IHSS

Eligibility for Waiver Personal Care Services

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The California Department of Social Services (CDSS) has provided information regarding Medi-Cal Home and Community Based Alternative (HCBA) Waiver through the Waiver Personal Care Services (WPCS) program. CDSS also clarifies new roles that the counties must adhere to regarding information sharing and referrals through the waiver program.

The HCBA Waiver provides care management assistance to people at risk for institutional or nursing home placement. With HCBA, a multidisciplinary team of registered nurses and social workers provide care management services to waiver beneficiaries. The waiver covers direct and indirect care services, including WPCS. Under the HCBA waiver, recipients may get up to 24 hours of direct care. The Department of Health Care Services (DHCS) administers the HCBA waiver program by contacting the HCBA Waiver agencies.

HCBA Waiver Services include:

  •     Private home health services/nursing
  •     Case management
  •     Habilitation
  •     Home and Family respite
  •     Community transition services
  •     Environmental accessibility adaptations
  •     Waiver Personal Care Services (WPCS) 

County In-Home Supportive Services (IHSS) Staff must:

-Notify DHCS/Waiver Agency staff of services hours approved by the recipient, and

-Determine eligibility for IHSS hours for those not authorized for WPCS services.

County staff must also share case file information to help DHCS/Waiver Agencies determine the number of WPCS hours to approve. County staff may request that the Waiver Agency supplies a list of mutual recipients in their county.

To be considered for the Waiver Personal Care Services Program candidates apply for enrollment in the HCBA waiver. A receipt will be sent for the candidate’s application. Then a representative from DHCS or relevant HCBA waiver agency will schedule a first in-home assessment to see if the candidate qualifies. Individuals must be currently receiving IHSS and have a maximum of 283 IHSS hours to be eligible for WPCS for specific tasks not covered by IHSS hours.

County IHSS staff will assess the recipient annually to determine IHSS service needs. This reassessment must include updating DHCS/Waiver Agency staff regarding any changes in services to the recipient.  (ACL 21-154, December 30, 2021.)

 

COVID-19 updated information regarding submitting SOC 873

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The California Department of Social Services has provided information about completion of the In Home Supportive Services (IHSS) SOC 873 form.

Counties can allow a good cause extension for failure to submit the IHSS SOC 873 form within 45 days of application when they were unable to do so because their health care provider was unavailable because of work related to COVID-19.  The option for that good cause extension is extended through the end of the COVID-19 state of emergency in California.  Counties can determine on a case-by-case basis when good cause exists. This evaluation should consider various factors including the applicant being in the hospital, the health care professional scheduling appointments more than 45 days out, the SOC 873 being lost in the mail, and the applicant’s primary health care provider being unavailable because of the Omicron variant.  (ACL 22-11, February 9, 2022.)

Instructions on interpreter services and confidentiality agreement

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County welfare departments must offer free bilingual or interpreter services to all non-English speaking or limited English proficient persons. The California Department of Social Services (CDSS) has issued a new form, the CR 6181, to inform non-English speaking or limited English proficient persons of the risks of using their own interpreter instead of using a free interpreter provided the county.  Counties must use this form when applicants or recipients choose to use their own interpreter after being offer a free interpreter by the county.  The CR 6181 form replaces any county form previously used for this purpose.

The county must ensure that the applicant or recipient and their interpreter have read and understood the CR 6181 form.  The county must provide the CR 6181 form in the applicant or recipient’s primary language (if it has been translated into that language), and provide an interpreter to help with understanding the form.   If the applicant/recipient or their interpreter refuse to sign the form, the county must use a county-provided interpreter or bilingual staff member.

The form must be completed at redetermination, if it was signed over a year previous, or if the applicant/recipient chooses a different interpreter.

For telephone or virtual communication, the county must use a county provided interpreter unless a CR 6181 is already on file.  If there is a CR 6181 on file, the applicant/recipient can use their own interpreter.  If there is not a CR 6181 on file, it was signed over a year previous, or a different interpreter was named on the form, the county must read the form to the applicant/recipient in their primary language age get verbal consent to the risks of using their own interpreter.

The CR 6181 does not replace the GEN 1365 Notice of Language Services which informs individuals of their right to free language assistance services.  Counties are reminded that they must advise clients of their right to a free interpreter, and must provide interpreter services promptly and without delay.  Although clients can use their own interpreter, a county must not compel or encourage them to do so.  A client can use a minor as an interpreter only in extenuating circumstances.  (ACL 21-128, November 12, 2021.)

IHSS able and available spouse rule

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The California Department of Social Services (CDSS) has issued clarification regarding the In Home Supportive Services (IHSS) able and available spouse rules.

An able and available spouse is presumed to be available to provide without compensation any IHSS service except for personal care services and paramedical services.  This includes Domestic Services, Related Services, yard hazard abatement, teaching and demonstration, and heavy cleaning.  Spouse includes persons who are legally married or legal domestic partners, or two individuals of the opposite sex are holding out to be married.  As long as the couple remains married and does not obtain a divorce or annulment, or are not legally separated, the able and available spouse rule apples, even if the couple lives in separate locations and are estranged.

Any spouse who does not receive IHSS benefits is presumed to be able to provide all IHSS tasks except for personal care services and paramedical services, unless there is medical verification of the spouse’s inability to do so. If the spouse submits medical verification of inability to perform a task, the county should authorize house for a non-spouse provider to provide those IHSS services.  The spouse would continue to be counted as an able and available spouse for any other services that there is not verification of inability for the spouse to perform.

Services can be performed by another provider when the spouse is unavailable because of employment, health, or other unavoidable reasons such as incarceration, military deployment, a restraining order against the non-recipient spouse, or when recipient spouse has left the home or evicted the non-recipient spouse because of domestic violence, or the recipient spouse has left the home because of domestic violence.  This means that meal preparation, medical accompaniment and protective supervision that must be performed while the spouse is unavailable can be provided by another provider.

In addition, if an able spouse is out of the home for employment, health, or other unavoidable reason, for over 24 hours, the spouse is presumed to be unavailable to provide any IHSS services during the period of absence from the home.

If the spouse must leave full-time employment or is prevented from full-time employment because no other provider suitable is available, the spouse may provider medical accompaniment and protective supervision.

This ACL supersedes ACL 08-18, Question 7, that incorrectly stated that the able and available spouse rule does not apply when a married couple does not reside together.  (ACL 21-91, September 29, 2021.)

 

Extension of COVID-19 exceptions to IHSS program requirements

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The California Department of Social Services has provided guidance regarding extension of COVID-19 related exceptions for self-attestation of In Home Supportive Services (IHSS) forms.  County IHSS offices should begin transitioning back to in-person initial assessments and reassessments when possible.  When initial assessments and re-assessments are in person, required forms should be presented signed and collected at the assessment.

However, when the applicant or recipient or someone in their household has been infected with, has symptoms of, or has been exposed to COVID-19 in the two weeks prior to the assessment or re-assessment, the county should use telephone or video-conference to conduct the assessment. In such cases self-attestation of documents is acceptable.  This policy will continue until the end of the COVID-19 state of emergency.  However, some forms cannot be self-attested.  Original signatures may be mailed to the county IHSS for the Request for Order and Consent—Paramedical Services (SOC 321), IHSS Designation of Authorized Representative (SOC 839); and the IHSS Recipient’s Request for Provider Waiver (SOC 862).

When the COVID-19 state of emergency ends, the county must require original signatures on new forms at the recipient’s next annual reassessment.

Counties could accept copies of provider identity verification documents until September 30, 2021. However, when closure of county IHSS offices is required by their local Board of Supervisors, counties can continue to accept mailed in copies or fax copies of identity verification documents until the end of the COVID-19 state of emergency.  When the state of emergency ends, all applicant providers will again be required to present original identity verification documents.  Providers who provide copies of their identity verification documents will not be required to present original documents.  (ACL 21-112, September 29, 2021.)