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 on our State Budget page

Quick Link to new pvovider 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.

Advocacy
Resources, Appendix 

FAQ: Questions & Answers About IHSS

1. How will recent changes to state law affected my job?
2. What is a "Functional Index Ranking" and how does it impact my client’s assessed hours or eligibility?
3. Preparing for the annual assessment
4. What IHSS will pay for
5. How to "Log" your time
6. How to get the right documents from the doctor
7. What is Protective Supervision & how does it qualify a consumer for more hours?
8. Using an "Advocate" or representative
9. Understanding the "Notice of Action"
10. When to ask for a re-assessment
11. You can appeal the assessment when consumer’s hours are reduced or an assessment is not right
12. How to keep the same hours until your appeal is heard
13. If I loose my job, can I qualify for unemployment insurance?
14. 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

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 (This site, State Budget Page)

Fact Sheet on California Budget Cuts & IHSS (Disability Rights California)

Update on lawsuits & legal actions (IHSS Coalition website)

KQED (Public Radio) NOV. 16 Broadcast (58 minute forum covering changes to IHSS)

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.

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)

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.

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.