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.)

The California Department of Social Services (CDSS) has issued a reminder to counties regarding completing preliminary assessment of In Home Supportive Services (IHSS) eligibility for applicants and recipients who are being discharged from hospitals, medical institutions, or non-medical out-of-home placements.

IHSS applicants can be preliminarily assessed and services authorized prior to discharge from the out-of-home placement.  The social worker can help the applicant apply for IHSS while they are in the out-of-home care facility and they must determine what services the applicant will need when they return home.

When there is a referral for an IHSS applicant in an out-of-home facility, counties must complete the assessment in the out-of-home facility.  Counties can get permission from the applicant to work with the facility’s discharge planner or other personal to coordinate documentation for IHSS eligibility.  Counties should prioritize the most vulnerable applicants.

The county must conduct a second needs assessment to determine final service needs when the applicant returns to their own home.

Existing IHSS recipients must inform the county when they are admitted to a hospital or other out-of-home care facility in order to determine services that will not be provided while the recipient is in the facility.  When an IHSS recipient is discharged from an out-of-home care facility and the recipient reports they have additional needs when they return home, the county must do a reassessment.  This reassessment may include working with the facility discharge planner, the recipient’s doctor, or other personnel who are helping with discharge.

Counties should provide all needed IHSS documents to the applicant/recipient prior to discharge.  Counties can email these documents.  With permission, counties can provide the IHSS documents to facility staff.  Counties can work with facility staff to assist in completing documentation.  Discharge paperwork can be accepted instead of the IHSS SOC 873 certification form.  If discharge is to another county, the counties must work with each other.

If the applicant has a provider for when they return home, the social worker should confirm whether they have gone through the provider enrollment process, and if not provide information about how to do that.  If the applicant does not have a provider, the social worker should connect the applicant with the County’s Provider Registry.  (ACIN I-62-23, December 7, 2023.)