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Call our Member Communication Center to have specific questions answered in person, or to find someone that can help in your area. We have Spanish and Vietnamese speaking personnel.
UDW Homecare Providers Union has advocacy information and workshops at many of our local meetings.
We can assist you to understand what services your client is eligible for, what the new rules and proposed reductions mean to your client, how to understand the IHSS assessment process, or where to find the resources you need to represent your client.
For information on how the state budget cuts and new provider requirements may impact you, see Updated Summary of Changes to IHSS .
Understanding IHSS Regulations
*Please make sure to read guidelines for use
Quick Link to new provider requirements and budget cuts
New anti-fraud measures, changes to the program created by state legislators and administrators, as well as ongoing lawsuits resulting from these changes, have created confusion for those who use IHSS. Clear information regarding new eligibility rules for consumers and new provider requirements has been difficult to obtain.
Additionally, since consumers (recipients) of IHSS have their hours authorized during the assessment process, it is important that both homecare consumers and providers understand that procedure. The topics below will help both consumers and providers understand the Needs Assessment, the Fair Hearing processes and help to clarify new requirements caused by 2009 state legislation. At the end of each topic there is a reference to the resource(s) where that subject is covered in more detail.
FAQ: Questions & Answers About IHSS
- How will recent changes to state law affecte my job?
- What is a “Functional Index Ranking” and how does it impact my client’s assessed hours or eligibility?
- Preparing for the annual assessment
- What IHSS will pay for
- How to “Log” your time
- How to get the right documents from the doctor
- What is Protective Supervision & how does it qualify a consumer for more hours?
- Using an “Advocate” or representative
- Understanding the “Notice of Action”
- When to ask for a re-assessment
- You can appeal the assessment when consumer’s hours are reduced or an assessment is not right
- How to keep the same hours until your appeal is heard
- If I loose my job, can I qualify for unemployment insurance?
- What happens if I must leave work (my IHSS consumer) to care for a seriously ill parent, child, or spouse
- How to Get Professional Help With all of the Above
1) 2009-10 IHSS Program Changes
Quick Link to new provider requirements
As part of the 2009-10 budget agreement, mandated IHSS program changes were passed. These changes include anti-fraud initiatives; fingerprinting of providers and recipients, random unannounced home visits, extensive new provider orientation requirements and changes to consumer eligibility. The mandated changes were never properly clarified by the state in spite of countless efforts on the part of UDW and other advocates to demand fair and timely process. Changes were further complicated by lawsuits. Further, the mandated changes were also not translated into multiple languages for counties to distribute to all IHSS providers. This has caused great stress and even panic to consumers and providers whose livelihood depends on the program, as well as many administrators that are expected to implement the changes. On November 1, 2009 the mandated changes to the program took effect without clarification from the governing agencies, despite the fact that 28 counties notified the Schwarzenegger administration of impending chaos if these changes were not delayed.
References for detailed information:
Action Steps and Detail of Current Changes
Update on lawsuits & legal actions
Fact Sheet on California Budget Cuts & IHSS (Disability Rights California)
Powerpoint training (prepared by Disability Rights California for consumers regarding IHSS budget cuts, in convenient online format)
2) What is the “Functional Index Ranking” and how does it affect my client’s assessment and eligibility?
Description of “Functional Index Ranking:”
The “Functional Index Rank” is set for a task when the social worker evaluates the hours and type of care an IHSS consumer needs to remain independent. For example, a consumer can be ranked as a “3″ for meal preparation and as a “4″ for laundry.
| Rank 1 | Functioning is independent, and he or she is able to perform the function without human assistance, although the recipient may have difficulty in performing the function, but the completion of the function, with or without a device or mobility aid, poses no substantial risk to his or her safety. |
| Rank 2 | Able to perform a function, but needs verbal assistance, such asreminding, guidance, or encouragement. |
| Rank 3 | Can perform the function with some human assistance, including, but not limited to, direct physical assistance from a provider. |
| Rank 4 | Can perform a function, but only with substantial human assistance. |
| Rank 5 | Cannot perform the function, with or without human assistance. |
| Rank 6 | Paramedical Services Needed *the IHSS CMIPS computer presently does not recognize “Rank 6″ |
The “Functional Index Score” is determined by the statewide computer for IHSS, after the social worker has input the individual case assessment and rankings.
Because recent cuts use the Functional Index Score to determine eligibility issues, and because the determining formula is complicated – not a simple average of rankings, it is very important that consumers call their case worker and ask for their individual Functional Index Score as determined in the computer, from their last assessment. That is the figure that will be used to determine eligibility under the latest budget cuts.
Specific References for further information:
Functional Limitation Self Assessment Packet
Request for Information, Documenting Patient’s Functional Limitations
3) 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.
More information here: Appendix (1, 2, 3,4,5,6, 7,8,18)
4) Know 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:
Domestic & related chores; housekeeping, food preparation & menu planning, laundry, shopping, etc.
Personal care services; ambulation (helping client move), bathing, bowel & bladder care, dressing, feeding, medications, etc.
Para-medical services; wound care, injections, catheters etc.
Medical transportation; to Dr. appointments.
Protective supervision; for clients that may be a danger to themselves if left alone. Complete list of categories and tasks that IHSS will pay for are listed in the following resources:
More information here: Appendix (1, 2, 3,4,5,6, 7,8,18)
5) “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 Fair Hearing & Assessment Package (Appendix 1) includes complete instructions and worksheets to help you keep track of the tasks and which ones IHSS will pay for.
More information here: Appendix (1,3,5)
6) 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.
More information here: Appendix (1,3,6,10,11,12,18)
7) 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.
More information here: Appendix (1,2,3,5,6,18)
8) 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.
More information here: Appendix (1,2, 3,4,5,10,14,18)
9) 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.
More information here: Appendix (1,2,3,4,5,18)
10) 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 often a very short deadline to keep the same hours while waiting for a hearing. The appeal must be filed before the date the reduction takes effect (this is on the NOA).
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 (you may need this information for a hearing).
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.
More information here: Appendix (1,3,4,5,6,7,8,18)
11) How to Appeal if you don’t agree with the assessment– 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.
More information here; Appendix (1, 3,4,5,10,14,18)
12) 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,
More information here: Appendix (1, 3, 14,18)
13) If I loose my job as a homecare provider, can I collect unemployment insurance benefits?
Most IHSS providers pay in to (and become eligible for) Social Security, State Disability Insurance, Unemployment Insurance, Workers Compensation, and Earned Income Credit through their IHSS employment. Some family providers do not contribute to these programs and are therefore not eligible. Check with your local IHSS office or case worker to make sure you are paying in to these programs.
Your County Page on this website will have contact numbers for your local IHSS office.
California Employment Development Dept. has information on filing an Unemployment Insurance claim.
14) What happens if I must leave work (my IHSS consumer) to care for a seriously ill parent, child, or spouse?
“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
This is all very complicated; where can I get help?
If you need help with an IHSS assessment or hearing, contact your local UDW office and explain that you need help with Advocacy.
There are also professional “advocates” or “benefit planners” in every community that have various skills and specialties. See Benefits Planning & Advocacy for a list pf websites and sources of professional help.
Guidelines for use and disclaimer
By providing information and links to other sites, UDW Homecare Providers Union does not in any way guarantee, approve or endorse the information or products available at these sites, nor does a link indicate any association with or endorsement by the linked site to UDW. We are making these resources available so that home care workers and their clients may streamline their research process as well as network on local, state, and national levels. Information about IHSS rules or legal issues given on this site is meant strictly to be a research starting point and is subject to current rules and law. While we try to publish the most current information available, the laws & rules that govern IHSS are complex and do change. Always use professional advice and verify all information to make sure it is current before making changes that might affect your eligibility.
