Understanding How IHSS Hours are Calculated

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Oct 6, 2021
#5611.01

Understanding How IHSS Hours are Calculated

This publication explains how In-Home Supportive Services (IHSS) monthly hours are calculated.This publication assumes you have already applied for IHSS, gone through the in-home assessment with the IHSS Social Worker, and received a Notice of Action (NOA) approving hours. For more information on the IHSS application process, please see the IHSS Nuts and Bolts Manual, # 5470.01.

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Disclaimer: This publication is legal information only and is not legal advice about your individual situation. It is current as of the date posted. We try to update our materials regularly. However, laws are regularly changing. If you want to make sure the law has not changed, contact DRC or another legal office.

 

This publication explains how In-Home Supportive Services (IHSS) monthly hours are calculated.1 This publication assumes you have already applied for IHSS, gone through the in-home assessment with the IHSS Social Worker, and received a Notice of Action (NOA) approving hours. For more information on the IHSS application process, please see the IHSS Nuts and Bolts Manual, # 5470.01.2

A)  Background Information

(1)  IHSS Funding

First, it is important to understand the different funding sources for IHSS because which funding source (also known as “program”) you are placed in will determine the maximum amount of monthly IHSS hours that are available to you.  Note, that “hours available to you” does not mean that you will get all those hours. Factors determining the hours you receive will be discussed in this publication.

There are four IHSS programs. Each program has different eligibility criteria and maximum monthly hours available, depending on whether you are considered Severely Impaired or Non Severely Impaired (more on this below). These programs are:

  1. Personal Care Services Program (PCSP);
  2. IHSS Plus Option (IPO);
  3. In-Home Supportive Services Residual (IHSS-R); and
  4. Community First Choice Option (CFCO)

You can find information about what program you are on by looking at your Notice of Action3 approving your application for IHSS, or by asking your IHSS Social Worker.

The following chart lists the programs and the maximum available monthly IHSS hours:

Program If you are considered Severely Impaired (SI) – up to: If you are considered Non-Severely Impaired (NSI) – up to: Citation/source of information
PCSP 283 hrs/mth 283 hrs/mth All County Information Notice (ACIN) Number I-28-06
IPO 283 hrs/mth 195 hrs/mth All County Letter (ACL) Number 11-19
IHSS-R 283 hrs/mth 195 hrs/mth ACIN I-28-06
CFCO 283 hrs/mth Up to 283 hrs/mth ACL 14-60

i. PCSP:

To be eligible for PCSP, you must be receiving full-scope Medi-Cal4 and your IHSS provider cannot be your spouse or parent.

ii. IPO:

To be eligible for IPO, you do not qualify for the PCSP program because of one of the following:

  • your IHSS provider(s) is your spouse or parent,
  • you receive Advance Pay5
  • or you receive a Restaurant Meal Allowance.6

iii. IHSS-R:

To be eligible for IHSS-R, you do not receive full-scope Medi-Cal, or do not receive full-scope Medi-Cal with federal financial participation.7 This generally means IHSS-R is for lawful permanent residents, or persons residing in the United States under color of law.8

iv. CFCO: Community First Choice Option

To be eligible CFCO, you must be eligible for full-scope, federal financial participation Medi-Cal, and meet a nursing facility level of care based.9

If you are on IPO but can also be on CFCO, consider switching to CFCO. CFCO allows for a greater maximum of hours (which you would still need to prove eligibility for), and you may benefit from the spousal impoverishment rules (see DRC publication # 5392.01; 10 and the “All County Welfare Directors Letter, No. 17-25.11)

(2)  Severity:

HSS establishes maximum monthly hours depending on whether you are considered Severely Impaired (SI) or Non Severely Impaired (NSI). According to IHSS regulations, whether you are NSI or SI is determined by adding the hours in these categories: Meal Preparation, Meal Clean Up, Respiration Assistance; Bowel, Bladder Care; Feeding; Routine Bed Bath; Dressing; Menstrual Care; Ambulation; Transferring; Bathing, Oral Hygiene, Grooming; Rubbing Skins, Repositioning; Help with Prosthesis; Paramedical Services.12

If you receive alternative resources13 providing any of the above services, then those hours are included in determining whether a recipient is NSI or SI, even though those same hours are not counted towards that consumer’s IHSS need.14

Example: if you go to an adult day care center and receive assistance with meal clean-up for lunch, then your IHSS monthly hours will not include the assistance you need in cleaning up after lunch. The lunch clean up assistance you receive at the adult day care center will count towards whether you are “Severely Impaired” or “Non Severely Impaired,” however. This means that your maximum monthly hours may be 283, or 195, depending on whether you are found to be “Severely Impaired” or “Non Severely Impaired”.

You are considered SI if you receive 20 hours or more in the above categories each week.15 You are considered NSI if you receive 19 or less hours in the above categories each week.

(3)  Home Assessment

The Social Worker will assess you in your home to determine what services you need and how much time you need for each service. Thereafter, if applicable, the Social Worker will prorate certain services, and will deduct time if there are alternative resources. Proration and Alternative Resources are discussed more below. Note that protective supervision may be prorated depending on your circumstances. Please see the DRC publication # 5612.01, for more information.

(4)  Proration

When IHSS services can be met in common among anyone in the home, the hourly need for that service should be prorated.16 For example, if multiple people benefit from the provision of a related or domestic service, then the time it takes to prepare that service is divided equally among everyone who benefits, including non-IHSS recipients in the household.

Example: if it takes a parent 100 minutes to do weekly laundry for all five members of the family (including the parent and the single IHSS beneficiary), then the amount of time allotted to the IHSS beneficiary is 20 minutes (100 ÷ 5 = 20 minutes).

These service categories are prorated:

  • Domestic Services and Heavy Cleaning;17
  • Related Services,18 and
  • If a service is not provided to more than one person at a time, then it should not be prorated.

Example: if a parent in the above example does her son’s (and he is the IHSS recipient) laundry separately because of bowel and bladder issues, then the laundry does not benefit the other household members. Here, the son’s laundry is not prorated among the other four family members.

(5)  Alternative Resources:

Alternative Resources are IHSS-like services you receive through other programs such as an adult day care program, or school.19 After determining the amount of alternative resources you receive, the Social Worker will deduct this time from your total assessed need.

Example: You live in a household with your IHSS provider. The provider cleans up after breakfast, and dinner for both of you. You go to an adult day care center where you receive assistance cleaning up after your lunch. In the meal clean-up category, there is a column labeled “Services You Refused or You Get From Others.” Here, the County Social Worker would first add up the total amount of time spent cleaning up after breakfast, lunch, and dinner. Then the County Social Worker would make an adjustment, or proration, because the clean-up services your providers provides benefits both you and the provider. This means the Social Worker assigns your prorated time to you in the column “Amount of Service You Need.” Then, the County Social Worker indicates the clean-up assistance you receive from the alternative resource; this information is listed in the “Services you Refused or You Get From Others” column.