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Presented by: Maria F. Iriarte, Managing Attorney

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1 Presented by: Maria F. Iriarte, Managing Attorney
IN-HOME SUPPORTIVE SERVICES (IHSS) OSTER v. LIGHTBOURNE COORDINATED CARE INITIATIVE Presented by: Maria F. Iriarte, Managing Attorney A special thanks to National Senior Citizens Law Center for allowing us to use some of their slides


3 What is IHSS? IHSS is the largest publicly funded, non-medical service to help people with disabilities remain in their homes.

4 Who is Eligible? On Medi-Cal; California resident; Living in own home;
Otherwise eligible applicant who: Is living in a facility; Wants to live on his/her own; Can safely live on his/her own; and Undergoes a needs assessment.

5 What Types of IHSS Services Are Available?
Domestic Services (cleaning; sweeping; dusting; taking trash out, etc.) Related Services (meal preparation; meal planning and cleanup; laundry; including ironing and putting items away; food shopping.) Personal Care Services (assistance with feeding; dressing; grooming; bathing; toileting; bowel and bladder, getting in and out of bed.) Accompaniment to Doctor (or to alternative sources of services such as a day program.) Paramedical Services (injections; range of motion exercises, etc.) Protective Supervision (monitoring a cognitively or mentally impaired individual to safeguard from injury or hazard.)

6 When Are Children Eligible to Receive IHSS Services From Non-Parent?
When disabled and low-income. If income too high for SSI, may qualify with share of cost. If parents are out of the house working, school, training, or If parents are unable to provide care due to disability or illness, or If parents are sleeping or caring for other family members.

7 When Can A Parent Be Paid As An IHSS Provider?
If the parent quit job or can't get a job full-time because he or she must care for the disabled child, AND If no other suitable care provider is available (willing and able); AND If the child is at risk of out-of-home placement or inadequate care. If both the parents live in the home, one parent may get paid when the other parent is working, in school, sleeping, or disabled. Payments will not affect child’s SSI, but will affect family’s welfare grant or Medi-Cal eligibility.

8 What Happens When I Call the Social Services Agency?
A Social Worker will request: Information about your needs to remain living safely in your home. Information about your finances to determine eligibility. A social worker will schedule a visit to your home to conduct a needs assessment.

9 When Are Needs Assessments Performed?
When person applies for services. Every twelve months thereafter. Whenever the county has information that the recipient’s physical/mental condition or living social/condition has changed.

10 Assessing Need Social worker makes an assessment of what your need for in-home care is using: Available medical Information. Face-to-Face home visit: Recipient’s physical/mental Conditions. Living/social Situation. Time-For-Task Guidelines. Recipient’s statement of Need. Other Information Necessary and Appropriate to Assess Need.

11 How Services are Authorized
Using assessment information, time-for-task guidelines and rankings, the social worker determines the amount of authorized services. “Time-For-Task” Guidelines: Set ranges of time that can be authorized for services: Meal preparation, Meal cleanup, Bowel and bladder care, Feeding, Routine bed baths, Repositioning, Bathing, oral hygiene/grooming, Dressing, Transfer, Care and Assistance with prosthesis, Routine menstrual care, Ambulation, Domestic, Laundry, Food Shopping and Other errands. Social worker must document tasks that might require more or less time than the guidelines, and the reason for the increase or decrease. Keep a log of your daily care needs so that you can explain why you need more time.

12 How Services Are Authorized (cont’d)
Rankings: as part of the assessment for services the county determines the person’s ability to complete certain tasks. The county then gives a “functional index rank” from “1” to “6” for each of the tasks. General Standards (Rankings): Functioning is independent, and person is able to perform the function without human assistance but might have difficulty in performing the function, but the completion of the function, with or without a device or mobility poses no substantial risk to person’s safety.

13 How Services Are Authorized (cont’d)
Able to perform a function, but needs verbal assistance, such as reminding, guidance, or encouragement. Can perform the function with some human assistance including, but not limited to, direct physical assistance from provider. Can perform a function, but only with substantial human assistance. Cannot perform the function with or without human assistance. Paramedical services needed. Note: not every ranking is always used in assessing a specific area of need, ie. Laundry only uses ranks 1,4,5.

14 Preparing for an Assessment
Read the Disability Rights California IHSS Self-Assessment Packet. Fill out the Disability Rights California IHSS Self Assessment Worksheet. Do this before the in-home assessment. Talk to your/child’s health care provider(s). Remember you/child is not authorized hours based on the basis of diagnosis or disability alone, but upon disability related impairments that prevent you/him/her from performing these task on your/his/her own. Always try to have friend, family member or other person present to witness the face-to-face assessment. Think about the types of assistance your /child needs on the worst days.

15 Oster v. Lightbourne

16 Quick Facts about IHSS Cuts
2009 and 2011 proposed cuts 3.6% in 2009 Oster v. Lightbourne lawsuit Oster Settlement

17 Oster Settlement- IHSS Reductions
When: July 1, 2013 Where: Statewide What: 8% reduction in IHSS hours Contingent on court & legislative approval of Oster Settlement. 4.4 % + 3.6% (prior cut) = 8% Reduction will decrease to 7% (7/1/14)

18 Advice for IHSS consumers to minimize impact
Can apply 4.4% cut to unmet need (see next slide) Protective supervision hours don’t count as unmet need. Make sure unmet need is accurately assessed! Consumers can choose how to apply cut to services. YES: tell provider about how to apply cut to hours. NO: county SW does not need to know how hours will be cut. Consumers on waivers administered by In-Home Operations should contact IHO to try to increase waiver personal care hours to make up for lost IHSS.

19 Unmet Need Total assessed monthly need for IHSS
Maximum IHSS Hours Unmet Need 283 hour/month maximum for severely disabled IHSS recipient (unmet hours for protective supervision don’t count) Total assessed monthly need for IHSS 320 Total Assessed Need- (320 x 0.08) = 294.4 Still gets maximum IHSS after Extra 4.4% Cut

20 Consumers may be able to get reassessment, but cannot appeal cut
Consumers will get Notice of Action prior to extra 4.4% cut. No right to appeal solely based on extra 4.4% cut (unless there is a math error). BUT consumer can request reassessment if medical needs or circumstances change Settlement agreement clarified: no need for new medical certification form or doctor’s note.

21 Coordinated Care Initiative

22 Coordinated Care Initiative
When: 1/1/2014 Where: 8 Counties What: Mandatory Medi-Cal for all SPDs, including persons on Medi-Cal and Medicare (Duals) LTSS integration Cal MediConnect

23 Coordinated Care Initiative: Where
Alameda Los Angeles Orange San Bernardino San Diego San Mateo Santa Clara

24 Coordinated Care Initiative: What
CCI Change Description Status Mandatory Medi-Cal Managed Care Duals and previously excluded SPDs must enroll in Medi-Cal Managed Care Pending LTSS Integration LTSS added to Medi-Cal Managed Care Plan benefit package: IHSS, Community Based Adult Services (CBAS); Multipurpose Senior Services Program (MSSP); Nursing Facility Medicare Integration (Cal MediConnect) For duals, passive enrollment of Medicare benefits into same MC plan Approved. Begins 1/1/2014

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