MEDI-CAL: SUPPORTIVE SERVICES & ASSISTANT WAIVER PROGRAMS
While Medi-Cal provides a comprehensive range of medical care and treatment services, some recipients may require additional services to take care of their daily needs at home, and others may prefer to be cared for in an assisted living home rather than a nursing home.
For these individuals, Medi-Cal offers two programs: In-Home Supportive Services (IHHS) and assisted living waivers. Both programs are available for those who qualify for Medi-Cal by age, disability, blindness, or another factor. To receive IHSS, you do not necessarily have to be on Medi-Cal, but you must qualify for it.
If you’re in Redlands, California, or nearby Riverside, Rancho Cucamonga, or Palm Springs, and you wish to pursue either of these programs, contact The Elder & Disability Law Firm, APC. Our attorneys are dedicated to helping others obtain the benefits they deserve under federal and state programs such as Medi-Cal, IHHS, and the assisted living waiver program.
WHAT IS IHHS?
In-Home Supportive Services, or IHHS, is designed to assist Medi-Cal-eligible individuals who need help in their daily life routines. Services vary according to the individual’s desire to remain safe and independent in their homes based on an assessment of their needs. Services can include:
Homemaker Services: Housecleaning, laundry, shopping, errands, and cooking.
Paramedical Services: Wound care, catheter care, injection assistance, blood sugar checks.
Personal Care Services: Non-medical assistance with daily living activities, such as bathing, dressing, toileting, and eating.
Protective Supervision: Supervision to help prevent accidents and injuries to cognitively or mentally impaired persons.
Teaching / Demonstration Services: Teaching the beneficiary to do housework, prepare meals, bathe, etc.
Transportation Assistance: Traveling to and from medical appointments.
IHHS services can be received in one’s own home or the home of a family member, but not in a community care or long-term care facility.
IHHS PROGRAMS CATEGORIZED BY NEED
IHHS comprises four separate programs, but the first two represent the majority of beneficiaries served:
Community First Choice Option (CFCO): For those eligible for Medi-Cal who require a nursing home level of care.
Personal Care Services Program (PCSP): For the Medi-Cal eligible who do not require nursing home-level care but require personal care assistance.
IHSS Plus Option Program (IPO): For those eligible for Medi-Cal and receiving personal care from spouses or parents.
IHSS Residual Program (IHHS-R): For those who require IHHS care services but are not yet eligible for Medi-Cal.
IHHS imposes an income cap on recipients, which currently stands at $1,481 a month; however, it will adjust in April 2022 to reflect new federal poverty level (FPL) guidelines. If both spouses are applicants, the income limit is currently $2,003 monthly.
The program uses a somewhat complicated formula to determine the recipient’s share of cost (SOC) payment if income exceeds those levels. To determine if you will be required to pay a SOC for receiving IHHS services, and how much, contact our attorneys and let us work the math for you. There are legitimate deductions that can be made to lower your monthly income and thus your SOC if any.
ASSISTED LIVING WAIVER PROGRAM
The federal Medicaid program, of which Medi-Cal is part, allows states to apply for waivers to provide services not generally authorized or covered by Medicaid. Waivers are also known as Home and Community-Based Services (HCBS) or Waiver Funded Services.
California applied for and received a waiver for its assisted living program in 2009, which was renewed for five years in 2019. An HCBS waiver, however, has a limited number of allowed participants. Thus, unless there is a slot open, you may be put on a waiting list if you apply for assisted living.
The Assisted Living Waiver Program (ALWP) allows those who prefer an assisted living environment to a nursing home and wish to reside in an assisted living residence. However, not all California counties have providers. So far, only Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma counties have authorized providers.
The California Department of Health and Human Services requires participants in the ALWP to contribute to their room and board. In 2021, the monthly cost was either $1,079.37 or $1,099.37, depending on one’s income.
CONTACT OUR ATTORNEYS FOR GUIDANCE
If you or a family member requires either IHHS or the ALWP, contact us at The Elder & Disability Law Firm, APC. We can help determine your eligibility and assess your share of the cost, if any, for IHHS. We proudly serve clients in Redlands, Riverside, Palm Springs, Rancho Cucamonga, and neighboring communities. Contact us immediately with all your Medi-Cal needs and questions.