Transcript IHSS Overview

CCWRO.ORG
1901 Alhambra Blvd., Sacramento, CA 958167012
• Tel: 916-736-0616 • Cell: 916-712-0071
• Email: [email protected]
ATTENTION : This “powerpoint” presentation is
intended to be presented with an oral presentation to fill
in the blanks left vacant.
If you want a presentation, please contact CCWRO at
916-736-0616 or complete our “training request form”
at:
http://www.ccwro.org/index.php?option=com_content&
view=article&id=47&Itemid=55
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State Department of Social Services
John Wagner, Director.
Telephone: 916-657-2598
Eva Lopez, Deputy Director, Adult
Services.
Telephone: 916-653-5403
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Welfare & Institutions Code §
12300-12317.2
14132.951 – IHSS Plus Waiver
14132.95 – IHSS Personal Care Services
Program (PCSP)
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MPP § 31-700 et.seq.- IHSS State
Regulations
MPP §30-009.22 – Application for IHSS
MPP §30-009.23 – Eligibility Determination
How to access state regulations?
http://www.dss.cahwnet.gov/ord/PG310.htm
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All County Letter –
http://www.dss.cahwnet.gov/lettersnotic
es/PG931.htm
All County Information Noticeshttp://www.dss.cahwnet.gov/lettersnotic
es/PG1011.htm
Policy Interpretation – California Public
Records Act
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County Welfare Director
Deputy Director for IHSS
Program Specialist
State Hearings Representative
Social Worker Supervisor
Social Worker
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Counties are given a certain amount to spend
every year.
This drives the mentality of cutting benefits
to the poor by SW who were trained to help
people, but are now the slashers of benefits.
IHSS
Residual
PSPC – Medi-Cal
IHSS-Plus – MediCal
 Domestic
Services
 Related Services
 Non-Medical Personal
Services
 Protective Supervision
 Paramedical Services
Domestic Services in house cleaning.
Related Services are:
1. Meal Preparation – 3.02 to 7.00, MPP
30-757.131.
2. 1.17 to 3.50, MPP 30-757.132. Meal
cleanup does not include general
cleaning of the refrigerator, stove, oven,
counters, or sink which is covered under
“domestic services.
3. Laundry.
4. Other Shopping Errands.
5. Medical Appointment.
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Bowel, Bladder Care -.58 to 8.00, MPP 30757.14(a)
Feeding - .70 to 9.33, MPP 30-757.14(c)
Routine Bed Baths-.50 to 3.50, MPP 30757.14(d)
Dressing - .56 to 3.50, MPP 30-757.14(f)
Menstrual Care-.28 to .80, MPP 30-757.14(j)
Ambulation-.58 to 3.50, MPP.30-757.14(k)
Bathe, Oral Hygiene, Grooming-.50 to 5.10,
MPP 30-757.14(e)
Rub Skin, Massage, Assistance with
Prosthesis-.75 to 2.80, MPP 30-757.14(g)
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Protective Supervision.
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Gets up to 283 hours a month.
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Or 195 hours a month if the nonmedical
personal services is less than 20 hours a
week.
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MPP 30-009.22 governs IHSS applications.
Application can be made by the applicant or
any person on his or her behalf by phone,
letter referral.
The application form CA 295 is only signed
by the applicant during the face-to-face
assessment for services.
MPP 30-759.11 provides for 30 days to
determine IHSS hours from the date that the
CA 295 is signed.
PRACTICE POINTERS: Widespread county
violation of due process of law.
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County does a home visit.
Don’t allow a in the house without an
appointment.
Watch out for:
◦ Counties asking applicants to sign blank releases
of information;
◦ HIPPA releases.
◦ Clients should provide the information, especially
medical information.
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Rank 1- Does not need help. Can do the task
without any assistance.
Rank 2. – Able to do the task, but needs
verbal assistance.
Rank 3. - Able to do task with human
assistance.
Rank 4. – Able to do task with substantial
human assistance.
Rank 5. Can’t perform task without human
assistance.
PRACTICE POINTER: Get a copy of the county
rankings.
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Counties reassess every 12 months.
IHSS clients have a right to ask for
reassessment anytime.
Hours cannot be reduced at assessment
unless there is a change. MPP 30-761.28
Hours cannot be changed without an
assessment.
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If the IHSS applicant has a spouse, IHSS will
be denied for those services that the spouse
is able to provide.
PRACTICE POINTER – Get a statement from
the doctor that the spouse cannot do x y and
z tasks. Counties have forms for these.
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Counties often prorate services solely based
on the number of people living in the house
for related services.
Counties can only prorate Domestic Services
and cannot prorate “related services.
Always challenge the proration - an element
of widespread county abuse in California.
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Persons who need PS can get 195 hours a
month or 283 hours a month.
A person is eligible for PS is he or she
wanders and gets lost, turns on the water and
forgets, turns on the stove and forgets, etc.
Needs a completed SOC 821 by the doctor.
Make sure the doctor says the person needs
24 hours a day PS.
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Children can get protection supervision services.
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Children are often denied unlawfully by counties.
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Get a doctor’s statement and do not allow the
county to go fishing for information to make the
child ineligible.
Counties can prorate protective supervision if two
clients are living in the same house and receiving
services from the same provider.
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Not allowing persons to sign the CA 295 until
the social worker (SW) comes to the house.
Not allowing children to apply. Denying
applications with a NOA.
Prorating based on assumption not verified.
Reducing hours without appropriate cause to
save money.
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CWDs can use alternative resources to reduce
hours.
Defense – The alternative hours have to be
voluntary.
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Judicial Relief.
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Legislative Advocacy.
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Administrative Advocacy.
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Sue.
Current litigation efforts.
IHSS NOA potential lawsuit.
Types of litigation:
◦ 1094.5.
◦ 1085.
◦ Class Action.
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LSC programs can performs legislative
advocacy if invited by a legislator to do so.
There are many IHSS bills.
SEIU is a big supporter of IHSS.
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Meetings with DSS
◦ Every three months
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Meetings with the CWD
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State Hearings – Every two (2) months
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For more information visit ccwro.org and look
at the calendar.
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Goldberg v. Kelly, 397 U.S., 254
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Calderon v. Anderson, l996) 45 Cal. App. 4th 1841
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Yee-Litt v. Richardson, 353 F. Supp. 996
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Dowling v. David, (1994) 19 F 3d 445
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Madrid v. McMahon, 183 Cal. App. 3d, 151
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Marshall v McMahon, (1993) 17 Cal. App. 4th, ,1841
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Morales v. McMahon, 223 Cal. App. 3d, 184
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Miller v Woods, (1983) 148 Cal. App. 3d 862
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Bonnette v California Health and Welfare Agency, (1976) 414 F Supp 212
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Federal
CFR Title 45, Section 210 -Governing all hearing except
for CalWORKs.
State
Welfare and Institutions Code § 10950 et.seq.
State regulations.
Division 22.
http://www.dss.cahwnet.gov/ord/CDSSManual_240.htm
All County Letter and All County Information Notices
http://www.dss.cahwnet.gov/lettersnotices/default.htm
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Training Notes and Paraphrased Regulations.
http://www.dss.cahwnet.gov/shd/default.htm
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Any NOA is a Request for a FH.
Anytime an application is not taken.
Anytime an assessment is not done.
Anytime the application is not processed
within 30 days.
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Authorized Representative (5 days to get
an A.R. form)
22-001.(5) Authorized Representative An individual or organization that has
been authorized by the claimant or
designated by the Administrative Law
Judge or Department pursuant to
Sections 22-085 and 22-101 to act for
the claimant in any and all aspects of the
state hearing or in an administrative
disqualification hearing.
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90 days from the date of the NOA.
Before the effective date of the action or ten
(10) days for Aid Paid Pending.
22-001.d. (1) Days - Days shall refer to calendar
days unless otherwise specified.
22-001 h. (1) Holiday - A Saturday, Sunday, and
the holidays as specified in Government Code
Sections 6700 et seq. which result in a postal
holiday or the closing of Department or county
offices.
FAX TO
916-229-4110 or
916-229-4131
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A general statement to keep your options
open. For example: “The county is wrong”.
Also specificity, like where you think there
should be additional hours, if you want to to
resolve hearings.
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Background – Yee-Litt v. Richardson
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5 working days to restore- §22-073 .1
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APP does not have to be paid back unlike
Food Stamps and CalWORKs
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County has to do a position statement.
The position statement shall be available 2
working days before the hearing - §22073.252,
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22-049.75 Examine all documents
prior to and during the hearing.
22-051.1 Upon request, the CWD shall allow the claimant to examine
the case record during regular working hours (see Section 19-005).
.11 If portions of the case record are privileged under the
provisions of Section 19-006, the claimant shall be entitled to inspect
such material only if the claimant is the holder of the privilege.
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.2 The claimant shall have the right prior to and during the
hearing, to examine nonprivileged information which the county has
used in making its decision to take the action which is being appealed.
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Know your case.
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Talk to the CWD before the hearing.
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Remember, the County Appeals Worker can
tell the District what to do in many cases.
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You can always lose the “slam dunk” case
depending on which Judge you get.
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There are always “Stipulated Decisions” in lieu
of CWs.
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Get maximum information from the
claimant.
Ask about past hearings.
How long have they been on aid?
Explore for underpayments.
Underpayments can be used to off set
overpayments.
Have they talked to the CWD about these
issues?
DV Waivers?
Review the case file if necessary.
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MPP 22-001.a(1) – Adequate NOA.
ACIN 81-151- Great ACIN.
22-049.52 - Attack the NOA to get
jurisdiction or a better Judge.
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22-073.3 At the hearing, the county
representative shall assume full responsibility
for presentation of the county's case.
22-073.36 Having the burden of going
forward in the hearing to support its
determination.
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Hearsay by itself is not enough.
Always make an objection on the record to
preserve the hearsay objection on a 1094.5
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22-049.5 The issues at the hearing shall be
limited to those issues which are reasonably
related to the request for hearing or other
issues identified by either the county or
claimant which they have jointly agreed, prior
to or at the state hearing, to discuss.
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Adequacy of the NOA.
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Standards for Postponements.
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No Position Statement.
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King and Ball penalties
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Never “withdraw” a hearing request. Always do a CW if you want to
withdraw.
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If the withdrawal is conditional:
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(A) The withdrawal shall be accompanied by an agreement signed by
the claimant and by the county.
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(B) Any agreement under this provision shall provide that the actions
of both parties will be completed within 30 days from the date the
conditional withdrawal form is signed by both parties and received
by the county. See Section 22-071.14 regarding adequate notice
with conditional withdrawal.
(C) After the county issues notice of its redetermination, if the
claimant does not reinstate the hearing request within the time
limits set forth in Section 22-009, the request shall be dismissed.
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Use this option when the county does not
have the proof, rather than giving the CWD
time to gather evidence.
Benefits of the Stipulated Decision.
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Reopen within 15 days – APP is back on.
Second time has to show good cause.
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22-062.3 The decision of the Director shall be in
writing.
.31 The decision shall include:
.311 A statement of the facts;
.312 The statutes and regulations involved
.4 The decision shall determine only those
circumstances and issues existing at the time of
the county action in dispute or otherwise agreed to
by the parties.
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30 days to ask for a rehearing
AB 921- Chapter 502 statutes of 2007
http://www.leginfo.ca.gov/cgibin/postquery?bill_number=ab_921&sess=C
UR&house=B&author=krekorian
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CCP § 1094.5
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W&IC § 10962
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One Year from the date of hearing decision
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No filing fee required
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Prevailing party is entitled to attorney fees
Questions
Answers
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