In-Home Supportive Services, or IHSS, is a county-administered program that helps elderly, blind or disabled people live safely in their own homes by matching them with a consumer-selected caregiver for a certain number of hours, who then provides help with daily living activities. Services IHSS caregivers provide include cleaning, cooking, dressing, grooming, bathing and shopping. IHSS is considered an alternative to out-of-home care (as opposed to moving into nursing homes or board-and-care facilities).
To qualify, a person must be over 65 years of age (or disabled or blind), be eligible for Medi-Cal and live in his/her own home (long-term care and community care facilities). Once a person has been found eligible, a social worker will assist the person in finding a caregiver.
Under the CCI:
IHSS is still considered a Medi-Cal benefit
All Medi-Cal consumers must now choose a managed Medi-Cal plan to continue receiving those services. Despite the change, IHSS is still counted as a Medi-Cal benefit the way it was before and function in the same way – including assessments conducted by county social workers, who have expertise and training in evaluating people for IHSS needs. (The only difference is that service bills are now sent directly to that managed Medi-Cal plan instead of the state.)
IHSS consumers still decide who gives them care
Just like before, consumers can still hire, fire, and supervise their caregivers, along with scheduling their working hours.
IHSS services continue regardless of participation in Cal MediConnect
Consumers who receive both Medicare and Medi-Cal benefits – Medi-Medis – are eligible to participate in Cal MediConnect and have both of those health plan benefits managed by one coordinated plan. This means that if consumers choose to involve their IHSS workers, their IHSS services can be coordinated more closely with other services, like doctors and medical care.
However, if consumers choose to opt out of Cal MediConnect by selecting a Medi-Cal plan only, their IHSS benefits will continue uninterrupted – but managed by a Medi-Cal plan instead.
A Cal MediConnect plan may increase an IHSS provider’s hours
Unlike IHSS under traditional or managed Medi-Cal, a Cal MediConnect plan may independently increase an IHSS provider’s hours if the plan determines more hours may reduce the risk of higher medical costs.
Managed care encourages lower-cost, preventative care when possible
Under the CCI, the health plans will pay for all medical services and long-term services and supports, including doctor’s visits, hospital stays, IHSS, and long-term nursing home care. As a result, the plans will be motivated to authorize the use of lower-cost home- and community-based services, such as IHSS, whenever possible to prevent more expensive care in hospitals or nursing homes.