Report 2020-109 Recommendation 7 Responses
Report 2020-109: In-Home Supportive Services Program; It Is Not Providing Needed Services to All Californians Approved for the Program, Is Unprepared for Future Challenges, and Offers Low Pay to Caregivers (Release Date: February 2021)
Recommendation #7 To: Social Services, Department of
For counties that struggle to comply with its regulations regarding providing timely services, Social Services should require—and regularly follow up on—corrective action plans from these counties.
Annual Follow-Up Agency Response From December 2022
Social Services did not report a change to this recommendation's status in 2022.
- Estimated Completion Date:
California State Auditor's Assessment of Annual Follow-Up Status: Will Not Implement
1-Year Agency Response
No change to previous response.
- Response Date: March 2022
California State Auditor's Assessment of 1-Year Status: Will Not Implement
The Department of Social Services has indicated it does not have changes to provide from its previous response.
6-Month Agency Response
CDSS will not require corrective action plans regarding the annual county plans, the regulation concerning 15 days from application to provision of services, or the regulation concerning the requirement to approve IHSS applications in 30 days because CDSS plans to either repeal or is in the process of revising those regulations.
Monitoring activities are already ongoing by the Quality Assurance and Monitoring Units and Program Integrity Unit. The Program Integrity Unit Issues Quality Action Improvement Action Plans (QIAP) to the counties as needed.
- Completion Date: July 2021
- Response Date: August 2021
California State Auditor's Assessment of 6-Month Status: Will Not Implement
The Department of Social Services has indicated it will not implement corrective action plans for counties that are not complying with its regulations related to providing timely services. As we have previously noted, state law obligates each county to ensure that services are provided to all eligible recipients during each month of the year in accordance with the county plan.
- Auditee did not substantiate its claim of full implementation
- Auditee did not address all aspects of the recommendation
60-Day Agency Response
The CDSS plans to repeal the regulation that requires counties to submit annual county plans. The requirement for county plans is an outdated regulation from when services were primarily provided by county homemakers that are employed and directed by the county. As the program evolved to a self-directed model, and recipients became responsible for the hiring and directing of the care provider, county plans were no longer meaningful as the county does not control the service provision of the program.
The CDSS plans to also repeal the regulation regarding 15 days from application to provision of services. As a self-directed program, IHSS recipients are responsible for managing their own care. Recipients sign an SOC 332 (IHSS Recipient/Employer Responsibility Checklist) at their assessment that states it is the recipient's responsibility to hire and manage their own provider and direct how and when they receive their services. Counties have no authority to hire a provider for a recipient. The county ensures recipients are assessed and authorized for services; it then becomes the recipient's responsibility to hire a provider.
Regarding the requirement to approve IHSS applications in 30 days, the CDSS is in the process of revising regulations to include the new statutory requirements for an IHSS applicant to complete a Medi-Cal eligibility determination and health care certification prior to authorization of IHSS. Both requirements allow 45 days for the applicant to complete and run concurrently.
Lastly, the CDSS has established Quality Assurance and Monitoring Units and a Program Integrity Unit which is responsible for monitoring counties in the areas which they are responsible for (application processing, assessing recipients and authorizing hours correctly, conducting reassessments timely, etc.) and will continue to do so.
- Estimated Completion Date: Unknown
- Response Date: May 2021
California State Auditor's Assessment of 60-Day Status: Pending
Social Services provided the same response to all our recommendations, however in doing so it did not specifically respond to this recommendation. We will update this assessment based on Social Services six month response due in August 2021.
All Recommendations in 2020-109
Agency responses received are posted verbatim.