“California Paid Family Leave (PFL) program,” is an enhancement to the State Disability Insurance Program (SDI).  It is intended to create a family temporary disability insurance program to help reconcile the demands of work and family for eligible California workers. 

Home care providers who must leave work (their IHSS consumer) to care for a seriously ill parent, child, spouse, registered domestic partner, or bond with a new minor child are eligible.  PFL can be used for a maximum of 6 weeks in a 12 month period.  The provider will receive partial payment based on the prior quarter's earnings -- approximately 55% of lost wages.

Only those IHSS providers who have paid in to SDI are eligible.  Family member providers (mother, father, son, daughter, brother, sister) do not pay in to SDI unless they elect to do so.  Other providers pay in automatically.  Home care providers can see on their pay stub whether SDI is being deducted.  PFL is administrated by the state Employment Development Department (EDD) and applications are filed with them.

It is important not to leave your client/consumer without a home care provider if you use PFL.  The consumer should be given as much notice as possible so that s/he can arrange for a replacement.  The consumer is not required to hire the original home care provider once s/he has completed the PFL so it is important to talk this over together and come to a clear understanding.

Providers should also check their county's health care benefit policy if they are using the health benefit provided with IHSS.  PFL should not jeopardize their coverage if the county policy allows 3 months before they are termed out (due to hours falling below the requirement).

More information
http://www.edd.ca.gov/fleclaimpfl.htm  (Employment Development Website)
All County Information Notice  (PDF file)
Call (English): 1-877-238-4373   (Spanish):1-877-379-3819   TTY 1-800-563-2441

FAQ for Understanding the Annual Needs Assessment, Fair Hearing Process, and other
IHSS Regulations
please make sure to read disclaimer above

Eligibility, Annual Reviews and IHSS Hours;
what you need to know and where to find it:
Since consumers (recipients) of IHSS have their hours authorized (set) during the assessment process, it is important that homecare providers also understand that procedure and be present to advocate for their client when necessary.  In fact, the provider (home care worker) can and should ask for their client to have a re-assessment if they observe changes in the consumer's condition.  This informs the social worker so that they understand exactly what the consumer needs to live safely and remain healthy in their own home. The resources listed below in the Advocacy Resources, Appendix will help both consumers and providers understand the assessment process, fair hearings, eligibility, share of cost, and other aspects of the IHSS program.
The key to an accurate assessment is understanding the rights of the consumer, and also having the correct records (paperwork).  The topics below will help both consumers and providers understand the Needs Assessment and Fair Hearing processes.  At the end of each topic there is a reference to the resource(s) where that subject is covered in more detail: Advocacy Resources, Appendix   

• Preparing for an Assessment or Review; know your rights.  For your information, maximum IHSS hours allowed are 283 per month.  IHSS only pays for specific tasks and you can not ask for time to do things that are not authorized (example; watering plants).  The hours authorized for each consumer vary according to the case worker's assessment of the consumer's needs.  This assessment is the case worker's interpretation of the law.  Although case workers use guidelines to determine the hours for each authorized task, they are still required by law to adjust time for task allowance (provide additional time) if it can be shown why it is necessary.  If the case worker does not do this the consumer (or their representative) can ask for a hearing (appeal) before an administrative law judge.  Also for your information, there is a category of IHSS called Protective Supervision (see below) that will authorize a "qualified" consumer for 195-283 hours.
  References (Appendix 1,3,4,6,7,8,10,18)
• "Log" Your Time: To make sure the consumer's rights are upheld and he/she gets the hours they are entitled to, keep a diary (log) of the actual time it takes to complete each task over a minimum two week period.  Since the time required often changes with the condition of the consumer, this allows the case worker to average the "good" days with the "bad" ones.  Make sure to make notes about why time is necessary i.e. "Recipient eats in bed, therefore bed must be cleaned & vacuumed 3 times a day," or "Respiratory condition requires extra cleaning for dust-free environment."   The PAI Package (Appendix 1) below includes complete instructions and worksheets to help you keep track of the tasks and which ones IHSS will pay for. 
  (Appendix 1,3,5)
• How to ask for documentation from your doctor and other health care professionals:  IHSS uses specific forms that you need to take to the consumer's doctor and have him sign.  The case worker should give or mail you these forms, although some are available online.  For personal care services like bathing and feeding etc, use the log (record) you create to make a list of the tasks which the consumer must have assistance with to live safely in their own home.  Most doctors do not know these personal details about their patients, even when they know their medical condition.  Give the doctor your written record, and ask him or her to verify it and give you a signed paper that states the consumer's needs.  The doctor can verify any of these specific needs with your client through physical examination / office visit if necessary.  Do not ask the doctor to verify how long it takes to do each task.  You are asking for a clear list of the types of services that the consumer needs to live safely in their own home, based on the consumer's physical capacity.  Also get additional documentation for the consumer's diagnosis, medications prescribed, and any other assistance prescribed by the doctor (like physical therapy, injections, use of catheter/colostomy etc.)  All these things should be documented by the doctor as necessary.  
  (Appendix 1,3,6,10,11,12,18)
• What IHSS will pay for:  All IHSS hourly "Needs Assessments" are based on what is required for health and safety (not comfort or companionship).  Examples of "need" include personal care services; ambulation (helping client move), bathing, bowel & bladder care, dressing, feeding, medications, etc, and domestic & related chores (cleaning, food preparation & menu planning, laundry, shopping, etc).  Para-medical services, medical transportation, respite (to relieve a non-IHSS family care provider) and protective supervision, are other types of services IHSS will cover.  The exact categories and tasks that IHSS will pay for are listed in
  Appendix (1, 2, 3,4,5,6, 7,8,18)
• The consumer has a right to have an authorized representative present at the Needs Assessment, or at a Fair Hearing .  Consumers are often embarrassed or intimidated about revealing what they can not do for themselves during the assessment process.  IHSS case workers usually want to question the consumer directly (not the home care provider) about what they can do or can not do.  However in some cases the consumer is not mentally or physically able to answer questions accurately.   It is important that there be a witness or advocate present during the Needs Assessment process.  This can be the home care provider, AND/OR a union representative OR a friend, OR a family member, OR an attorney, OR an advocate from the community. 
  If the home care provider is advocating (speaking) for their client it is important to address the case worker about the consumer's needs -- not your own need for additional hours. This distinction must be very clear.
  Your local Office on Aging, or Independent Living Center can often provide an advocate free of charge.  Consumers may also have someone represent them at a hearing before an administrative law judge (if the assessment is disputed).  The consumer needs to authorize their representative by providing a signed, dated paper, stating that the person is authorized to represent the IHSS consumer.  The resources below will have additional information about finding an advocate in your area if you need one.
  Appendix (1,2, 3,4,5,10,14,18)
• When to ask for a Re-Assessment: The consumer or the home care worker can ask for a re-assessment at any time if the consumer's condition has changed, or if the consumer or their representative(s) don't agree with an assessment given by the case worker.  The consumer should get a "Notice of Action" within 30 days after the IHSS case worker visits them in their home for an assessment.  If the county plans to reduce or deny services then they are required by law to mail the NOA 10 days before the reduction or denial takes effect.  When a "Notice of Action" (NOA) has been received that shows a reduction of hours, do the paperwork for the appeal immediately because there is a 10 day deadline to keep the same hours while waiting for a hearing.  Also it will help if the case worker understands you are willing to take the case to hearing. 
  Because IHSS case workers often have large case loads, it is sometimes hard to get them to return your phone calls, when asking for a re-assessment.  In this circumstance use a certified letter (that requires a signature on receipt).  You may also ask to speak with the case worker's supervisor.   Always write down the name of who you talk to, and when you talked with them. 
  The re-assessment is particularly important if the IHSS consumer has been in the hospital, as additional care such as assistance with physical therapy or apparatus such as catheters are often needed.  The client's IHSS case worker should be informed as soon as the client is admitted to the hospital, and should do a re-assessment as soon as they are sent home.
  A re-assessment should also take place if the consumer moves, because the accessibility level in a home affects time for task determination.  Also you should know that if the consumer moves to a different county the rate of pay may be different as well as the needs assessment.  To see rates of pay in different counties go to our Statewide Information page. You can find additional information for UDW counties by clicking the name of the county on our County Pages.
  Appendix (1,3,4,5,6,7,8,18)
• Understanding the Notice of Action (NOA):  The "Notice of Action" is a legal document that the consumer should get in the mail after having an assessment (or annual re-assessment) in their home.  If the county denies or intends to change a person's IHSS services, the county must give a written notice to that person.   Except in a few limited circumstances (like death or institutionalizing of the consumer) the county is legally required to mail the NOA at least 10 days before the effective date of the action.  In cases where there is no change in services the county may take up to 30 days to send the NOA. 
  Since there are time deadlines involved in appeals, make sure to pursue this document by calling your IHSS regional office if the NOA has not been received.  The NOA is a piece of paper that has "Notice of Action" written on it.  The NOA states exactly how many hours per month the consumer has been authorized, and how much time is authorized for each task.  The paper will list the tasks and name them (like "feeding," or "dressing"), as well as naming the category (like "Personal Care," or "Domestic").  The NOA will also have a date at the top telling when the authorization of hours becomes effective.  This date is very important when asking for an appeal.  On the back of the NOA is a place to ask for an appeal, and the address where the request for appeal is sent.  (Appendix 1,2,3,4,5,18)
• How to Appeal -- Ask for a Fair Hearing before an Administrative Law Judge.  When the consumer has hours authorized by an IHSS case worker, this assessment is the case worker's interpretation of the law.  Asking for a "Fair Hearing" is how you ask for a higher authority to re-assess the case when the consumer -- or his/her representative(s) -- don't agree with what the IHSS social worker decided.  The Fair Hearing takes place before an administrative law judge.  This administrative law judge is highly trained in the law that covers your case, and also trained to be fair and impartial.  The Fair Hearing process does require more paperwork, but you can get someone to help you.  It is important to prepare for a hearing (resources #1 and #3 in the Appendix cover hearings in detail).  The consumer or their representative should appear in person for the hearing.
  How to get started: The consumer should get a "Notice of Action" in the mail within 30 days of the case worker's home visit (assessment).  This Notice of Action lists exactly which tasks the consumer is authorized for and how much time is authorized for each task.  On the back of the document is the portion that can be filled out for an appeal (Fair Hearing) and the address where the appeal form is mailed.  The Notice of Action also has a date that the new authorized hours take effect.  It is necessary to fill out the request for appeal within 10 days of that date and ask for "Aid Paid Pending" if the consumer's hours were reduced.  The consumer should always keep a copy of the Notice of Action (after the Appeal portion is filled out) for their own records.  If you are representing the consumer in a fair hearing, ask their permission to keep a copy for your own records.  If the consumer's hours have been reduced, it is even more important to act quickly (see below).  Sometimes when you ask for an appeal, an IHSS supervisor will decide to re-examine the case worker's Needs Assessment before going through the Fair Hearing process, and adjustments can also be made at that stage.  The consumer always has the right to appeal decisions of the case worker or IHSS supervisor, before an administrative law judge. Appendix (1, 3,4,5,10,14,18)
• How to keep the same hours while waiting for a Hearing: Ask for an appeal, and state that you want " AID PAID PENDING" (in writing) 10 days BEFORE the effective date on the Notice of Action.  Make sure to keep a copy.   This means the consumer can keep the same hours until they go to a hearing.  Sometimes it takes weeks or months to complete the Fair Hearing process.  The Aid Paid Pending the decision will not be considered an overpayment (you will not need to pay it back) even if the judge decides in favor of the county,
  Appendix (1, 3, 14,18)
• Do you have a client that can't be left alone? They may qualify for Protective Supervision  This category is for monitoring the behavior of non self-directing, confused, mentally impaired, or mentally ill persons (examples; Alzheimer's patients or the developmentally disabled).   Protective Supervision is not based on physical disability, but on mental disability; where the person may harm themselves or others if left alone.   Protective Supervision will qualify the consumer for 195-283 hours.  Because this category is based on mental conditions it requires very specific documentation. IHSS case worker's are supposed to inform home care providers about Protective Supervision.
  Appendix (1,2,3,5,6,18)
• Do you know someone that needs In Home Supportive Services?  The In-Home Supportive Services program (IHSS) is designed to keep low income persons living in their own homes and communities whenever possible, rather than being institutionalized.  The IHSS program does not provide 24-hour assistance.  Someone with mental limitations who needs continuous supervision 24 hours a day, or who needs round-the-clock nursing care, may be denied IHSS coverage unless family, or other community resources cover the unpaid hours.  However if having a home care provider come in and help during the day will prevent nursing home or institutional placement then they should apply for IHSS.  Appendix (1,2,3,4,6,7,8,18)
• Who is eligible for IHSS, and how do they apply? 
  A person is eligible for IHSS who is a California resident, living in his/her own home and who meets one of the following:
  • Currently receives SSI/SSP benefits and Medi-Cal linked to SSI or 1619(b) Medi-Cal;
  • Receives Medi-Cal with no share of cost including through institutional deeming, or the continuous eligibility for children program, or the Aged and Disabled Federal Poverty Level Program, or the 250% Working Disabled Program;
  • Receives Medi-Cal with a share of cost.
  • Is eligible for Medi-Cal but has not applied.
    
  Otherwise eligible applicants who are currently institutionalized or living in a licensed residential arrangement but wish to live in their own home and are capable of doing so if IHSS is provided, should also apply.
  If you are not sure, but the person is low income and needs help, then contact your local In Home Supportive Services Public Authority (find their listing in Your County)   Your local IHSS Public Authority will tell you how to apply.  The document "What About IHSS" (Appendix document 3 ) has very complete information about eligibility and the application process and can help you gather the correct paperwork. Appendix (1,2,3,4,5,7,8,18)
• Do you know someone who wants to work as a home care provider, or do you need another client?  Most counties provide an IHSS Registry designed to match home care providers with consumers (recipients).  Often you must attend training or orientation meetings and complete a background check to be on the registry.  Contact the IHSS Public Authority in your county. 
  Appendix (1,3,5)
• What benefits and responsibilities come with being a home care provider?
  Home care providers pay in to and may become eligible for social security, and Medicare benefits.  These deductions are automatically made by the state payroll agency.  Some providers pay in to and may become eligible for state disability insurance (SDI), unemployment insurance (UI), and worker's compensation benefits.  Family members (mother, father, sister, brother, etc.) must elect to pay in to the above three insurance/benefit programs (the deductions are not made automatically when the provider is a family member).  It may be important for family members to be covered under these programs if they are injured on the job or loose their job.  Additionally, Paid family leave (an enhancement to SDI) may be available under state disability for eligible workers who have paid in to SDI. 
  If the provider works in a county represented by a union, with a contract that includes healthcare, then providers (home care workers) will be eligible for medical benefits under the terms of the contract.  There is usually a small co-pay.  If the contract includes "agency shop" (which most contracts have), then union dues will be automatically deducted from the providers paycheck.  There are additional benefits to being a union member.  For UDW counties get more information here for dues and union member-benefits; for information on wages and medical benefits go to Your County and click on the name of your county in the list or on the map.
  Home care providers are providing a service for pay - therefore they are responsible to pay income taxes if their income is high enough.  Income tax withholding (automatic deduction from paycheck) is available but not mandatory. The provider must request the county to withhold state and federal taxes from their pay if he or she wants this done.  If tax withholding is not requested, wages may still have to be reported and taxes paid depending on income level and/or tax status.  Also depending on income level & tax status, the home care provider may be eligible for Earned Income Credit (EIC).  This may be a reduction of income taxes or a cash benefit if the provider has low income and does not pay income taxes.  For more information on the EIC contact your local IRS office or your tax consultant and ask for a form W-5. 
  Appendix (1,2,3,4,5,18)

References; Advocacy Resource Appendix
(links to PDF documents and web pages)

(1) IHSS Fair Hearing and Self-Assessment Package
Multiple IHSS topics, has 2006 update that details changes made to the program.
This is a key resource document published by Protection and Advocacy Inc. If you are confused by all the resources and only look at one - this should be that one.  It has detailed information and worksheets to prepare for an IHSS Initial Intake, Annual Assessment or Hearing before an administrative law judge.
Also covers the subjects of Protective Supervision, Paramedical Services, Children with developmental disabilities, psychiatric diagnosis, and other categories of IHSS eligibility.
One of the features of this package is that it describes reasons which IHSS case workers use to deny benefits, and what you need to say in response to clarify why the benefits are justified.

English (Includes 2006 update)
IHSS Fair Hearing and Self-Assessment Package
(PDF file, 29 pg, 224 KB)
View as web page
Spanish:
IHSS Fair Hearing and Self-Assessment Package
(PDF file, 26 pg. 227 KB)
Vietnamese:
IHSS Fair Hearing and Self-Assessment Package
(PDF file, 327 KB)

Other languages available on the PAI website.

English:
Protective Supervision
(PDF file, 8 pg. 77 KB)
Spanish:
Protective Supervision
(PFF file, 26 pg. 58 KB)

English:
(PDF file, 1 pg. 39 KB)
Authorized Representative Form

English: (HTML - Web Page)
Payroll and Timesheets

Spanish: (HTML - Web Page)
Nómina ay Tarjetas de tiempo

English: (HTML - Web Page)
Dept Social Services Letters and Notices