timesheets to be reconciled.

Failure to submit a time sheet within 90 days of the date of payment allows counties to change a recipients payment method from Advance Pay to payment in arrears.

If a recipient is deceased, the county can consider the Advance Pay amount reconciled.  (ACL 24-38, June 6, 2024.)

The California Department of Social Services (CDSS) has issued instructions about In Home Supportive Services (IHSS) recipients as employers of their providers.  The IHSS recipient is an employer of record of the provider.  CDSS performs payroll and other functions for the IHSS recipient. For CDSS to complete these functions, all IHSS recipient and applicants must have a Social Security Number (SSN).  If the applicant or recipient does not have a SSN, they must have or apply for a Individual Taxpayer Identification Number (ITIN).

CDSS must register IHSS as an employer of record with the Employment Development Department (EDD). To establish the IHSS recipient as an employer of record, EDD requires the recipient to have either a SSN, or, if ineligible for a SSN, apply for an ITIN through the Internal Revenue Service.

Counties cannot deny an IHSS application if the applicant does not have either a SSN or ITIN. The county will redirect applicants who do not have a SSN or ITIN to apply for an ITIN through the Internal Revenue Service. During the process for receiving an ITIN, which can take 60 to 90 days, the county must still process the IHSS application. Counties can help applicants or recipients apply for an ITIN. (ACIN I-70-23, November 21, 2023)

The California Department of Social Services (CDSS) has issued guidance regarding the end of In Home Supportive Services (IHSS) provider eligibility requirements for minor recipients.  Previously, minors could only hire a non-parent IHSS provider if their parents were not available to be providers.  In addition, parents could only be providers for their minor children if there were no other suitable providers, and the parent was prevented from full-time employment because of the need to care for the child.  Effective 60 days after December 21, 2023 (the date of the release of this ACL) these limits on parent providers are eliminated.

The limits on providers for minors still apply to minor recipients in the Personal Care Services Program.  Counties should ensure that minor applicants who want a parent provider are enrolled in the Community First Choice Option, the IHSS Plus Option, or the IHSS Residual program.  Counties should transfer qualifying minor recipients from the Personal Care Services Program to the Community First Choice Option upon request of the recipient or at the next scheduled reassessment, whichever is first.  Minor recipients who are institutionally deemed and enrolled in the Personal Care Services Program may hire a non-parent provider without limitation.

Other rules for IHSS remain unchanged.  Service assessment rules for minors are unchanged.  Minors remain ineligible for domestic services, heavy cleaning, yard hazard abatement, and teaching and demonstration. Provider enrollment rules are unchanged.  Provider overtime rules and exemptions are unchanged. (ACL 23-106, December 21, 2023.)

In Home Supportive Services (IHSS) is available to persons who cannot remain in their own home without services.  Persons who receive SSI can get an additional payment if they are in a non-medical out-of-home living arrangement.

Individuals who receive the SSI non-medical out-of-home care rate are considered not to be living in their own home and are not eligible for IHSS.

IHSS applicants who are eligible for both IHSS and the SSI non-medical out-of-home care rate can choose whether they want IHSS or the SSI non-medical out-of-home care rate. Counties must inform people of this choice.

If an IHSS applicant states that they are not receiving the SSI non-medical out-of-home care rate, but the MEDS system says they are, the applicant must get a letter from the Social Security Administration stating that they do not get the SSI non-medical out-of-home care rate.  The applicant must also complete the SOC 810 form stating that they told the Social Security Administration that they have been discharged from a facility.

When evaluating for IHSS, county social workers must assess for all IHSS services, and must document any unmet need in the case file, identify other resources to meet the unmet need, and refer applicants to those programs at no cost.  (ACL 23-108, December 27, 2023.)