History of IHSS

The Foundation of IHSS: Where it Came From and the Initial Legislation

In 1972, federal legislation allowed states to establish public assistance programs for older adults, the blind, and people with disabilities.

In 1973, AB 134 was signed into law, establishing the In-Home Supportive Services (IHSS) program, 283-hour cap, and the California Department of Social Service (CDSS) was responsible for administering the program.

CDSS delegated authority to the counties to execute the program with three different modes of service:

• Individual Provider (IP) mode
• Contract mode
• County Homemaker Service mode

IHSS is a federal Medicaid benefit. It provides various services to eligible aged (over 65 years of age), blind, or disabled persons who are unable to remain safely in their own homes without such assistance. IHSS providers assist recipients with a variety of tasks such as housework, bathing, feeding and dressing. Recipients are eligible to receive up to 283 hours of services per month.

County employees determine an applicant’s eligibility, and a county social worker performs an individualized assessment to determine how many hours they need for services. Once an applicant is approved and is considered an IHSS recipient or consumer they are considered the employer and are responsible to hire, train, supervise and fire their provider. IHSS is a self-directed program.

The idea for Public Authorities surfaced in 1992 after Realignment. Counties wanted to improve their IHSS programs, and there were concerns about liability around running registries and who would be the employer of record for IHSS providers. In 1993, SB 485 was enacted allowing counties to set up a Public Authority or Non-Profit Consortium.

Between 1993 -1999, eight counties set up Public Authorities, with Service Employees International Union (SEIU). The United Domestic Workers (UDW) had been trying to get counties to contract with National Home, which was bought out by Addus. Addus had a pilot program in Merced County in the early 1990’s, an attempt to have contract mode only in Merced County. Due to the way the statute worked, consumers received less hours than what a social worker had approved when services were delivered through contract mode. Across the state, counties recognized that consumers preferred the IP mode.

In 1999, SEIU, and UDW united with consumers to sponsor legislation that required all counties to establish an employer of record, with Public Authorities being one of the options. Important to note that in the statute, contract mode was an option for counties; however, it could not be the only option available to consumers. In every county, the consumer is entitled in statute to have the IP mode. This was part of the rationale that led most counties to establish Public Authorities. The statute required counties get information from their Advisory Committees and then establish an employer of record by 2003.