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In-Home Supportive Services (IHSS) Budget Cuts Training

In-Home Supportive Services (IHSS) Budget Cuts Training Presented by: Crystal Padilla Disability Rights California IHSS Cut #1 Effective September 1, 2009, Eliminate domestic and related services for individuals with functional index (FI) rankings below 4.

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In-Home Supportive Services (IHSS) Budget Cuts Training

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  1. In-Home Supportive Services(IHSS)Budget Cuts Training Presented by: Crystal Padilla Disability Rights California

  2. IHSS Cut #1 Effective September 1, 2009, Eliminate domestic and related services for individuals with functional index (FI) rankings below 4. • Eliminates those domestic and related services for recipients with functional index (FI) rankings below level 4 in the activity of daily living relating to the particular service (i.e., domestic/housework, laundry, shopping and errands, meal preparation and meal cleanup). • This eliminates those domestic or related services for individuals who cannot provide the service for themselves without human assistance (FI 3) or who cannot provide the service for themselves without verbal assistance such as reminding, guidance or encouragement (FI 2).

  3. IHSS Cut #2 Eliminates IHSS services entirely for individuals with functional index (FI) scores below level 2. • Eliminates IHSS services entirely for individuals with functional index scores below level 2 (i.e., the individual may have difficulty performing the function, but completion of the function by the individual poses no substantial risk to his or her safety). ***The reduction may not apply to individuals who receive protective supervision, paramedical services, or more than 120 hours of IHSS services per month. The legislation is not clear.

  4. IHSS Cut #3 Elimination of the state share of cost (SOC) buy out program effective October 1, 2009 for all Medi-Cal recipients with a share of cost. • Individuals will be required to spend down any income in excess of the Medi-Cal maintenance need level of $600 per month. • Individuals with a SOC should try to qualify for a Medi-Cal program with no SOC or a program with a higher income cap such as the Aged and Disabled Federal Poverty Level Program or Medi-Cal’s Pickle Disabled Adult Child Program or the 250% Working Disabled Medi-Cal Program.

  5. Functional Index (FI) Ranking A functional index ranking is a number between one (1) and five (5). A ranking is a measurement of an IHSS recipients level of functional ability and dependence on verbal and physical assistance by another for each of the IHSS "task or service" which must be ranked/measured. These numbers between 1 & 5 are based on a hierarchical scare measuring recipients level of functioning as follows: • Rank 1 - Independent: Able to perform function without human assistance although the recipient may have difficulty in performing the function, but the completion of the function, with or without a device or mobility aid, poses no substantial risk to his/her safety. A recipient who ranks a “1” in any function shall not be authorized the correlated service activity. • Rank 2 - Able to perform a function but needs verbal assistance such as reminding, guidance, or encouragement. • Rank 3 - Can perform the function with some human assistance, including but not limited to, direct physical assistance from a provider. • Rank 4 - Can perform a function but only with substantial human assistance. • Rank 5 - Cannot perform the function with or without human assistance. • Rank 6 - Paramedical Services needed.

  6. Functions That Require Ranking County IHSS workers are required to rank a recipient’s functioning in each of the following IHSS service or task areas: • Housework (can be ranked 1-5) • Laundry (can be ranked 1, 4 or 5) • Shopping and Errands (can be ranked 1, 3 or 5) • Meal Preparation and Clean Up (can be ranked 1-5 or, 6 if recipient receives tube feeding) • Mobility Inside/Ambulation (can be ranked 1-5) • Bathing and Grooming (can be ranked 1-5) • Dressing (can be ranked 1-5) • Bowel, Bladder and Menstrual (can be ranked 1-5) • Repositioning (can be ranked 1-5) • Eating (can be ranked 1-5 or, 6 if recipient receives tube feeding) • Respiration (can be ranked 1, 5 or 6 if recipient receives paramedical suctioning)

  7. Functional Index (FI) Score • A functional index score is a measurement of relative dependence on human assistance, for those functional limitations that must be ranked under the IHSS program. • The theory behind this is that the higher the FI score the more the client needs IHSS services.

  8. How the FI Score is calculated? Department of Social Services (DSS) created a weighted average formula to calculate a recipient’s FI score. The weights created by DSS are the numbers used to calculate a recipient’s FI score. The FI score is calculated by Case Management Information and Payrolling System (CMIPS) based on a recipient's FI rankings (information) entered into the system by an IHSS social worker. Here is what the process looks like: the IHSS social worker meets with a client and gathers information about the client’s functional limitations. The FI rankings determined by the social worker are entered into CMIPS and the computer calculates the FI score.

  9. Weights used in FI Score Calculation The weights are: • housework = .038 • laundry = .037 • shopping and errands = .040 • meal preparation and clean up = .222 • mobility inside (ambulation) = .079 • bathing and grooming = .095 • dressing = .057 • bowel, bladder and menstrual = .129 • transfer = .094 • eating = .127 • respiration = .082

  10. FI Score Calculation Steps • FI Score Step 1 - Every score of 6 is converted to 1. • FI Score Step 2 - 1 is subtracted from the rankings for each function. • FI Score Step 3 - Each resulting ranking is multiplied by the appropriate weight for each function. • FI Score Step 4 - All sums are added together and 1 is added to total. (The ratios are calculated to 3 decimal points.) • FI Score Step 5 - The FI score is rounded off to two decimal points.

  11. Example #1 Calculation of a Functional Index Score IHSS Recipient Rankings: Rankings • Housework 5 • Laundry 5 • Shopping and Errands 5 • Meal Preparation and Clean Up 4 • Mobility Inside/Ambulation 4 • Bathing and Grooming 3 • Dressing 1 • Bowel, Bladder and Menstrual 1 • Repositioning/Transfer 1 • Eating 1 • Respiration 6

  12. FI Score Step 1 IHSS Recipient Rankings: Rankings • Housework 5 • Laundry 5 • Shopping and Errands 5 • Meal Preparation and Clean Up 4 • Mobility Inside/Ambulation 4 • Bathing and Grooming 3 • Dressing 1 • Bowel, Bladder and Menstrual 1 • Repositioning/Transfer 1 • Eating 1 • Respiration 6 = 1 Every score of 6 is converted to one

  13. FI Score Step 2 IHSS Recipient Rankings: Rankings • Housework 5 – 1 = 4 • Laundry 5 – 1 = 4 • Shopping and Errands 5 – 1 = 4 • Meal Preparation and Clean Up 4 – 1 = 3 • Mobility Inside/Ambulation 4 – 1 = 3 • Bathing and Grooming 3 – 1 = 2 • Dressing 1 – 1 = 0 • Bowel, Bladder and Menstrual 1 – 1 = 0 • Repositioning/Transfer 1 – 1 = 0 • Eating 1 – 1 = 0 • Respiration (6) = 1 – 1 = 0 1 is subtracted from the rankings for each function

  14. FI Score Step 3 IHSS Recipient Rankings: Rankings • Housework 5 – 1 = 4 x .038 = .152 • Laundry 5 – 1 = 4 x .037 = .148 • Shopping and Errands 5 – 1 = 4 x .040 = .160 • Meal Preparation and Clean Up 4 – 1 = 3 x .222 = .666 • Mobility Inside/Ambulation 4 – 1 = 3 x .079 = .237 • Bathing and Grooming 3 – 1 = 2 x .095 = .190 • Dressing 1 – 1 = 0 x .057 = .000 • Bowel, Bladder and Menstrual 1 – 1 = 0 x .129 = .000 • Repositioning/Transfer 1 – 1 = 0 x .094 = .000 • Eating 1 – 1 = 0 x .127 = .000 • Respiration (6) = 1 – 1 = 0 x .082 = .000 Each resulting ranking is multiplied by the appropriate weight for each function.

  15. FI Score Step 4 & 5 IHSS Recipient Rankings: Rankings • Housework 5 – 1 = 4 x .038 = .152 • Laundry 5 – 1 = 4 x .037 = .148 • Shopping and Errands 5 – 1 = 4 x .040 = .160 • Meal Preparation and Clean Up 4 – 1 = 3 x .222 = .666 • Mobility Inside/Ambulation 4 – 1 = 3 x .079 = .237 • Bathing and Grooming 3 – 1 = 2 x .095 = .190 • Dressing 1 – 1 = 0 x .057 = .000 • Bowel, Bladder and Menstrual 1 – 1 = 0 x .129 = .000 • Repositioning/Transfer 1 – 1 = 0 x .094 = .000 • Eating 1 – 1 = 0 x .127 = .000 • Respiration (6) = 1 – 1 = 0 x .082 = .000 Sum of Above = 1.553 +1 = 2.55 (rounded off) All sums are added together and 1 is added to total. The FI score is rounded off to two decimal points.

  16. Outcome for client in example #1 This individual has a functional index score of 2.55 and will not be affected by the budget cuts.

  17. Example #2 Rankings & Calculation of a Functional Index Score IHSS recipient rankings and score calculation: • Housework 5-1=4x.038= .152 (domestic) • Laundry 5-1=4x.037= .148 (related) • Shopping and Errands 5-1=4x.040= .160 (related) • Meal Preparation and Clean Up 4-1=3x.222= .666 (related) • Mobility Inside/Ambulation 4-1=3x.079= .237 • Bathing and Grooming 2-1=1x.095= .095 • Dressing 2-1=1x.057= .057 • Bowel, Bladder and Menstrual 2-1=1x.129= .129 • Repositioning/Transfer 1-1=0x.094= .000 • Eating 2-1=1x.127= .127 • Respiration 1-1=0x.082= .000 Total = 1.771 + 1 = 2.77 (FI Score)

  18. Outcome for client in example #2 This individual has FI rankings of 4 and above and will not lose domestic and related services. Services FI Rankings • Housework (domestic) 5 • Laundry (related) 5 • Shopping and Errands (related) 5 • Meal Preparation and Clean Up (related) 4 This client has a FI score of 2.77 (i.e., above 2) and will not lose IHSS services as a result of budget cuts.

  19. Example #3 Rankings and calculation of Functional Index Score IHSS recipient rankings and score calculation: • Housework 4-1=3x.038= .114 (domestic) • Laundry 4-1=3x.037= .111 (related) • Shopping and Errands 4-1=3x.040= .120 (related) • Meal Preparation and Clean Up 3-1=2x.222= .444 (related) • Mobility Inside/Ambulation 4-1=3x.079= .237 • Bathing and Grooming 2-1=1x.095= .095 • Dressing 2-1=1x.057= .057 • Bowel, Bladder and Menstrual 2-1=1x.129= .129 • Repositioning/Transfer 1-1=0x.094= .000 • Eating 2-1=1x.127= .127 • Respiration 1-1=0x.082= .000 Total = 1.434 + 1 = 2.43 (FI Score)

  20. Outcome for client in example #3 This individual has a FI ranking of 3 in Meal Preparation and Clean Up (related service) and will lose that service. Services FI Rankings • Housework (domestic) 4 • Laundry (related) 4 • Shopping and Errands (related) 4 • Meal Preparation and Clean Up (related) 3 This client has a FI score of 2.43 (i.e., above 2) and will not lose IHSS services as a result of budget cuts.

  21. Example #4 Rankings and Calculation of a Functional Index Score IHSS recipient rankings and score calculation: • Housework 2-1=1x.038= .038 (domestic) • Laundry 2-1=1x.037= .037 (related) • Shopping and Errands 2-1=1x.040= .040 (related) • Meal Preparation and Clean Up 2-1=1x.222= .222 (related) • Mobility Inside/Ambulation 1-1=0x.079= .000 • Bathing and Grooming 2-1=1x.095= .095 • Dressing 2-1=1x.057= .057 • Bowel, Bladder and Menstrual 1-1=0x.129= .000 • Repositioning/Transfer 1-1=0x.094= .000 • Eating 2-1=1x.127= .127 • Respiration 1-1=0x.082= .000 Total = .62 + 1 = 1.62 (FI Score)

  22. Outcome for client in example #4 This individual has FI rankings of 2 or lower. This individual will lose domestic and related services in service categories with FI rankings under 4. Services FI Rankings • Housework (domestic) 2 • Laundry (related) 2 • Shopping and Errands (related) 2 • Meal Preparation and Clean Up (related) 2 This client has a FI score of 1.62 (below 2) and as a result of budget cuts will lose IHSS services.

  23. Appeal Rights • Notice of Action (NOA) with 10 days advance notice of the change is required. • Recipient may appeal because they disagree with a change or decision even if no NOA has been received. • Aid paid pending the hearing must be requested anytime before the change takes effect. • If denied aid paid pending by the county, or the recipient forgets to ask for aid paid pending, the recipient should ask for it at the hearing. • Timeline / Deadline to Appeal • You must request a hearing before the date of the intended action to get aid paid pending the hearing. • Otherwise, you have 90 days to request a hearing by calling 1-800-743-8525. Push 1, 1, 1 and, 3 to get through telephone tree.

  24. Preparing for a hearing • Challenge the FI rankings and FI Score by obtaining information (evidence) from doctor about individual’s functional limitations. • FI scores and FI rankings are contained in county IHSS case file. See SOC 293 form which is 2 pages long. • Information about how FI ranking and FI score was determined can be found in county IHSS case file (e.g. forms completed by a doctor about functional limitations and case worker notes about home visit observations/interviews, notes about errors, etc.). Counties are encouraged to use HTG Documentation Worksheets when conducting assessment but use of the form is not required. • The doctor should review any information provided to the county and check for accuracy and correct mistakes by submitting new information about functional limitations and explain any changes. • Sometime after the client receives confirmation of receipt of a request for hearing from the DSS State Hearings Division the case will be assigned a county appeals representative. The appeals representative represents the county at the hearing. You can call the county for the name and phone number of appeals worker assigned to the case. • The recipient has the right to review any information in IHSS case file related to a request for hearing. Contact the county appeals worker prior to hearing date to schedule an appointment to review the file. • Recipient has right to county position statement 2 days prior to hearing.

  25. At the Hearing • Appeals Representative represents the county at the hearing. • County has burden of proof. • The county must prove to the administrative law judge that your situation has changed (for example your medical condition has improved) and that your hours should be reduced. • To do this the county must explain the process it followed for making a decision, what information was relied upon (e.g. observations, interviews and notes, information provided by a doctor (such as reports and or completed forms) and provide copies of the documentation and information which was relied upon to make the decision about the change in circumstances. • If an individual’s hours have been reduced as a result of budget cuts, the individual should ask that the reduction not be applied if the individual also receives protective supervision, paramedical services, or more than 120 hours of IHSS services per month.

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