Report 2020-109 Recommendation 6 Responses

Report 2020-109: In-Home Supportive Services Program; It Is Not Providing Needed Services to All Californians Approved for the Program, Is Unprepared for Future Challenges, and Offers Low Pay to Caregivers (Release Date: February 2021)

Recommendation #6 To: Social Services, Department of

To help ensure that recipients receive timely care, Social Services should, by August 2021, begin monitoring counties' compliance with the following: Approval of IHSS applications within 30 days, unless an extension for obtaining a medical certification applies. Prompt approval of IHSS applications for which the 45-day extension for a medical certification applies. Provision of services within 15 days of application approval.

Annual Follow-Up Agency Response From March 2025

No change to previous response; CDSS will not implement recommendation.

CDSS plans to repeal the regulation that requires counties to submit annual county plans. The requirement for county plans is an outdated regulation from when services were primarily provided by county homemakers that are employed and directed by the county. As the program evolved to a self-directed model, and recipients became responsible for the hiring and directing of the care provider, county plans were no longer meaningful.

CDSS is in the process of repealing the regulation regarding 15 days from application to provision of services. As a self-directed program, IHSS recipients are responsible for managing their own care. Recipients sign an SOC 332(IHSS Recipient/Employer Responsibility Checklist)at their assessment that states it is the recipient's responsibility to hire and manage their own provider and direct how and when they receive their services. Counties have no authority to hire a provider for a recipient. The county ensures recipients are assessed and authorized for services; it then becomes the recipient's responsibility to hire a provider.

Regarding the requirement to approve IHSS applications in 30 days, CDSS revised regulations to include the new statutory requirements for an IHSS applicant to complete a Medi-Cal eligibility determination and health care certification prior to authorization of IHSS. Both requirements allow 45 days for the applicant to complete and run concurrently. CDSS is now in the process of updating the Social Services Standards Manual of Policies & Procedures (MPP) Section 30-759.2 to bring the regulation into line with the updates made to the Welfare and Institutions Code.

Lastly, the CDSS has established Quality Assurance and Monitoring Units and a Program Integrity Unit which is responsible for monitoring counties in the areas which they are responsible for.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

The Department of Social Services has indicated it will not implement this recommendation.

Annual Follow-Up Agency Response From December 2022

Social Services did not report a change to this recommendation's status in 2022.

California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement

1-Year Agency Response

CDSS revised the regulations to include the new statutory requirements for an IHSS applicant to complete a Medi-Cal eligibility determination and health care certification prior to authorization of IHSS. Both requirements allow 45 days for the applicant to complete and run concurrently. Refer to Welfare and Institutions Code Section 12309.1.

California State Auditor's Assessment of 1-Year Status: Will Not Implement

In its initial response CDSS indicated that it planned to repeal certain regulations, including one that required counties to approve IHSS applications within 30 days unless an extension related to a medical certification applies. In its one year response CDSS indicated that it has revised its regulations to reflect amendments to Welfare and Institutions code 12309.1. The agency's decision to not implement our recommendation remains unchanged.

6-Month Agency Response

No change to previous response.

California State Auditor's Assessment of 6-Month Status: Will Not Implement

The Department of Social Services has indicated that it will not implement this recommendation.

60-Day Agency Response

The CDSS plans to repeal the regulation that requires counties to submit annual county plans. The requirement for county plans is an outdated regulation from when services were primarily provided by county homemakers that are employed and directed by the county. As the program evolved to a self-directed model, and recipients became responsible for the hiring and directing of the care provider, county plans were no longer meaningful as the county does not control the service provision of the program.

The CDSS plans to also repeal the regulation regarding 15 days from application to provision of services. As a self-directed program, IHSS recipients are responsible for managing their own care. Recipients sign an SOC 332 (IHSS Recipient/Employer Responsibility Checklist) at their assessment that states it is the recipient's responsibility to hire and manage their own provider and direct how and when they receive their services. Counties have no authority to hire a provider for a recipient. The county ensures recipients are assessed and authorized for services; it then becomes the recipient's responsibility to hire a provider.

Regarding the requirement to approve IHSS applications in 30 days, the CDSS is in the process of revising regulations to include the new statutory requirements for an IHSS applicant to complete a Medi-Cal eligibility determination and health care certification prior to authorization of IHSS. Both requirements allow 45 days for the applicant to complete and run concurrently.

Lastly, the CDSS has established Quality Assurance and Monitoring Units and a Program Integrity Unit which is responsible for monitoring counties in the areas which they are responsible for (application processing, assessing recipients and authorizing hours correctly, conducting reassessments timely, etc.) and will continue to do so.

California State Auditor's Assessment of 60-Day Status: Will Not Implement

We are disappointed that the Department of Social Services has indicated that it will not require counties to comply with state law which obligates each county to ensure that services are provided to all eligible recipients during each month of the year in accordance with the county plan.

All Recommendations in 2020-109

Agency responses received are posted verbatim.