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.)

The California Department of Social Services (CDSS) has established a permanent Back-Up Provider System (BUPS) for the In-Home Supportive Services (IHSS) and the Waiver Personal Care Services (WPCS).

The permanent BUPS allows any eligible IHSS recipient to receive temporary IHSS or WPCS from a backup provider. This is available when the recipient has an urgent need for backup related to personal care services that cannot be met by an existing provider, or the recipient is transitioning to home-based care and does not yet have an identified provider. For BUPS to be available, the need must be immediate and cannot wait until the provider is available to provide the need, and the need has a direct impact on the IHSS recipient, and delaying it would potentially jeopardize the health/safety of the IHSS recipient which may result in the need for emergency services and/or out-of-home placement.

The Back-Up Provider System provides eligible recipients with a maximum total of 80 hours per fiscal year (July 1 to June 30) and will reset to 80 hours on July 1 of each year. There are exceptions to the 80-hour annual limit, granted on an as-needed basis for severely impaired recipients. The exceptions cannot exceed 160 hours per fiscal year. These exceptions may only be granted if the funding for the exception is appropriated in the annual State Budget Act.

Counties shall work with recipients who are transitioning to home-based care and, requesting backup services to consider the following when determining if a backup provider is appropriate for that individual: how much urgent care the recipient would need upon transition and whether the use of BUPS is appropriate and safe for the situation being requested, whether or not the recipient would have difficulty managing a provider from the BUPS, and that a BUPS provider can only provide services temporarily and they may also need the direct support of friends and/or family until they hire permanent provider.

Counties should try to assist recipients in obtaining a backup provider whenever possible. Examples of when a backup provider would be appropriate and safe to use the BUPS while transitioning to home care may include: a newly approved recipient who is being released from the hospital and has the support system of family/friends and a family member who will be designated authorized representative to manage the BUPS provider during the time the permanent provider is being located; and an existing recipient who has an extended hospital stay, no longer has a permanent provider and has an urgent need for services.

For recipients with two or more regular providers, if the recipient has the need to use the BUPS. An exception from the provider workweek limitations may be authorized for one of the regular providers. The recipient may assign the hours to their other provider without requiring county approval so long as the hours worked by the single provider do not exceed the maximum weekly hours, or, if the provider works for more than one recipient, does not cause them to exceed 66 hours in a workweek.

The recipients are allowed to hire, terminate, and supervise the backup provider. However, if they choose to not use or terminate the backup provider referred by the county or public authority, it is their responsibility to find and hire a backup provider. Any provider they choose that is not part of BUPS, will not be paid the two-dollar salary differential. Moreover, the chosen provider must be eligible and enrolled within the IHSS program in the county the recipient resides.

In order to be eligible to serve as a backup IHSS/WPCS provider the provider must not have been convicted of any crime in Tier 1 and 2 within the previous ten years. However, a provider with a Tier 2 criminal conviction is permitted to work for a recipient that has submitted an Individual Waiver. Waivers cannot be used for providers in the BUPS. The provider must meet all requirements of provider enrollment including the submission of provider enrollment. An individual who is listed on the county and Public Authority registry but has yet to complete all enrollment requirements to serve as an IHSS provider cannot be included on the BUPS registry.

All eligible providers who provide emergency backup services shall be paid a wage that is two dollars per hour above the current county/public authority locally negotiated wage rate for an IHSS/WPCS provider, subject to an appropriation in the annual State Budget Act. Additionally, the current two-dollar salary differential for the emergency backup providers related to COVID-19 will continue through September 30, 2022.

When operating the BUPS, county and public authorities shall be responsible for making reasonable efforts to recruit and enroll any available provider if possible, responding to recipient requests for an emergency backup provider, and referring recipients to one or more backup providers, if available and align with the recipients preferences and needs. (ACL 22-65, August 2, 2022.)

The California Department of Social Services (CDSS) has issued a letter reiterating IHSS requirements for timely processing of applications and reassessments, and for following Hourly Task Guidelines.

Individuals have the right to apply for IHSS services.  When an individual or their authorized representative indicates that they want to apply, the county must take their application immediately.  Counties must accept applications by telephone, fax or in person.  Counties that have the capability must accept applications online, by email or through other electronic means.

The date the applicant requests services is the “protected date of eligibility” even if the client has not already applied for Medi-Cal.

The applicant must submit the SOC 873 Health Certification form, or other acceptable documentation, within 45 days of the date the county requests it.  Benefits can be issued prior to the applicant submitting a SOC 873 when the applicant is at imminent risk of out-of-home placement, or the applicant is being discharged from a hospital or nursing home and services are needed to safely return to the community.  Applicants who receive benefits pending submitting the SOC 873 can get an additional 45 days to submit the SOC 873 for good cause.  In addition, applicants who have not yet applied for Medi-Cal can have 90 days to submit the SOC 873 because there is 45 days to determine Medi-Cal eligibility.

Reassessments must be done every 12 months.  CDSS requires counties to complete reassessments timely in 80 percent of cases.  Counties must complete reassessments time in 100 percent of Community First Choice Options cases, CDSS will find noncompliance if the county complete assessments timely in 90 percent of Community First Choice Options cases.  Counties will be required to submit a Quality Improvement Action Plan if they do not meet these requirements.

Counties must use the Hourly Task Guidelines for initial assessments or reassessments.  These guidelines establish a range of time for each IHSS service.  The county must document the need to services that fall outside the Hourly Task Guidelines.  Beginning in fiscal year 2023-24, CDSS will require a Quality Improvement Action Plan for counties that do not correctly apply and document applying Hourly Task Guidelines.  (ACL 22-57, July 22, 2022.)

The California Department of Social Services (CDSS) has issued guidance regarding changes to sponsor deeming for In Home Supportive Services – Residual (IHSS-R) recipients.  IHSS applicants who receive state-only full scope Medi-Cal are assessed under the IHSS-R program.  People who are denied Medi-Cal for a reason other than failure to comply with Medi-Cal requirements  or failure to complete the Medi-Cal eligibility process also can be eligible for IHSS-R.  Counties must process these IHSS-R application regardless of the applicant’s immigration status.  Sponsor deeming is counting the income of a sponsor of an immigrant as the immigrant’s income.

IHSS-R applicants who receive state-only funded full scope Medi-Cal are no longer subject to sponsor deeming for purposes of IHSS-R eligibility.

IHSS-R applicants who are not eligibile for Medi-Cal are subject to sponsor deeming.  For IHSS-R applicants who are not eligibile for Medi-Cal, sponsor deeming is limited to three years after entry to the United States as a lawful permanent resident.  In addition, applicants whose blindness or disability began after they entered the United States are not subject to sponsor deeming.

All IHSS applicants must have or apply for a Social Security Number, or must have an Individual Taxpayer Identification number.  This is because the IHSS recipient is the provider’s employer for certain purposes.  When someone without a Social Security Number applies for IHSS, the county must accept their application and assist with applying for an Individual Taxpayer Identification number.   (ACL 22-44, June 1, 2022.)