Understanding IHSS "unmet need" and how it impacts consumer hours

Why this is important:
If the consumer has documented unmet need, across the board cuts to IHSS (like the recent 3.6 percent cut) will be applied first to this unmet need.  Therefore, the actual reduction in IHSS hours may be significantly less.

Note that for almost 2,000 consumers with documented unmet need, the notices sent in late December about the 3.6% cut contained an inaccurate calculation of total authorized need.  DSS says that this was caused by a “programming error” and that corrected Notices of Action were sent to affected consumers on January 7, 2011.

Know Your Rights

Unmet need” refers to a situation where the consumer already gets the maximum hours allowed by IHSS but needs additional care not provided by IHSS or another program like Regional Centers.   The additional hours of unmet need must be for services normally authorized by IHSS, but not covered because the consumer already has maximum hours.  Example: A consumer is already authorized for 283 hours from IHSS and they don’t qualify for Regional Center or other services.  But they actually require more time for bathing and ambulation (services that IHSS authorizes).  The unmet need is being provided by a relative that volunteers the service (is not paid for it).  This unmet need should be documented by the case worker. 

If you have “unmet need” that is not documented, under assessed, or incorrectly printed on your NOA,  we recommend that you submit an appeal as soon as possible, using the instructions contained in your NOA, and register the document when you mail it.  It is likely the county will take action on correctly documenting unmet need if you file for a hearing. 

You do NOT have the right to an appeals hearing when the only issue you disagree with is the state law requiring a reduction in your IHSS hours.  You must be very clear that your appeal is not about cuts to the program.

  • If you need to adjust your service hours because you believe you have not been assessed enough hours, it is your right to request a state hearing at any time to review the current amount of aid you are receiving. You should do this as soon as possible. Instructions on how to appeal are included with your latest NOA.  If appropriate, we recommend that you request that the review extend back as many as 90 days from the date in which you file a request for a hearing. 
  • When unmet need is documented by the case worker, the consumer will need to show how that need is being met.
  • Keep in mind that any hours authorized as the result of a reassessment will still be subject to program reductions.
  • If you or your client want additional information about unmet need or case assessments, contact UDW toll-free at 1-800-621-5016 and ask for the Member Call Center. You can also contact your local UDW County office.

    Thank you for helping your client deal with this difficult situation, and thank you for your continued support of UDW


    *The maximum number of hours is currently 195 for most consumers; it is 283 for those who are severely impaired or who need protective supervision

    ADDITIONAL INFRMATION:

     
     

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