IHSS In Home Support Services

Transcription

1 IHSS In Hme Supprt Services What is IHSS? The IHSS prgram is a statewide mandated prgram administered by each cunty under the directin f the Califrnia Department f Scial Services. It prvides thse with limited incme wh are disabled, blind r ver the age f 65 with in hme care services t help them remain safely in their wn hmes. The three different IHSS prgrams explained There are three different IHSS prgrams: The Medi Cal Persnal Care Services Prgram (PCSP), The IHSS Independence Plus Waiver Prgram (IPWP) and The Original r Residual IHSS Prgram (IHSS R). The PCSP and IPWP prgrams are funded with Federal, State and Cunty dllars, while the IHSS R prgram is funded with State and Cunty dllars nly. Each f these prgrams prvides the same services, but have different eligibility criteria. PCSP Recipients are eligible because they have qualified fr Medi Cal n basis f age, blindness r disability. Mst IHSS recipients are part f the PCSP prgram. IPWP Recipients are eligible because they have qualified fr Medi Cal and are als part f ne f the fllwing grups: parent prvider fr a minr child, spuse prviders, advance pay cases and meal allwance cases. IHSS R Recipients d nt meet PCSP r IPWP requirements and usually have Satisfactry Immigratin Status, which denies them federal reimbursement. What services des IHSS prvide? Services include, but are nt limited t: Dmestic Services: meal preparatin, cleaning, laundry and taking ut the garbage. Persnal Care Services/Nn Medical Care: bathing, feeding and tileting. Prtective Supervisin: safeguard frm injury fr persns with mental impairments. Paramedical Tasks: assistance with medicatins, bwel and bladder care r catheter insertin. Wh is eligible fr IHSS? Any Califrnia resident is eligible fr IHSS if they: 1. Are SSI/SSP r Medi Cal eligible. 2. Are living in their wn hmes. 3. Are blind, disabled r 65 years f age r lder. 4. Are unable t live safely at hme withut care.

2 5. Meet certain financial requirements. Nte: Residents f lng term facilities may nt receive IHSS in the facility, but may apply if they are expected t be discharged s that IHSS is in place when they return t their hmes. What are the resurce limits fr IHSS? Recipients f SSI/SSP autmatically meet financial requirements. Recipients wh meet SSI/SSP eligibility criteria except fr incme are eligible, but might have t pay a share f cst. Applicants wh have mre than $2,000 in nnexempt assets ($3,000 fr a cuple) are nt eligible. Applicants can spend dwn assets in rder t qualify; hwever, they shuld be aware f penalties/perids f ineligibility. Nte: Althugh resurce requirements fr IHSS Persnal Care and Waiver prgrams are the same as Medi Cal, many IHSS recipients are als n SSI/SSP. Transfers that are permissible under the Medi Cal and IHSS prgrams culd impact SSI/SSP eligibility. What are the incme limits fr IHSS? The IHSS incme limit is the current SSI mnthly benefit. The current SSI benefit is $845 fr a single persn r $1,407 fr a cuple. Sme beneficiaries receive IHSS free f charge if they autmatically qualify fr a Medi Cal prgram with n share f cst (SOC). Beneficiaries with a SOC shuld try t qualify fr a Medi-Cal prgram with n SOC r a prgram with a higher incme cap such as the Medi-Cal Pickle Prgram r the Aged and Disabled Federal Pverty Level Prgram. Under the "Pickle Prgram," individuals wh were disqualified fr SSI because f a Cst f Living Adjustment (COLA) increase in Scial Security will remain eligible fr Medi Cal at n Share f Cst and will als meet the incme limits fr IHSS. In rder t qualify fr Medi Cal at n share f cst under the Aged and Disabled Federal Pverty Level Prgram, applicants must have a cuntable incme belw $1138 (fr individuals) r $1536 (fr a cuple). Thse wh qualify fr the Aged and Disabled Medi-Cal prgram als meet the IHSS incme limits, and will be eligible fr bth IHSS and Medi-Cal at n share f cst. Incme rules fr IHSS can vary depending upn which Medi Cal categry yu are enrlled in (e.g., SSI linked Medi Cal, Aged and Disabled Federal Pverty Level Medi Cal). If the applicant is nt eligible fr the Pickle Prgram and his/her incme is abve the Aged and Disabled Federal Pverty Level prgram incme limits, there will likely be a share f cst fr IHSS. Thse wh qualify fr Medi Cal and IHSS with a share f cst will receive tw Ntices f Actins (NOA). One NOA frm the Medi Cal prgram stating the share f cst amunt and the ther NOA frm IHSS stating they are eligible fr benefits. Even thugh there are tw NOA s the beneficiary will nly have ne share f cst. If he/she is cut ff frm IHSS r n lnger needs it, but is still eligible fr Medi Cal benefits, the beneficiary will be respnsible fr paying the share f cst determined in the Medi Cal ntice f actin. As f 10/1/2009, the IHSS share f cst will be calculated differently. There will n lnger be a buy ut, meaning that IHSS will nt subtract the current SSI amunt frm the applicant s cuntable mnthly incme t determine the share f cst. If the beneficiary is ver the Medi-Cal incme limit,

3 he/she will nly be able t retain a Maintenance Needs Allwance (MNA) f $600 fr a single persn (see examples belw). The fllwing is deducted each mnth: $20 frm unearned incme Health insurance premiums Earned incme deductins: $65 An additinal $20 can deducted frm earned incme if there is n unearned incme. Wrk expenses related t disability (cst f items related t impairment that are necessary t becming r remaining emplyed maintenance f a van that fits yur needs, certain clthing, attendant care services, transprtatin, medical devices, wrk related equipment, etc.). Half f the remaining earned incme. Example 1: Disabled Cnsumer ver Unearned Incme Limit Mr. Lee gets $1,300 frm SSDI every mnth. It is his nly incme. $1300 (Mr. Lee s unearned incme frm SSDI) $ 20 (General Incme Deductin) = $ 1280 Cuntable Incme Mr Lee s cuntable incme is $142 abve the $1,138 incme limit fr the Aged and Disabled Federal Pverty Level Medi Cal prgram. His share f cst fr Medi Cal wuld be $680 because f the $600 Maintenance Needs Allwance ($1,280 $600 = $680). Hwever, if Mr. Lee incurs $142 in additinal medical premiums each mnth, he culd reduce his share f cst t $0. Example 2: Aged Cnsumer ver Unearned Incme and Medical Deductins Ms. O Cnnr is 84 years ld and receives $1,500 a mnth in Scial Security benefits. $1,500 (Ms. O Cnnr s unearned incme frm Scial Security) $ 20 (General Incme Deductin) = $ 1,480 Cuntable Incme Ms. O Cnnr s cuntable incme is $342 abve the $1,138 incme limit fr the Aged and Disabled Federal Pverty Level Medi Cal prgram. Her share f cst fr Medi Cal wuld be $880 because f the $600 Maintenance Needs Allwance ($1,480 $600 = $880). Thus, she must pay r incur $880 each mnth in medical expenses befre Medi-Cal will kick in. Ms. O Cnnr can reduce her SOC if she reduces her incme t $1,138 with insurance premiums (such as dental, visin, etc.), incurred medical expenses nt cvered by Medi-Cal (chirpractic, pdiatry, dental, ptmetry,

4 vitamins, etc.). Prf f these must be submitted t the Medi-Cal ffice at the beginning f the mnth t ensure that the SOC will nt be taken ut f the IHSS prviders' checks. Example 3: Aged/Disabled Cnsumer with Earned Incme and Wrk Related Deductins Mr. Smith earns $1,000 at his part time jb mnthly, and receives $500 frm Scial Security. He als pays his neighbr $200/mnth t drive him t wrk, because he cannt drive due t an injury t his legs. $ 1,000 (Mr. Smith s earned incme) $ 65 (Earned Incme Deductin) $ 935 $ (Half f remaining earned incme after the deductin - 1/2 X $935) (Mr. Smith s unearned incme) $ (Unearned Incme Deductin) 200 (Wrk Related Expenses due t Disability) = $ Mr. Smith is eligible fr n share f cst IHSS because his incme is under the SSI incme limit f $845. Imprtant: All Medi-Cal beneficiaries wh have a Medi-Cal share-f-cst f mre than $500 will n lnger have their Medicare Part B premium cvered by Medi-Cal, it will autmatically be deducted frm the beneficiary s Scial Security check. Wh prvides IHSS services? Each cunty can chse different mdes f services delivery: Cntract, Cunty Hmemaker,r Independent Prvider (IP). Hwever, it is up t the individual t decide what mde f service delivery they wish t receive. In the Cntract mde, an utside agency dispatches a caregiver t yur hme. In the Cunty Hmemaker mde, the Cunty trains and emplys caregivers. Mst IHSS clients use the IP mde f service, where the client hires, fires and supervises wrkers. In mst cunties, Public Authrities have been established t imprve IP service delivery. IHSS pays IP s wh are hired and supervised by the recipient r the recipient s guardian/authrized representative. Many IP s are relatives f the client. Payments are issued by the State Cntrller s Office, directly t the IP. The current IP wage thrughut mst f Califrnia is $8.00 (CA minimum wage). In the Bay Area Cunties, Public Authrities have been able t negtiate higher wages and cmprehensive health and dental benefits. Hw des IHSS calculate hw many hurs I get?

5 The State has limited mnthly services hurs t 195 hurs per mnth fr nn severely impaired applicants and 283 hurs per mnth fr the severely impaired. The Cunty Scial Services Agency is respnsible fr ding a needs assessment fr each client at the time f applicatin and yearly thereafter t determine hw many hurs an applicant will receive mnthly. The prcess f the needs assessment will be repeated yearly, and the number f hurs authrized may change with each evaluatin. The assessment evaluates: 1. The client s physical/mental cnditin, living/scial situatin and ability t perfrm varius functins f daily life. 2. The client s statement f need. 3. Medical recrds/physicians statement f need. 4. Other infrmatin the case manger may cnsider necessary and apprpriate t assess the need. Hw d I apply fr IHSS? Call r visit yur lcal Department f Scial Services t cmplete an IHSS applicatin (see link belw). Once IHSS receives yur applicatin, a casewrker will be assigned t cnduct a needs assessment. During the needs assessment, the casewrker will cme int yur hme and ask yu questins abut yur physical and mental capacity in rder t determine what yu can and cannt d. Yur living situatin will als be evaluated. After the needs assessment, the IHSS casewrker will cntact yu and let yu knw if yu have been apprved r denied the service. If apprved, the casewrker will tell yu hw many hurs were authrized. Appeals If yu are denied Medi-Cal r IHSS r if yu d nt agree with the number f hurs authrized, yu may appeal the decisin by filing fr a fair hearing. Yu shuld cntact yur lcal legal services ffice t assist yu in the appeal. Click here fr a listing f Califrnia In Hme Supprtive Services Prgrams and telephne numbers. Page Last Mdified: May 13, 2011 Fr further infrmatin, please cntact Passages, Area Agency n Aging