California Department of Social Services - State Hearings Division
Notes from the Training Bureau - July 6, 2005

In response to the Fiscal Year 2004-5 state budget crisis, the California Department of Social Services (CDSS) and Department of Health Services (DHS) submitted a waiver application to the federal Center's for Medicaid and Medicare Services (CMS) to provide Medi-Cal covered services to recipient's who received benefits under the IHSS Residual program. The CMS approved the IHSS Plus Waiver effective August 1, 2004. The statutory authority for the IHSS Plus Waiver Program is found at Welfare and Institutions Code (W&IC) §14132.951 (see also paraphrased regulations 567-1 through 567-5)

The IHSS Plus Waiver applies to individuals who apply for or receive in-home care, have been determined eligible for federally funded full-scope Medi-Cal, and are not eligible for PCSP because they have a spouse provider, a parent (for minor child) provider, receive advance pay or a restaurant meal allowance (RMA).

There are now three in-home care programs:
" IHSS Residual for applicants or recipients who are not eligible for full-scope Medi-Cal but meet eligibility criteria under MPP §30-755.1;
" IHSS Plus Waiver for full-scope Medi-Cal applicants or recipients who have a spouse or parent provider, or receive advance pay or an RMA;
" PCSP that now includes protective supervision and domestic/related services only, as long as there is no spouse or parent provider, no advance pay and no RMA.

Protective Supervision

If the applicant/recipient receives in-home care under PCSP, and the recipient requires protective supervision but is not severely impaired under the IHSS definition found at 30-701(s)(1), the recipient is entitled to 195 hours of protective supervision plus hours for other assessed needs up to a total of 283 hours.

If the applicant/recipient receives in-home care under the IHSS Plus Waiver program, and the recipient requires protective supervision but does not meet the IHSS definition of severely impaired found at 30-701(s)(1), the recipient is entitled to a total of 195 hours of services, just as in the IHSS Residual program.

Share of Cost Under PCSP or the IHSS Plus Waiver

For hearing purposes, when there is an issue concerning PCSP/IHSS Plus Waiver share of cost, counties are required to compute the share of cost based on the lower share of cost based on Medi-Cal rules and IHSS Residual rules (see paraphrased regulation 564-5, also ACL 05-05 pages 2 and 3)

What Rules Apply?

If the applicant/recipient is receiving services under either PCSP or the IHSS Plus Waiver, Medi-Cal eligibility rules apply. This includes, among other rules:

" Resources - Title 22, CCR §§50401-50489.5 and related All-County Welfare Directors Letters
" Transfer of property-CCR §§50408-50411 (no transfer of property rule for someone living at home)
" Minor child (CCR §§50014, 50030 defining adult and child)
" Retroactive benefits-CCR §50197
" Application process-CCR §§50141 et. seq.
" Overpayments-CCR §§50781 et. seq.

Once Medi-Cal eligibility is established, IHSS Plus Waiver follows IHSS Residual rules regarding needs assessments.

Decisions

" If the issue at hearing is an eligibility issue, judges should write the decision for DHS.
" If the issue is a needs assessment, judges should write the decision for both CDSS and DHS.
" If the issue is involves the share of cost, judges should write the decision for both CDSS and DHS.

On occasion, a hearing may involve an applicant or recipient who is not eligible for full-scope federally funded Medi-Cal. The applicant or recipient, if eligible, would receive in-home services under the IHSS Residual program. For those applicants or recipients, IHSS residual rules apply to eligibility issues, share of cost issues as well as to needs assessments. Any hearing involving the IHSS Residual program should be written only for the CDSS.