The Social Security and Disability Resource Center is an informational website that provides answers to questions about how to apply for disability, how to appeal a claim in the event of a denial, how to navigate the federal system, and how to avoid certain mistakes that are commonly made by applicants. Social Security Disability Resource Center.com
What is IHSS?
The In-Home Supportive Services (IHSS) program — administered at the state level by the Department of Social Services (DSS) and provides support for in-home care for over 460,000 low income seniors and persons with disabilities who cannot safely remain in their own homes without such assistance. IHSS is a lifeline program that promotes independence, freedom of choice and well-being for its recipients. Without it, many of these individuals could end up in more costly nursing home placement. Contact your local county for IHSS information. In Marin County, call 415-499-7115.
What is HCBA and WPCS?
The Home and Community-Based Alternatives (HCBA) Waiver (formerly known as the Nursing Facility/Acute Hospital Waiver) — For IHSS recipients whose level of disability would qualify them for nursing home care, the HCBA Waiver is an additional program to help them continue to live at home instead of a nursing facility. This waiver is administered by In-Home Operations (IHO) of the Department of Health Care Services.
The HCBA Waiver covers a wide range of home care services which includes Waiver Personal Care Services (WPCS). The WPCS provides participants with additional hours for personal care services.
To qualify to receive WPCS services, an individual must meet all of the following criteria:
be enrolled in either the IHO or HCBA Waiver;
be receiving State Plan personal care services through In Home Supportive Services (IHSS);
have a doctor’s order that specifies that he or she requires waiver personal care services in order to remain safely in his or her own home. The WPCS must be described in the participant’s current primary care physician-signed plan of treatment (POT).
HCBA Application Form:
Home and Community-Based Alternatives (HCBA) Waiver Application
When complete, mail the application to the following address:
Integrated Systems of Care Division
HCBS Programs Eligibility/Intake Unit
311 South Spring Street, Ste. 800 Los Angeles, CA 90013
Or submit the application by FAX:
To Contact the Waiver Program
Northern California – 916-552-9105, Southern California – 213-897-6774
email – IHOWaiver@dhcs.ca.gov
Medicare and What You are Entitled to.
Medicare home health coverage is not just a short-term, acute care benefit. Unfortunately, unfair coverage denials still occur on the basis that the individual was not improving or did not demonstrate a potential for improvement (known as the “Improvement Standard”). Jimmo v. Sebelius, a nationwide class-action lawsuit, was brought on behalf of Medicare beneficiaries who received care in skilled nursing facilities, home health care, and outpatient therapy settings, but who were denied Medicare coverage based on this Improvement Standard. The Jimmo Settlement clarified that improvement is not required to obtain Medicare coverage.
Medicare law authorizes up to 28 to 35 hours a week of home health aide personal hands-on care and nursing services combined, as well as therapies.
There are three requirements in order to qualify for your home health aide benefits.
You must be under the Care of a Physician or Allowed Practitioner (who certifies/recertifies patient's eligibility, and orders home health services). This practitioner is to review a new plan every 60 days.
Confined to Home. This means you are unable to leave without the assistance of another individual or a supportive device. Homebound does not mean that you are bed-bound.
You must need & receive at least One Skilled Service. Intermittent Skilled Nursing, (less than daily visits, but at lease once every 60 days), Physical Therapy or Speech Language.
Then Physician would recommend the need for a home health aide personal (this does not need to be skilled, but provided with a Medicare-certified home health agency. Again, this process must be done every 60 days.
For more information and details of what Confined to Home means, visit: MedicareAdvocacy.org
Watch this helpful webinar written and produced by the Kaiser Family Foundation that details Medicare’s impact on the elderly/disabled and the fiscal challenges the program faces going forward. The Story of Medicare