Report 2020-109 Recommendations

To help ensure that recipients receive prompt approval for services and also receive all approved services, Butte County should, by August 2021 and annually thereafter, complete required plans that include, at a minimum, specific provisions for how it will ensure prompt approval of services and that recipients promptly receive the approved services.

To help ensure that recipients receive prompt approval for services and also receive all approved services, Kern County should, by August 2021 and annually thereafter, complete required plans that include, at a minimum, specific provisions for how it will ensure prompt approval of services and that recipients promptly receive the approved services.

To balance the need to attract a sufficient number of caregivers into the IHSS program with the need to maintain control over the State's costs, the Legislature should consider using the annual budget process to allocate additional funds to counties to enable counties to better afford increasing caregiver wages.

To ensure that these offset funds are used to best address wage disparities, the Legislature should prioritize their availability to counties where caregivers earn the least, relative to a living wage, and should exempt these wage increases from Welfare and Institutions Code 12306.16, subdivision (d), so that the amounts allocated are not included in adjustments to the county contribution.

To limit the disincentive for counties to provide caregiver wage increases, the Legislature should modify the State's cost-sharing system to eliminate the ongoing costs that counties pay for local wage increases that are nullified by increases to the State's minimum wage.

To provide for more equitable financial participation by counties, the Legislature should revise the State's IHSS funding formula to include annual updates based on current program growth and costs and a review of specific funds available to counties. To the extent that some counties' revenues dedicated to IHSS are insufficient to cover their IHSS contributions, the Legislature should provide counties with assistance as it deems appropriate or designate additional funding sources in state law.

To help ensure that recipients receive prompt approval for services and also receive all approved services, San Diego County should, by August 2021 and annually thereafter, complete required plans that include, at a minimum, specific provisions for how it will ensure prompt approval of services and that recipients promptly receive the approved services.

To help ensure that all recipients throughout the State receive prompt approval for services and receive all approved services, by August 2021 and annually thereafter, Social Services should require counties to submit required annual plans. These plans should include, at a minimum, a description of how each county will ensure that services are promptly approved and that recipients promptly receive the approved services.

To help counties prepare to meet future needs for IHSS services, Social Services should revise its regulations to require counties to include long-range projections and strategies in their annual plans.

To help ensure that recipients receive timely care, Social Services should, by August 2021, begin monitoring counties' compliance with the following: Approval of IHSS applications within 30 days, unless an extension for obtaining a medical certification applies. Prompt approval of IHSS applications for which the 45-day extension for a medical certification applies. Provision of services within 15 days of application approval.

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.

To help ensure that recipients receive prompt approval for services and also receive all approved services, Stanislaus County should, by August 2021 and annually thereafter, complete required plans that include, at a minimum, specific provisions for how it will ensure prompt approval of services and that recipients promptly receive the approved services.