IN-HOME SUPPORTIVE SERVICES (IHSS) OSTER v. LIGHTBOURNE COORDINATED CARE INITIATIVE Presented by:...

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

www.disabilityrightsca.org

IN-HOME SUPPORTIVE SERVICES


What is IHSS?

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


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.


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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.)


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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.


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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.


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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.


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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.


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.


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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.


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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):

1. 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.


How Services Are Authorized (cont’d)

2. Able to perform a function, but needs verbal assistance, such as reminding, guidance, or encouragement.

3. Can perform the function with some human assistance including, but not limited to, direct physical assistance from provider.

4. Can perform a function, but only with substantial human assistance.

5. Cannot perform the function with or without human assistance.

6. 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.


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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.


Oster v. Lightbourne


Quick Facts about IHSS Cuts

•2009 and 2011 proposed cuts▫3.6% in 2009

•Oster v. Lightbourne lawsuit•Oster Settlement


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)


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.


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


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.


Coordinated Care Initiative


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


Coordinated Care Initiative: Where

AlamedaLos Angeles

OrangeSan Bernardino

San DiegoSan MateoSanta Clara


Coordinated Care Initiative: WhatCCI 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

Pending

Medicare Integration (Cal MediConnect)

For duals, passive enrollment of Medicare benefits into same MC plan

Approved. Begins 1/1/2014

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