IHSS parent provider issues

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The California Department of Social Services has issued clarification regarding application of In Home Supportive Services (IHSS) regulations to parent providers.   

A parent living with their minor recipient child is considered unable or unavailable to provide necessary care for their child, and therefore can hire a non-parent IHSS provider when: 1) the parent is unavailable because of employment, with unavailability limited to the hours of employment for a parent working part-time; 2) the parent is enrolled in an educational or vocational training program, with unavailability limited to the time of instruction for parents enrolled only part-time; 3) the parent is physically or mentally unable to provide IHSS services; 4) the parent is unavailable because of ongoing medical, dental or other health-related treatment; or 5) when the parent is unavailable to perform shopping or errands essential for the family, search for employment or essential purposes related to care for the recipients siblings, which allows IHSS services from a non-parent provider for up to 8 hours per week.

A parent can be a paid IHSS provider for their minor child when the parent has left full time employment or is prevented from obtaining full-time employment because no other suitable provider is available.  If a parent is not employed full time for a reason other than the recipient child’s IHSS needs, that parent is not eligible to be a paid IHSS provider for the child.  The county can request employment verification but cannot require the parent to provide an affidavit or other documentation.  A county cannot deny using a parent provider based only on the lack of documentation of employment status. 

A parent who is on paid or unpaid leave or has been laid off for a reason other than the need to care for their child is not considered to have left employment to care for their child and is ineligible to be an IHSS provider for the child.

If a parent who is an IHSS provider for other recipients reaches the maximum number of IHSS work hours, the family can hire a non-parent IHSS provider or a second parent in the household for their child.

An undocumented parent is ineligible to be an IHSS provider.  In that situation, the family can hire a non-parent provider.

In a two-parent household, a parent is an eligible provider if the parent left full-time employment or is unable to obtain full-time employment because of the need to care for their child.  However, a non-parent provider cannot be paid to provide IHSS when one or more parents in the home are able and available.

For parents of a child IHSS recipient who are living separately but share custody, the county assesses the child at the primary parent’s home.  If one parent wants to be the child’s IHSS provider, the county determines if that parent is eligible to be a provider.  If both parents are available to be the child’s IHSS provider, hours are assigned based on the child’s needs when the child is in each parent’s home.

Foster parents are not subject to the IHSS parent provider rules.  However, adoptive parents are subject to the IHSS parent provider rules because they have a legal duty to care for the child upon adoption.

Determining whether a parent can be a paid IHSS provider and/or hire a non-parent provider is a separate and distinct inquiry from whether the child is eligible for IHSS.  The minor must be assessed for IHSS regardless of whether the parent is allowed to be the provider or hire another provider.  The case cannot be terminated if the county finds that there is not an eligible provider.  If the parent’s circumstances change, provider eligibility will be reevaluated.

Counties are required to inform parents about the rules regarding providers for minor recipients.  Counties must review their existing processes to verify providers are being properly enrolled.  Providers must also review impacted IHSS cases as soon as administratively possible but no later than the regularly scheduled reassessment.  (ACL 19-02, January 9, 2019.)

Third Party Assessment Process

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The California Department of Social Services has issued a clarification regarding its policy regarding referral for third party assessment when the county and the participant cannot agree on a welfare-to-work (WTW) assessment or a WTW plan.

If the participant does not agree with the results of their WTW assessment and does not reach an agreement with the county about their WTW plan, the county must refer the participant to an impartial third party for an independent assessment.  The county must refer for a third party assessment if the county and the participant do not agree on WTW assessment or the unsigned plan or a signed WTW plan in limited circumstances.

Prior to the appraisal, counties must provide an orientation that informs participants of their right to a third party assessment.  Participants must sign Rights and Responsibilities (WTW 1) and the Plan Activities form (WTW 2), each of which inform the participant of their right to a third party assessment.

After the plan is signed, the client has a once-in-a-lifetime 30 day grace period from the beginning of the WTW activity to request a change in the plan or reassignment to another activity.  The county must grant the request if another assignment is available, is consistent with the WTW plan, and the county determines the other activity will lead to employment.  The participant can request a third party assessment during the 30 day grace period.

The county must allow the participant three working days after signing the plan or amendments to the plan to request changes.  During the three working days after signing the plan, the participant can request a third party assessment.  If the participant expresses dissatisfaction with the plan in the first three working days, it will not trigger the use of the client’s once-in-a-lifetime 30 day grace period.  If the participant expresses dissatisfaction with the plan after three working days and has not used their once-in-a-lifetime 30 day grace period, the county can apply the 30 day grace period and grant a third party assessment.

The participant must adhere to the signed WTW plan if it is after the three working day or 30 day grace periods.  The county can revised a WTW plan at any time if it is in the best interest of the participant to do so.

The results of a third party assessment are binding and used by the client and the county to create an appropriate plan.  The participant is not entitled to a state hearing to challenge the assessment until a third party assessment has been performed. (ACIN I-03-19, January 17, 2019.)

Recent DHCS Clarifications on Verifications and Paperwork

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Annual Redetermination Signature Requirements

DHCS is clarifying the signature requirements for the MAGI and Non-MAGI renewal forms, as well as the property supplement form.  The renewal form may be signed by handwriting,  electronic signature, or telephonic recorded signature. Beneficiaries may respond via the Internet, mail, phone, in person, or other electronic means.  Counties must accept electronic signatures. DHCS MEDIL I 18-13 (September 14, 2018).

Supplemental Income Verification

  • October 12, 2018 ACWDL 18-21

CDSS administers a commercial income verification service on behalf of counties for the CalFresh and CalWORKs programs.  Any recent reports from this service should be used to determine Medi-Cal eligibility as part of ex parte review. DHCS ACWDL 18-21 (October 12, 2018).

Social Security Number in MEDS for Children in the Child Welfare System

  • October 16, 2018 ACWDL 18-23

As a condition of eligibility, a Medi-Cal applicant must provide a Social Security Number to receive full-scope Medi-Cal.  Because of post-adoptive records, counties have inconsistencies in entry and maintenance of records.  DHCS directs counties to use the child’s existing SSN (if available) and CIN in MEDS throughout the child’s history in the child welfare system.  If the adoptive parents change the child’s SSN, the county should use the new SSN in MEDS. DHCS ACWDL 18-23 (October 16, 2018).

New Medi-Cal Authorized Representative Forms

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DHCS is providing counties with new documentation around designating an authorized representative for Medi-Cal.

  • Appointment of Authorized Representative Form (MC 382): provides an applicant/beneficiary with a way to appoint an AR, limit the AR’s scope, and authorize an individual or organization as AR.
  • Notice of Authorized Representative Appointment (MC 380): notifies the beneficiary and AR of appointment and scope of appointment.
  • Authorized Representative Standard Agreement for Organizations (MC 383): allows an individual acting on behalf of an AR organization to sign agreements.
  • Cancellation or Change to a Medi-Cal Authorized Representative Appointment Letter (MC 381): informs the applicant/beneficiary of cancellation or change in scope of AR appointment.

The current MC 306 Appointment of Representative form will no longer be acceptable after June 4, 2019. DHCS’s guidance includes examples about AR appointment and cancellation.

DHCS ACWDL 18-26 (December 4, 2018)

Expanding Guidance on Medi-Cal Spousal Impoverishment Rules

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The Affordable Care Act broadened the definition of an “institutionalized spouse” to include HCBS recipients and persons who have requested HCBS and generally reside at home or in the community. DHCS ACWDL 17-25 (July 19, 2018) initially extended spousal impoverishment rules from institutionalized spouses in long term care settings to applicants and recipients of other HCBS and waiver programs.  DHCS has clarified that the spousal impoverishment provisions apply to registered domestic partners.

Spousal impoverishment rules apply to the first month when a request for HCBS or IHSS has been made and the individual meets a nursing facility level care.  These rules must be applied to HCBS spouses who request IHSS and provide a verification form.  These provisions should be applied retroactively; DHCS provides examples of how to apply these rules.

The Letter walks through the process of applying spousal impoverishment rules to the HCBS spouse and community spouse.  First, the county needs to characterize property and apply any CSRA protections. Next, the county would calculate income. An eligible individual would be placed in a budget unit separate from the community spouse once the couple’s property meets the CSRA limit plus $2000.

The HCBS spouse will remain eligible (short of change in circumstance) unless and until the county denies the HCBS request.  At annual renewal, the HCBS spouse only needs to confirm continued HCBS participation. Continuous eligibility ends when the HCBS spouse or institutionalized spouse does not receive HCBS waiver services or inpatient care for a full calendar month.

If the community spouse applies for Medi-Cal, that spouse will need to spend down non-exempt countable property before the end of the month of application.  A spousal income allocation is still permitted.  However, if the community spouse requests HCBS, there is no longer a community spouse.  The letter also goes through applying these rules retroactively, including reimbursement through the Conlan process.

DHCS ACWDL 18-19 (August 21, 2018)