The Process for Re-Evaluating IHSS Eligibility

In-Home Supportive Services (IHSS) is a vital program that helps eligible individuals in California with disabilities or chronic conditions live independently in their homes. Whether you’re already receiving services or are considering applying, understanding the process for re-evaluating your IHSS eligibility and services is crucial.

Over time, your health needs may change, and the amount of assistance required may fluctuate. Re-evaluations ensure that the services you receive are aligned with your current needs, whether you need more help, fewer services, or the same level of support.

Why Does IHSS Require Re-Evaluation?

Re-evaluations are a routine part of the IHSS program. They ensure that individuals are still eligible for the services they receive and that the level of assistance reflects their current situation. This process helps maintain the integrity of the program by making sure that services are being used appropriately, based on actual needs.

When Will IHSS Eligibility Be Re-Evaluated?

In California, the re-evaluation process typically occurs at regular intervals, such as:

1. Annually – The state generally requires that you undergo a re-evaluation once every year to verify your continued IHSS eligibility and assess any changes in your care needs.
2. If There Are Significant Changes in Your Health or Situation – If your health or living situation changes significantly (e.g., if you experience a major decline in health or recover from an illness or injury), you may request a re-evaluation earlier than scheduled. This allows for any necessary adjustments to your services.
3. At the Request of a Social Worker or IHSS Caseworker – A social worker may request a re-evaluation if they believe there has been a significant change in your condition, or they might determine that a re-evaluation is needed based on their ongoing assessment.

Steps in the Re-Evaluation Process

Here’s a breakdown of the process for re-evaluating IHSS eligibility and services in California:

1. Notification of Re-Evaluation for IHSS Eligibility

Before your scheduled re-evaluation, you will typically receive a notice from the local county IHSS office. This notification will provide information about:

• The date when your re-evaluation will occur.
• The need to submit any updated information or documents.
• A request to provide evidence of any changes in your condition or needs since your last evaluation.

2. Contacting Your Social Worker

Once the re-evaluation process begins, your IHSS social worker will contact you, either by phone or through a scheduled appointment. During this meeting, they will:

• Review your current health and care needs: The social worker will assess any changes in your health, your ability to perform daily activities, and your need for assistance. This includes assessing how well you can perform tasks such as eating, bathing, dressing, and moving around.
• Ask about any changes in your condition or living situation. You’ll be asked if there have been any medical changes, changes in family support, or other circumstances that impact your ability to live independently.

You should be prepared to provide documentation of any changes, such as medical records, doctors’ notes, or any other information that may support your case for needing more or fewer services.

3. The Assessment Visit

In most cases, a home visit will be scheduled by the social worker to observe your living conditions and assess how well you are managing daily tasks. They will observe the level of care you need and evaluate if your current service plan still meets your needs.

During the assessment, the social worker will:

• Ask you to demonstrate the activities you may need help with.
• Evaluate the types of care you need, including any medical equipment, transportation needs, and other specific services.
• Take note of any changes that affect your eligibility and care plan.

This is your chance to communicate any concerns you have, including how well the current services are working or if any adjustments are needed.

4. Determining IHSS Eligibility and Service Levels

After the assessment is complete, the social worker will determine whether you remain eligible for IHSS and what level of services you require. The level of services you qualify for will be based on the following factors:

• Your physical and mental health condition.
• Your ability to perform daily living activities such as bathing, dressing, and preparing meals.
• Your ability to manage medications and any medical treatments.
• Changes in your living situation (e.g., if a caregiver moves in to assist you).
• Any changes in your family support system (e.g., if family members or others are no longer able to help with your care).

5. Notification of the Decision

Once the social worker has completed the re-evaluation process, they will send you a notice of action informing you of the decision regarding your eligibility and services. This notice will:

• Inform you of any changes to the level of services you’ll receive.
• Provide information about how many hours of care you are authorized for.
• Explain the reasons for any changes or denials in your services.

If your eligibility or hours are reduced, the notice will explain the reason behind the decision.

**6. Appealing the Decision

If you disagree with the decision made following your re-evaluation, you have the right to appeal. This is a crucial part of the process, as it allows you to challenge any changes to your eligibility or service level.

To appeal, you must file a Request for a Fair Hearing with the California Department of Social Services (CDSS) within 90 days of receiving the notice. The process for appealing includes:

• Filing the appeal: Provide a written request for a hearing and explain why you disagree with the decision.
• Hearing: A formal hearing will be scheduled, where you can present evidence, and the decision will be reconsidered by an independent judge.
• Decision: After the hearing, the judge will issue a decision, which can either uphold the original decision or reinstate your previous services.

What to Do in Preparation for a Re-Evaluation

To ensure a smooth re-evaluation process, here are some steps you can take:

1. Update Your Medical Information: Ensure that your healthcare providers have updated records of your health condition. Any recent doctor’s notes, reports, or changes in your medical treatment plan can be vital to demonstrate your needs.
2. Document Changes in Your Care Needs: If your health has improved or declined, make sure to note the changes. You may need to provide supporting documentation.
3. Prepare for the Assessment Visit: Be ready to show how you’re managing daily tasks, and make sure your living environment reflects your current needs.
4. Communicate with Your Caregivers: If you have a caregiver, it’s important they also provide input regarding your care and daily challenges.

Re-evaluating IHSS eligibility and services is a vital part of ensuring that individuals receive the appropriate level of care they need to live independently. The process allows both the state and the recipient to review the ongoing needs and adjust services accordingly. If there are changes in your health or living situation, or if you feel your current service level doesn’t meet your needs, don’t hesitate to request a re-evaluation.

By understanding the process, preparing the necessary documentation, and communicating effectively with your social worker, you can help ensure that your IHSS services continue to meet your needs as they evolve.

Need help? In California, the In-Home Supportive Services (IHSS) program provides crucial financial help for families raising children with special needs. American Advocacy Group is on the front lines every day, making positive change happen for people diagnosed with autism, Down syndrome, and a range of diagnoses across the continuum. As a leading advocate for all people with intellectual and developmental disabilities and their families, and the premier provider of the support and services people want and need, we understand the system and know how to take action regarding your best interests.

CONTACT US FOR HELP. Dial (877) 762-0702 or email us at [email protected].