In-Home Supportive Services Basics | Undivided Training Series

Start here if you’re brand-new to IHSS or you want to make sure your child is receiving all the benefits they’re eligible for. Undivided Public Benefits Specialist Lisa Concoff Kronbeck covers how to apply for IHSS, how to become a parent provider or hire a third-party provider, and how to file an appeal, all with expert tips and walkthroughs in the Undivided app.

Here are links to the Undivided articles and other resources included in the training with Lisa Concoff Kronbeck:

• To look up your local IHSS office, check out our article.

• Learn how to prepare for your IHSS Home Visit here in our article.

• To learn more about IHSS myths, check out our article here.

• Learn more about IHSS hours for bringing your child to a medical appointment.

• Learn how to appeal an IHSS reassessment.

Lisa Concoff Kronbeck
All right, so today, we're really going to go over the introduction and basics. Um, so just a couple of things to keep in mind, the information here is publicly available information and is not legal advice. We're here to not help you navigate the system, save you time, bring clarity and confidence and connect you with the best information, but best available like information and resources, but we cannot provide legal advice. So if you need legal advice, consult with an attorney. As Jen said, there's a lot of information. You're not going to need to remember all of this. The goal is, number one, like so you know kind of where to find it in the app, and two, just so you feel more comfortable navigating the system and getting some familiarity and confidence with the information, so that as it comes up in real time. It's familiar to you and not as intimidating.

Okay, so what is the IHSS program? IHSS is a Medi Cal program that provides home based personal care and related services so that people with disabilities can remain safely at home. Now this program is not limited to kids. In fact, it was originally started for elderly people and people with disabilities in general. But there are some some program rules that really only apply to children, because children have parents in the household who do have a legal responsibility to care for them. And so there's some specific rules that apply only to children because of the parent responsibility component. So ours will only be awarded for IHSS for specific services that exceed what a parent would usually be expected to provide to a typically developing child of the same age. That is going to be sort of your refrain as you, as you think about all the different services that IHSS provides, it's always going to be relative to a typically developing child of the same age. So hours are awarded based on need, not based on diagnosis. So it's not just if your child has x diagnosis they get y number of hours. It's based on your child's specific needs. So you need to be prepared to discuss your child's need mutations for each of these tasks.

You also need to be willing to talk about your child's needs and limitations. So this really tempting to just want to, like, share with everybody your child's accomplishments and share that pride. But a lot of times the case workers can take that out of context. So my example is always, you know, if you if you tell them, you know, I'm so excited, because with all this work, my child can finally recognize their name and print. They can finally read their name the caseworker might write down on the form. Can read. So just, you know, be cognizant of, you know, don't, don't exaggerate, but be honest and open about your child's limitations. Um, you know, some of our some of our families, have given the advice to sort of think about when you're talking about your child's limitations, to think about, like, their worst day, um, what they can and can't do on those, on those really difficult days. So let's actually take at the looks that the look at the steps to submit an application, because this is really sort of the basics on how to do the practical stuff, right? So in order to apply for IHS, and as Jen said, she's going to add a link to in the chat to the step by step walkthrough, and then divide it up for each of the goals that we're going to go over, so you can follow along or or add the goal to your roadmap or take notes. So the first goal is apply for IHSS so the first step you're going to take is to find your County IHSS office. If you just Google IHSS office by county, you can usually come up with a list pretty easily check your county's application options for submitting the SOC, 295, which is the initial application.

Some counties will let you do it online. Some counties will let you do it by mail, phone, fax. A lot of them have the option to call and do that initial application by phone, whatever you do that that date that you initially submit that application is your initial date in terms of retroactive and retroactive, retroactive benefits. So just think about that in terms of just and it can be a lengthy process, but if you get the services. They'll be approved back, usually back dated to the date of application. So, but one of the things that can happen sometimes when you call is that the person on the phone will say, Oh, we don't take children your your child's age. You need to wait a couple years and call back later. So. If that happens, just say nicely, I understand that, but I'd like to apply anyway, because the reality is that IHSS is not age limited. But, you know, there are certain services that are age limit, but, oh, but overall, it's not age limited. But if you don't apply, there's nothing to appeal. If you call and they tell you, Oh, call back in a couple of years, and you hang up. You have not applied. You have not done anything, and so there's no opportunity to appeal. So just tell them, thank you. I'd like to apply anyway.

And then after you submit the application, you need to bring the SOC, 873, the healthcare certification form to your doctor after you apply, IHSS will mail you a copy of that form. But you can also find it online. If you want to get a head start and have your have your doctor fill it out. If you don't get a copy of this form from ISS within a couple of weeks, you may want to just call and make sure that they actually process your application, because they should send that out. And then the next step will be to prepare for your home visit. And that is where a caseworker from IHSS will come out to your home, interview you, meet your child, and we'll talk about that next so we'll talk about preparing for your IHSS home visit. Again, you can find the step by step by step instructions in the platform and add it straight to your roadmap, so preparing for the home visit. So the first thing that you're going to do is you're going to review. You'll get a notice of home visit, and it will list off the date of the visit, the time. It'll give you a window for the time of the visit, and it will list any specific documents that you need to have. Now, if this is an initial visit, it will list a good number of documents. If this is a annual visit, there might be some additional there might be some forms that they want you to have filled out again, and it will note, it will note that on the notice. So gather those forms that you'll be submitting to the caseworker. Get everything together, anything that you are going to hand to the caseworker keep a copy for yourself, because these records notoriously get lost. They somehow never make it to the file.

So just keep copies so that if something did not get added to your file, you have the ability to submit it again later. So if your child takes medications, print out a list of medications, or have the medications available for the case workers review. It's not here. But if your child has a lot of specialists, a lot of doctors, you may also want to just print out a list of those to give to the to the caseworker, so that you don't have to sit there reading off the names of the doctors and all the fun, which is give them a list. It's just sometimes a little bit easier in the weeks leading up to the meeting. It really helps if you keep track of the tasks that you do and how long it takes, as well as the degree to which your child needs help with certain tests. So IHSS does, they sort of for service. For the services that IHSS will cover, they assign a ranking based on the degree of assistance that your child needs. So you're not going to be asked to assign a rank to the child's need, but you will be able to say, Oh, he needs a lot of reminders. Or I kind of have to be there to make sure that the the task happens properly. They can kind of go through the motions, but I have to do hand over hand to, like, make sure that it actually happens the way it's supposed to. Or your child can't participate in any of it. You're doing the task entirely for them.

So kind of be able to articulate the not only what you do, but to the extent to which you are doing the task for the child. And then if you plan to apply for protective supervision, you should keep a behavior log, or a non exhaustive list of behaviors that you see often that could result in injury if you didn't intervene. Don't just keep and we'll talk about this in in future classes, especially protective supervision, but just keep track of the kinds of things that happen that would result in injury if you didn't intervene, not just every time they get hurt.

Jen Newsome
Lisa, can I? Can I just pop in with a quick question, just because it's relevant. So in speaking of the in home visit, preparing for the in home visit, what happens if you never get a letter notifying you about the home visit, but the case worker shows up anyway.

Lisa CK
If your child is home and you are able to do the home visit, I would say, do the home visit? Um, if as soon as you submit the health the healthcare certification form, you kind of have an idea in your head that the home visit should be happening soon. So it would be helpful, regardless of when you get the notice to kind of be thinking about the home visit and getting some of those papers filled out. Um. Uh, so that if, if they do show up and they shouldn't, but it happens, um, sometimes the notes gets lost. Um, so if you can do the visit, just do it on me and choose your battles.

Um, if your child is not present and the case worker shows up, you know you could, you could say, Well, how about we go over the things that we can go over, and then you come back at another time to meet my child. So they have to meet your child. If that doesn't work for them, see if you can reschedule. If they just submit a denial because you weren't there. If they refuse to cooperate with rescheduling and submit a denial, then I would say, appeal that immediately and say that the caseworker showed up without providing notice, and so your child was at school, and you tried to reschedule, and they didn't, and so you were appealing

Jen Newsome
Real quick, too. Lisa, as far as timeframe is concerned, when somebody submits an application via fax, when can they expect to hear back.

Lisa CK
It should be, I mean, you should get that healthcare certification within, within a couple of weeks. It's usually, it's usually pretty quick. If it's been, like, two weeks and you haven't gotten anything, you you may want to call and just, you know, say, I fax this. I have the fax confirmation. I just want to make sure that it was that it was that it was received, because that initial healthcare Certification Form usually gets it's a long process, but that part usually happens fairly quickly. So yeah, I would, I would say that, okay, thanks for jumping in, Jen. I want, I want to make sure that things are clear as I'm going, even though we're going to have a Q A at the end. So I appreciate that. Okay, so during the home visit, your your child has to be there. Your child must be physically present for the visit.

So just that, can be a little bit frustrating if you have to pull them out of school, but they absolutely have to be there. Sometimes the caseworker will usually not for the initial visit, but sometimes for the annual visit. Sometimes the caseworker will call you and get some of the administrative stuff out of the way so that the home visit can be shorter. A lot of things have sort of been that those processes have been sort of revised since the pandemic, in the way that they do things but, but when the case worker comes to your home, your child needs to be there, so just keep that in mind. Provide the worker with the documentation they may give you forms at the visit, and we're going to talk about how to become a parent provider and go over some of the forms that you need to fill out. They may bring some of those forms with them to the visit and ask you if you're planning to be the provider. And if you are, they may just have you fill out those forms right there. So just be prepared to do that. And before you give them to the caseworker, I suggest you, you know, take a little snap with your phone so that you have a copy of it, so that if you have any questions later, or you have to fill it out again, and you had to ask questions, you kind of know what you're supposed to be doing on the form.

If you don't have additional forms to submit, like if you're planning to submit a paramedical services form or projective supervision form, you can either ask that the worker provide you a copy of that form at the visit, or just let them know, you know, I'm going to be sending these documents to you, sort of, what is the time frame that you need them? Like, do you need them in? You know, three days? Do you need them tomorrow? Ask them what their time frame is, and ask their preferred mode of submission. Like, do they want to email? Some, some counties don't allow you to email at all, and some do. Some of them want you to come into the office and hand the papers in. Again, anything that you give them, you keep copies and again at the meeting, just be prepared to discuss your child's functional limitations. Yeah, after the home visit if you submitted any forms to the caseworker, especially if you submitted protective supervision and paramedical services forms, you may just want to follow up, maybe, like a week later and just make sure that they were added to the file. If you get a denial and they didn't, it seems like they didn't look at those paperworks, and we're going to talk later about how to appeal. But just keep in mind that that it's not uncommon for them to lose papers in transit between any point A and B.

So that's why I say keep copies of everything it's again, any after the visit, submit any additional documentation that you discussed the meeting. It like I said, it's nice to follow up maybe a week later and make sure that those that those documents were entered into the file and they have them on record, and then wait for your decision. If you haven't gotten a Notice of Action within a few weeks, you may want to follow up with the IHS. Office, they will not let you know. Generally, if something's missing, they will just issue a denial. So if you're not getting anything, you may just want to follow up with them and make sure that there's nothing that you need to do, or nothing additional that you need to do, and go from there. So just a few frequently asked questions that we get, what is the maximum number of hours? What if my caseworker tells me X, Y or Z? And again, we're going to talk about how to be your child's provider, and then what if you get to that? So one thing a lot of people want to know is, how many hours can I get? Well, the range is literally zero to 283, it's a massive range, and some of that will depend on whether your child is classified as severely impaired or non severely impaired.

So severely impaired means a child is or any recipient, but in this case, a child is authorized for 20 or more hours per week of non medical personal services and paramedical services and meal preparation. So all the other services like those, those, the the services that you can get under IHSS, the if those add up to 20 hours a week or more, then you can get then, then your maximum is 283 if you have hours that go beyond that, you should still make sure that they're documented, because I can explain that a little bit later, but you should still make sure that they're that they're documented, even If it's more than 283 non severely impaired recipients usually can get authorized for up to 195 hours, depending on your IHSS funding source. That can vary a little bit. For for most of our kids, it's going to be either 195 hours, or if they get protective supervision, it will be the monthly hours that they're allotted, plus 195 for protective supervision.

So these are some of the sort of most common misstatements we hear from caseworkers during the visit or throughout the process. In general, IHSS doesn't accept clients your child's age. And like, even though they might say that on the phone, they might also say that at the visit, oh, your child's too young. We don't give hours for that, because it's your responsibility as a parent. Or all children your child's age requires supervision. And sometimes that's sometimes that's true. Sometimes it is parent responsibility. And there, there is a chart that shows sort of which services are anticipated for for children based on what age they are. At which age it because it stops being parent responsibility and starts being something where they rate it based on the child's independence. The reality is there's no minimum age. There's no minimum age to get IHSS, the only question is whether your child's needs in that specific authorized task are greater than that of a typically developing child, and that is also true of protective supervision.

There are ages where it's harder to get protective supervision, because it is true that all very young children require supervision, but there are some children that require more supervision than a typically developing child of the same age, and so you need to be taking all of that into account. Okay? So another thing that you'll often see when it comes time to filling out paperwork is we need you to fill out this form listing all the people who are providing voluntary care for your child without pay. It's a voluntary services form, and they're going to say you gotta sign it. They're not supposed to expect that anybody who has a responsibility to provide, anybody who doesn't have anybody is voluntarily providing services that could be paid under IHSS. So if you get that form, you can just fill it out by saying nobody is volunteering to provide services that can otherwise be paid by IHS, services that are otherwise compensable. The other thing you want to hear is, Well, you can't get Chip hours for taking your child to the to their appointments, because that's parent responsibility. Well, taking them to their to their annual physical is parent responsibility.

However, some of our children have, you know, 56789, 10 appointments a week, and that is above and beyond what is expected of a typically developing child. So there is an all county letter, 1742, which lays out sort of the rules for getting transportation for a child. Number one is that they have extraordinary need that's due to a disability related functional impairment. Number two that the appointment itself is related to the disability and is a specialty appointment, so this is not your annual visit. Goal. This is not, you know, your annual dental cleaning. This is appointments that are specifically related to the disability. PT, OT speech. It could be if your specialist appointments, pulmonologist, cardiologist, if your child requires extra visits to the dentist because of their disability, and any of this transportation that is related to the disability, and an authorized IHSS task is needed during travel to and from the appointment. And that is, you know, if you're there's different tasks that you can get, like toileting, ambulation transfer or protective supervision. For that matter, if the child has specific IHS, specific needs on the way, during the appointment, or on the way back, then that's where they're going to authorize transportation.

So let's talk about how to become a parent provider. Again, you can go to your roadmap, and you can add this goal, and it'll lead you through all this that we're going to talk about. To talk about. So until February of last year, a parent could only be paid as the provider if they were working full time and there was nobody else to take care of the child. So like, if one parent was working, if one parent was working full time and the other parent was taking care of the child because they couldn't work full time because of the child's needs. That has changed. You no longer need to be work to be unable to work full time in order to be your child's IHSS providers. But even now, even a year later, I'm still occasionally hearing about a caseworker asking for the parents work schedule or for proof that they don't work full time. If there's any confusion, you can send them to all county letter number 23, 106, you can print it out for them, or just give them the citation so that they understand that that rule has been changed for for a good year now, they should not be asking you to prove that you can't work full time, or that the other parent works full time in order to be your child's provider, you do have to be eligible to work in the United States, and you will be required to complete a background check and fingerprinting as well as an orientation session, But that's it, that there are no longer any work requirements, but if you do work full time and your child needs services during that time, you you may have to find another provider, because you cannot build time while you're at work or while you're at school, or if you're ineligible to work due to your visa status or conviction history.

So you do have other options, and we'll we'll talk about this soon, but let's talk about how to become a parent provider first. So attend an orientation. That's the first step. If you're filling out some of the employment paperwork at the meeting, then it these. The order of these steps might change, because you might have filled out the paperwork first and then be going to an orientation. But generally speaking, you'll go to the orientation. This may be in person or online, depending on the county. If it's in person, they might ask you to bring ID and your social security card to the orientation. That's how they did things in the past. It kind of changes, and it goes. It changes from county to county. To County, so just follow the instructions from your county. You will need to fill says, fill out and submit and again, these are all in the roadmap, but this is the provider enrollment form, the provider enrollment agreement, the proof that you're eligible to work in the US. And if you're going to be signing your own timesheets. You need the SOC 839, A, that basically, some of the providers will say, Well, you can't sign your own timesheets if you're the provider. If you have the SOC 3839 A, you can, if you are your child's legal representative. So if you're, if you're, you're, you know, you're acting as your child's legal guardian, then you can sign it, and you will need to complete a live scan. There is generally a fee for that, or whatever background check your county uses. And then, once you have a provider number and you've been told that you're are ready to go, you need to fill out the designation of provider and submit it to your county office. Now, there is a function online, on the IHSS timesheet portal to us to hire a provider through your through the portal.

A lot of times it doesn't work for parent providers, but you can try um, and if it works and it works, but if it doesn't, then you need to fill out the form and submit it, and then fill out the live in provider certification in the E timesheets portal. You can also fill out the form to submit that. But this is this. This one is much easier to do in the actual timesheet portal. And then. If you're going to be allocating some of the hours to somebody else, there's a form that will basically say, Okay, I'm, I'm, this is one of my providers. I authorize them to work, you know, X hours per month, and then that, that's the only number of hours that they'll be able to submit. Some counties require you to allocate those hours ahead of time, but some counties don't. Some counties say just, you know, as long as you keep track and make sure that nobody's going over, then we're not going to make you assign specific sets of hours to different providers. So you might want to just check in on on your county. Los Angeles County generally does want you to fill out that form if you're going to regularly have have multiple providers on the case.

So if you are going to have a third party IHSS provider again, you can, you know, look up the goal and then add it to the roadmap. You can hire somebody else to do some or all of your child's hours. For example, if you're not eligible to work for IHSS, you need to have somebody else be the provider and your I just want to add this like your your ineligibility to be your child's provider has nothing to do with your child's eligibility to receive services. So just keep, keep that in mind your child's eligibility to receive, to receive services is completely separate from whether or not you can be the provider. Again, if you work or attend school full time, you can't bill hours while you're at work or school, so you'll need to have somebody else doing those tasks during the time that you're unavailable. And again, third party providers have to go through the same process of orientation, background checks, eligibility, fingerprinting, if you need help finding a provider, you can call your county's public authority for IHSS providers. You can usually, you know, search County Public Authority IHSS and that will usually come up. Jen, Hi, do you have another question?

Jen Newsome
Yeah, I'm so sorry. Kelly, just right before this, so somebody was asking if, let's see, there are any activities that parents are not compensable for that would otherwise be paid by a third party provider. And then clarification, okay, not anymore.

Lisa CK
It used to be. It used to be that there were certain domestic services and there were certain services that were considered parent responsibility. So a parent couldn't be paid for it, but a third party provider could. But now that parents, because it also used to be that if there was an available parent, you were not allowed to hire a third party provider. But all of that changed with the changes last February to allow parents. It basically what changed is the child the family's choice of who the provider is is now completely open. So it used to be that if you were the parent provider and you're available to provide these services, then you can't hire a third party provider, but now you can hire a third party provider, but those individual things that are considered parent responsibility are still parent responsibility, even if you have a third party provider. Does that make sense? So, so you can't, you can't hire a third party provider and have them do the things that we're supposed to be parent responsible. Responsibility. It's still considered parent responsibility.

Jen Newsome
Okay, one follow up question, is pick up from school considered solely parent responsibility?

Lisa CK
Yeah, because children are generally not expected to transport themselves to and from school.

Jen Newsome
Okay, great, thank you.

Lisa CK
Yeah, that's generally considered parent responsibility. Okay, so what if IHSS denies you or tries to reduce or terminate your hours if you're already getting hours. We have a goal for this too, so just add the appeal my IHSS decision to your roadmap, and let's look at it. So if you're already getting IHSS and you get a Notice of Action that says we're going to cut or or eliminate your IHSS hours, you should file an appeal within 10 days and write on the appeal form that you're requesting aid paid pending appeal, as long as you apply within 10 days, those those benefits should continue while you're in the appeal process. Obviously, if you're if this is an initial application, there's going to be no no aid to continue during appeal.

The California Department of Social Services has multiple methods for submitting a hearing. You can request a hearing online. You'd follow the instructions in your Notice of Action, but you can mail it, you can fax it. Just remember that if you're appealing because you feel like your child needs more hours when they do a reevaluation, they could go up or they could go down. Just keep that in mind a lot. Times when you file an appeal request, somebody from the state will call you and they'll find out some more information, and very frequently, they will offer you a reassessment in exchange for a conditional withdrawal, which means we will send somebody back out to do a reassessment, and in exchange, you'll you'll conditionally withdraw your hearing request, so we're going to put that on hold while we look at the case and see if we can resolve it without a hearing. And that's fine you.

It's up to you whether you want to go to a hearing and do that. A lot of times you may want to do that if you feel like the case worker ignored some of the things that you were saying or didn't, didn't look at certain forms. Um, so you can do that, just make sure that anything you sign is clear, that if you disagree with the reevaluation, that your appeal will pick up where it left off with the original date of application. Um, so, you know, just, just take a look at it. You might want to have an advocate or attorney look at the agreement first, if, if it's not clear whether it says that it goes back to the original date. But just keep that in mind, because again, retroactive pay goes back to the date that you applied, not the date that they're approved. Sometimes the case worker will say, You know what? Just, just drop the appeal and just, let's just start the whole thing over. If you do that, it will zero out of those retroactive benefits, so you're looking at the date that you originally applied. If you disagree with the reassessment, you have the right to reinstate your appeal and go back to the original date of eligibility and request a fair hearing. You can hire an attorney or advocate. Just keep in mind that a professional advocates usually take a percentage of the retroactive benefits, but they have a lot of practical experience in responding to county specific objections.

Jen Newsome
Quick question, can you accept the hours they approve, but also request for reassess, reassessment to potentially get more hours?

Lisa CK
You can. And usually, usually where that happens is, you agree with the hours, but they denied protective supervision. That's That's usually what the what the where the point of of contention is on an appeal like that, where you're okay with some hours, but you want it's usually on either paramedical services or protective supervision. So yes, you can accept those hours and appeal just on a specific issue. And what you would do in that case is you can begin to enter hours. They will send you timesheets, and you can enter the hours that you have worked. And depending on what happens at appeal. If you prevail at hearing, you can request supplemental time sheets to enter the hours to make up the difference for what the judge approved. That is a good question. Thank you again.

If you need help with a fair hearing, you can also contact agencies like Disability Rights California, or if you're a regional center client, you can reach out to OCRA, the Office of clients right to advocacy. They are housed at the regional center, but don't work for the regional center, but they may be able to assist you.