What determines the duration of IHSS?
The length of time a person receives IHSS is not a fixed period, but rather depends on ongoing eligibility determined by regular reassessments. The program is designed to provide long-term care, helping eligible individuals with disabilities, the blind, and those over 65 remain safely in their own homes.
Several key factors influence the continuation and level of IHSS support:
- Annual Reassessments: A county social worker must conduct an in-home reassessment at least once every 12 months. This evaluation reviews the recipient's current physical and mental condition, their need for services, and their living situation.
- Change in Circumstances: A reassessment can be requested at any time if there is a significant change in the recipient's needs, health, or living arrangements. This can lead to an increase or decrease in authorized hours.
- Medical Necessity: To maintain eligibility, a licensed health care professional must verify that the recipient requires assistance to safely remain in their home.
- Medi-Cal Eligibility: IHSS is a Medi-Cal funded program, so recipients must remain eligible for Medi-Cal benefits. Income and asset limits for Medi-Cal, or having a Medi-Cal share of cost, can impact continued eligibility.
The IHSS reassessment process
The reassessment is a crucial part of maintaining IHSS benefits and is very similar to the initial application process. Knowing what to expect can help ensure a smooth review:
- Notification: The county will notify you in advance of the scheduled annual reassessment.
- Home Visit: An IHSS social worker will visit the recipient's home to conduct the evaluation. During this visit, they will speak with the recipient and, if appropriate, their caregiver and family.
- Needs Evaluation: The social worker uses specific criteria to assess the need for services, including evaluating the recipient's functional abilities with daily tasks like bathing, dressing, meal preparation, and housekeeping.
- Authorized Hours Calculation: Based on the social worker's findings, the county authorizes a specific number of monthly hours for each service. This number can change from year to year depending on the recipient's assessed needs.
- Notice of Action (NOA): After the reassessment, the county issues a Notice of Action (NOA) detailing the decision regarding authorized hours. This notice also explains the recipient's right to appeal the decision if they disagree with the outcome.
Comparison: What Affects IHSS Duration and Hours?
| Factor | How it Affects IHSS Duration | How it Affects IHSS Hours |
|---|---|---|
| Annual Reassessment | Determines continued eligibility year-to-year. | Can increase, decrease, or maintain the number of authorized hours. |
| Change in Medical Condition | May trigger a reassessment at any time, impacting duration. | A worsening condition can increase hours; an improvement might decrease them. |
| Living Situation | If a recipient moves into a hospital or skilled nursing facility, IHSS ends. | Changes in living situation, such as a new family member providing care, can affect hours. |
| Medi-Cal Eligibility | Loss of Medi-Cal eligibility will terminate IHSS benefits. | Does not directly affect hour count but is required for program access. |
| Protective Supervision | A recipient remains eligible for protective supervision as long as a cognitive impairment or mental disability exists that poses a risk of harm. | Can add significant additional monthly hours, up to 283 for severely impaired recipients. |
Can IHSS be terminated?
Yes, IHSS can be terminated if a recipient no longer meets the eligibility requirements. Some common reasons for termination include:
- Loss of Medi-Cal: IHSS is dependent on Medi-Cal eligibility.
- Moving into a Facility: If the recipient moves into a hospital, skilled nursing facility, or licensed community care facility, they are no longer eligible for IHSS.
- Improved Condition: If a reassessment determines the recipient no longer requires the level of care provided by IHSS to remain safely at home, benefits may be reduced or terminated.
- Failure to Participate: Refusal to cooperate with the reassessment process can lead to a loss of benefits.
Conclusion
In-Home Supportive Services in California is not a temporary benefit with a set expiration date. Instead, it is an ongoing program designed to provide long-term care to eligible individuals. The duration of IHSS is tied directly to a recipient's ongoing need for services and their ability to maintain program eligibility through required annual reassessments. By understanding the reassessment process, being prepared for evaluations, and promptly communicating any changes in condition, recipients can continue to receive the support they need for as long as it is medically necessary. For further information or assistance with the IHSS process, consider reaching out to a local advocacy group or checking the California Department of Social Services website.
Can IHSS last indefinitely?
Yes, IHSS can last indefinitely in California, provided the recipient continues to meet the eligibility criteria, as determined by annual reassessments.
How often is IHSS reviewed?
IHSS eligibility and authorized hours are reviewed and reassessed at least once every 12 months through a home visit by a county social worker. A review can also be requested at any time if the recipient's needs change.
What happens during an IHSS reassessment?
During a reassessment, a social worker conducts a home visit to evaluate the recipient's current physical and mental condition, their need for services, and their ability to perform daily tasks. They will speak with the recipient and relevant caregivers to gather information.
Can IHSS hours be decreased during a reassessment?
Yes, if a reassessment determines that a recipient's need for services has decreased, the authorized hours can be reduced. Conversely, if needs have increased, hours may be increased.
What can cause IHSS benefits to end?
IHSS benefits can end if a recipient loses their Medi-Cal eligibility, moves into a hospital or care facility, or no longer has a verified need for services to remain safely at home.
Can I appeal a decision to reduce or terminate my IHSS benefits?
Yes, if you disagree with a decision to reduce or terminate your IHSS hours, you have the right to request a state hearing. The Notice of Action (NOA) will include information on how to appeal.
Does my doctor's input matter in the IHSS reassessment?
Yes, a doctor's input is very important. The IHSS program requires a Health Care Certification form (SOC 873) or similar documentation from a licensed health care professional verifying the need for services.
What if I need more hours than are currently authorized?
If your needs increase, you can request a reassessment at any time, not just during your annual review. You or your caregiver should contact the county IHSS office to inform them of the change in circumstances.
