County of San Diego Health and Human Services Agency HHSA MediCal Program Guide InHome Supportive Services IHSS Number Page 052101 1 of 3 Revision Date 06012021 BackgroundInHome Supportive Services IHSS provides homemaker and personal care assistance to lowincome customers who need assistance in their home so they can remain independent These inhome services are provided by independent providersIHSS providershomemakers Customers applying for or receiving IHSS must have a MediCal eligibility determination completed before inhome services are authorized IHSS Programs The following programs provide inhome services IHSS Plus Option IPO Aid Code 2L Personal Care Services Program PCSP Aid Code 2M IHSS Residual Aid Code 2N Community First Choice CFCO Aid Code 2K IHSS aid codes are reported to the MediCal Eligibility Data System MEDS via the Case Management Information and Payrolling System CMIPS and NOT entered by the MediCal Human Services Specialist HSS into CalWIN PurposeThis section is updated to add the IHSSCFCO program and clarifications from All County Welfare Directors Letter ACWDL 2015 regarding the Beneficiary Reimbursement Process also known as the Conlan process PolicyIHSS Programs IHSS Plus Option IPO Aid Code 2L To qualify for IPO MediCal eligibility is required Customers not receiving Supplemental Security IncomeState Supplemental Program SSISSP or another MediCal linked cashbased program for example Foster Care CalWORKs Refugee Cash Assistance RCA Adoptions Assistance Program AAP must be determined eligible for federally funded fullscope MediCal and qualify for inhome services through a Needs Assessment completed by an IHSS Social Worker Personal Care Services Program PCSP Aid Code 2M To qualify for PCSP customers not receiving SSISSP or MediCal linked to a cashbased program must be determined eligible for federally funded fullscope MediCal and be found in need of personal care services through a Needs Assessment completed by an IHSS Social Worker IHSS Residual Aid Code 2N IHSS Residual Program services will be available to customers who are eligible under current IHSS regulations but are not eligible for federally funded fullscope MediCal Community First Choice CFCO Aid Code 2K The CFCO program is an alternative for PCSP and IPO customers CFCO provides home and communitybased attendant services and supports for customers who are eligible for MediCal meet County of San Diego Health and Human Services Agency HHSA MediCal Program Guide InHome Supportive Services IHSS Number Page 052101 2 of 3 specific income criteria and the Nursing Facility Level of Care NFLOC CFCO customers are eligible to be evaluated under MediCal Spousal Impoverishment SI Provisions if applicable See MPG 051801 for the SI Provisions eligibility and Doctors Verification process Case Processing Application The Single Streamlined Application and related forms are used to complete the MediCal determination The MediCal application packet must contain Disability Determination Services Division DDSD forms for cases in which the applicants disability has not already been determined Redetermination The MC 210RV and related forms are used to complete the annual redetermination ShareofCost SOC Customers with a SOC are treated as Medically Needy customers with a SOC The SOC may be met with any medical service including payments to the IHSS provider and outofpocket expenses for personal services IHSS Plus Option Income Payments made under the IHSS Plus Option are exempt as income and property These exempt payments include Caregiver wages that are paid to a parent of an IHSS Plus Option minor child recipient for services provided to that child Caregiver wages that are paid to a spouse of an IHSS Plus Option recipient for services provided to that recipient Restaurant meal allowances from IHSS for the IHSS Plus Option recipient The advance payments made to IHSS Plus Option recipients to pay their caregivers directly for services provided under the IHSS Plus Option InHome Caregiver Wages Inhome caregiver wages received by a spouseparent for the care of their spouse or minor child in receipt of federal state or local government inhome services program are exempt as income and property for MediCal purposes This exemption includes payments received by a parent or spouse of an IHSS Residual recipient InHome Care Services Payments Payments made by the Department of Health Care Services DHCS to an inhome care recipient for the purpose of purchasing inhome care services including restaurant meals are exempt as income and property for MediCal purposes Procedure Application Complete a MediCal eligibility determination using MediCal rules forms and Notices of Actions NOAs for all applicants or recipients of IHSS The IHSS Needs Assessment can be completed by the IHSS Social Worker at any time during this process County of San Diego Health and Human Services Agency HHSA MediCal Program Guide InHome Supportive Services IHSS Number Page 052101 3 of 3 Hospital Community Support Services HSSs Process IHSS related MediCal referrals according to the procedures outlined in MPG 42 MPG 43 and MediCal Processing Guide 02 CMIPS II Interface Activities Aged Disabled Federal Poverty Level AD FPL Program The MediCal determination is separate from the IHSS determination Determine potential eligibility to the AD FPL according to the policies outlined in MPG 519 Disability Determination Services Division DDSD For cases that require a disability determination follow the DDSD requirements outlined in MPG 54 CalWORKs Discontinuance When a CalWORKs recipient who is also receiving IHSS is discontinued and has no other MediCal eligibility contact the IHSS Social Worker to request a copy of the DDSD determination If the DDSD determination shows that the recipient is disabled and the reexamination date has not passed use that determination for MediCal eligibility Redetermination Each Family Resource Center FRC is responsible for completing the annual redetermination of these cases according to the procedures outlined in MPG 415 and MediCal Processing Guide 02 CMIPS II Interface Activities Beneficiary Reimbursement Process BRP IHSS beneficiaries who are MediCal eligible and paid an outofpocket expense for the excess SOC can file a claim to request reimbursement See MPG 040210J for the BRP also known as the Conlan process For scenarios where Spousal Impoverishment SI provisions are involved see Processing Guide 25 Program ImpactsNone References ACLs 0505 0505E 0711 ACWDLs 0521 0529 0702 0705 1502 1725 1819 2015 County Policy Sunset Date This policy will be reviewed for continuance by 06302024 Approval for Release Rick Wanne Director SelfSufficiency Services