CDCAN
California Disability Community Action Network: Advocacy Without Borders
The following are several official letters from various counties to the California Department of Social Services - the state agency under the California Health and Human Services Agency - that oversees statewide the In-Home Supportive Services (IHSS) program.  The counties have responsibility to administer and implement the program locally under rules, guidelines and direction provided by the Department of Social Services.  The Department of Health Care Services also plays a role in the IHSS program because it oversees the state's Medicaid program (called "Medi-Cal") and nearly all of the IHSS program is Medicaid funded.  
As of October 27, at least 17 counties have sent letters to the Department of Social Services regarding concerns and problems related to the implementation of the IHSS provider requirements.
ALAMEDA COUNTY
Dated October 21, 2009, Stewart Smith, assistant agency director of Adult and Aging Services of the Alameda County Social Services Agency, wrote that his county "…will be unable to comply with the November 1, 2009 deadline for the implementation of" the new IHSS worker (provider) orientation, enrollment and new provider background checks.
Smith cited the time needed for county staff training on fingerprinting, the need to hire additional staff to handle the new background checks and other requirements of the IHSS workers (providers), and securing facilities to conduct the orientations - "at least 120 orientations per day to complete provider orientations for our 18,000" providers.  
Smith wrote that instructions from the California Department of Social Services "…on various Notices and letters have been incomplete…guidelines for termination of workers for "certain misdemeanors" are unclear…we have no clear instruction on when a worker will be terminated if we discover, through fingerprinting, that they are ineligible prior to the June 30, 2010 deadline for processing enrollments. Without clarity on these issues, the county is at substantial risk of appeals and lawsuits."
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 1 PAGE LETTER - PDF FILE)
FRESNO COUNTY
In a letter dated October 27, 2009, Julie Hornback, director of the Fresno County Department of Employment and Temporary Assistance, wrote asking for further clarification of several issues regarding implementation including who will generate the notification of a IHSS worker's eligibility or ineligibility (the county or the state?.  She asked when the Department of Social Services would be releasing additional All County Letters and information on the fingerprinting and background checks for IHSS providers, orientations, appeals and more, and also release of new enrollment forms that are in other languages.  She also asked when the State would be providing information about other program changes, including home visits, timesheet changes and recipient fingerprinting.  Hornback, in her letter, did not ask for a delay in implementation however - though said the information requested was needed to "fully implement" the changes.
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
IMPERIAL COUNTY
Dated October 26, 2009, Gary Andrews, deputy director of the Imperial County Department of Social Services, wrote of "serious concerns" that the county has with the November 1, 2009 implementation date of the IHSS worker (provider) requirements.  He cited that the state has not provided forms in languages other than English when "…our population (clients and providers) is approximately 75% Spanish speaking.  If we implement the use of these new forms on November 1, 2009, prior to having them translated into Spanish, 75% of our population will be signing statements under penalty of perjury that they may not completely understand.  This may be in violation of their civil rights and may undermine any prosecution effort in the future if fraud is committed."
He citied problems resulting from the lack of translated materials needed for the required orientations for IHSS workers (providers) and the time needed to certify county workers to conduct fingerprinting and criminal background checks using the California Department of Justice system. 
Andrews also cited a concern that the county taking on the role of an employer of the IHSS workers (providers) in this process, saying that the Department of Justice provides criminal history background checks as a service to employers and that "…if the county takes on this role, we may be placing ourselves in legal jeopardy in the future since we don't have the protection afforded to Public Authorities regarding tort liability. If providers were to sue the county in the future, it would be difficult to make the case that we are not the employer when in fact we are utilizing this DOJ background check system as though we were the employer, and making the decision on whether to hire or not based on the results."  
He said that the county "…would like to get a legal opinion on this matter before proceeding and will not have time to accomplish that" before the November 1st deadline and that failure to extend the date "…will place counties in the position of being out of compliance, creating an environment for appeals and potential law suits by providers and clients."
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
KERN COUNTY
Dated October 20, 2009, Kris Grasty, director of the Kern County Aging and Adult Services, wrote that while the county has "worked feverishly" to meet the implementation deadline of November 1, 2009 of the new IHSS worker (provider) enrollment requirements, "…in considering the resources, allocation, and timeframe provided, counties were not given sufficient time to implement" those changes.  Grasty wrote that "…like other counties throughout the State, we are still waiting on further direction" from the California Department of Social Services "on the revised content required for the new provider orientation. The orientations themselves require us to re-evaluate how we administer, deliver and schedule orientations. "  
Grasty cited that "…like some counties, we need to receive approval from our Board of Supervisors in order to enter into agreement with the California Department of Justice to conduct criminal background checks, and receive criminal history information on our providers."
Grasty closed urging a delay in implementation - either December 1, 2009 or the beginning of 2010 saying that "…these issues are in addition to all the confusion that is occurring amongst our providers and clients regarding the changes we are implementing….Although the mandate is clear, the timeframe provided significantly hinders a co9unty's ability to implement the new procedures which results in providers and clients unnecessarily being subjected to not only confusion and frustration, but poor service in light of the changes we are imposing on them."
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 1 PAGE LETTER - PDF FILE)
KINGS COUNTY
Letter dated October 26, 2009 by Peggy Montgomery, director of the Kings County Human Services Agency, wrote that "…any attempt to implement the provider requirements at this time would be disastrous. With the deadline, information that should have been received months ago is just now trickling in. This delay in information will provide the County with little to no time to interpret and develop the necessary policies required by the regulations."  She noted several concerns, including the lack of provider orientation materials in languages other than English, writing that "Due to the high Spanish speaking population in Kings County, there will be a high need for translated materials…"
She concluded that "If Kings County is forced to meet the deadline, mandatory client services will most definitely be affected, which will backlog the system with even further problems…"
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
LOS ANGELES COUNTY
Letter dated October 27, 2009, Phillp Browning, director of Los Angeles County Department of Public Social Services, wrote that "This is to confirm that the Los Angeles County Department of Public Social Services….cannot implement the new provider enrollment requirements effective November 1, 2009." Noting that in LA County, over 185,000 persons are receiving services under IHSS said that that "…new provider enrollment requirements are both labor intensive and very time consuming" and that the county "..only received the ACL [All County Letter] instructions on October 26, 2009."
He urged a 60 to 90 day extension to comply with the new IHSS provider requirements saying that without that extension "…it will be virtually impossible for us to approve any new providers for IHSS consumers. We process over 4,000 new IHSS applications each month and the inability to approve new providers will create an extreme hardship on aged and disabled individuals in this county and could ultimately lead to their dependency on nursing homes for services."
Browning wrote that as of September 2009 LA County had over 150,000 active IHSS workers (providers) - the most of any county in the State, adding that  "…in addition to the more than 4,000 new applications processed monthly, we complete an average of 1,000 provider changes monthly.
He mentioned his office has been "flooded" with office visits by persons returning provider forms without proper documentation - or county staff to receive them; cited that the County had not received final instructions regarding fingerprinting, that proposal to handle fingerprinting for the County still requires approval from the LA County Board of Supervisors; have not received from the State orientation and training packets for County staff; and are working to restore services to over 36,000 persons who would have been impacted by service reduction or elimination.
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
MONTEREY COUNTY
Dated October 26, 2009, Mary Goblirsch, branch director of Aging and Adult Services of the Monterey County Department of Social and Employment Services, wrote to "…strongly recommend the Department of Social Services extend the implementation date of November 1, 2009 for the new In-Home Supportive Services (IHSS) Provider Enrollment Requirements" and that "Simply put, there Is insufficient time between the issuance" of the All County Letter No. 09-52 on October 1, 2009 and the implementation date "…for Monterey County IHSS to complete the activities necessary for implementation and there are several issues that need clarification."
After citing specific problems and concerns related to background checks, staffing needed to conduct required orientations and other new requirements, she wrote that "There remains incomplete directions" from the California Department of Social Services "…on elements of the Provider Enrollment Requirements, such as the list of 'serious misdemeanors' that would disqualify a provider from IHSS has not been provided to the counties", listing out several other specifics not provided. 
She closed saying that "…the manner in which implementation directions have been issued within the past month has created total chaos for IHSS recipients, providers , and county IHSS staff" and urged that the implementation date for the Provider Enrollment Requirements be delayed and that the Department of Social Services provide more clarification and specifics on outstanding issues. 
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
PLUMAS COUNTY
Dated October 22, 2009, Elliot Smart, director of the Plumas County Department of Social Services and Public Guardian wrote that the "…purpose of this letter is to advise you that Plumas County will not be able to fully initiate all of the new provider enrollment requirements" by the effective date for several reasons including that the county has not received its "fiscal allocation for the criminal background check process, orientation or appeals process. In the present fiscal environment, my Department simply will not recommend to our Board [of Supervisors] that we go forward with any new state initiative without official confirmation of the availability of funding."
Smart wrote that "Even if allocations were in hand, with less than ten business days to implementation, my Department has had no time to consider important operational issues" on how to implement the new requirements, including any staff training, planning and even where required orientations of IHSS workers (providers) are to be held within the county.  
He noted that "…we do not yet have complete instructions regarding how the criminal background check information should be handled nor do we know what to do with the enrollment forms. Particularly disturbing is the fact that we have no instructions [from the State] about what can be done with background checks that yield information (such as criminal history or licensing violations) that may disqualify a provider from enrollment. (We use the term 'may' because we do not yet have information regarding the particular licensing violations that would disqualify a provider)".  
Smart cited the problems of logistics dealing with other IHSS worker (provider) requirements saying that "…I am also quite concerned about the fact that the new provider enrollment requirements tend to view California's counties as a level playing field with respect to the provider's ability to access Live Scan imaging systems and provider orientation services."  He noted that in Plumas County that Live Scans are conducted three days per week in only one location at Quincy Main Jail from 1 to 4 PM and that  this would mean IHSS workers (providers) living in outlying areas such as the towns of Chester or Portola "…would have to make a 70 to 90 mile round trip to Quincy to be fingerprinted."  He noted a similar concern for the required orientations of IHSS providers, citing one location and the problems of a person living in the outlying parts of the county, especially when factoring in dangerous weather conditions during the next several months of the year.  He raised concerns about the cost to providers for the background checks which could reach $70.00. 
He raised concerns that the State is proceeding with making changes to its computer system that "will effectively prevent counties from paying providers. This ultimately will penalize IHSS recipients as they will not have access to services they are entitled and eligible to receive.  This seems particularly unfair to those recipients given that [the California Department of Social Services] has not provided us with adequate or timely instructions and the funding that is needed to implement the new requirements."
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 3 PAGE LETTER - PDF FILE)
SACRAMENTO COUNTY
Dated October 26, 2009, Bernadette Lynch, chief of Senior and Adults Services in the Sacramento County Department of Health and Human Services, wrote that the county was "…struggling to meet the November 1, 2009 start date as outlined by the state. In large part, this is due to delays in receiving necessary materials. [from the State] , saying that "…we have no translated materials with which to train the very diverse group of providers in Sacramento County…We do not have a list other than a draft of the criminal convictions that would bar an individual from seeking employment as a care provider."
Lynch said in her letter that "Other difficulties in implementation are caused by a lack of clarity in the requirements themselves. "  
Saying that "…our agency is working diligently to meet the deadlines for the new training and enrollment requirements yet the timeframe seems unrealistic. This could result in recipients being left in unsafe situations or that a lack of providers may cause increased levels of institutional care.  Moreover, lack of specificity about enrollment requirements will likely prove confusing to providers, staff, and recipients alike."  She urged extension of the implementation date, saying that even the deadline to complete the IHSS worker (provider) enrollment requirements by July 1, 2010 is "unrealistic" because it would mean that Sacramento County would have to require that "…over 225 providers EACH DAY must be identified in-person, attend an orientation…complete necessary paperwork," and begin the background check process with the California Department of Justice. 
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
SAN BERNARDINO COUNTY
Dated October 22, 2009, Linda Haugan, assistant county administrator for the Human Services Division of the County of San Bernardino, wrote of "serious concerns" in meeting the November 1, 2009 effective date for the new requirements for IHSS providers (workers) saying that "…there are no providers currently in compliance with the new mandates, and any new providers and current providers taking on new customers will need to be processed under the new guidelines. This will create a lag time in providing IHSS recipients with caregivers when needed, and could result in severely impaired recipients going without needed services."
She wrote that "…counties cannot implement new requirements without specific information about, and understanding of, what the requirements involve" regarding what felonies or misdemeanors would disqualify a person from working as an IHSS provider. 
She raised concern of liability to the county, saying that counties approve IHSS workers (providers) using the current Criminal Offender Record Information report information and "adjustments are made later, who is responsible for recipients with providers who are subsequently disqualified? What if a county allows a provider to be used based on a background report that does not include the new requirement information and the recipient suffers harm?"
Haugan said that the California Department of Social Services "…has not made the changes compliant with civil rights laws by making forms and orientation video available in translated languages for appropriate population groups.  Informing notices were sent to recipients and providers in English only, with no other languages available, and Provider Orientation materials have been provided in English only."
She cited that in her county 12% of the IHSS workers (providers) are Spanish speaking and that "…we have not been supplied with the tools to provide information to them in that language."
She wrote that the notices of action informing providers and recipients of the new requirements were sent out to them "…prior to the County being notified. County staff was unprepared to manage the massive demand for answers to questions regarding changes/effects to services" from those impacted. Our lobbies are flooded, telephones ring continuously, and staff have insufficient information to provide answers; this has created a major disruption in the ability to provide service and perform necessary work."
She concluded her letter saying that the California Department of Social Services "…has placed the County in an untenable position by requiring changes be made and providing incomplete and inadequate directions for implementation.  It is impossible for the County to provide responsible and thorough customer service to a critically important segment of our population under these circumstances. The County is in urgent need of clarifications and answers regarding the unresolved issues" she wrote, "…in order to move forward with implementation."
Haugan urged extension of the implementation date "…in view of the potential harm to IHSS customers".  
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
SAN DIEGO COUNTY
In a letter dated October 26, 2009, Pamela Smith, director of Aging and Independence Services under San Diego County's Health and Human Services Agency, wrote that the County was "…extremely concerned about the timeline and financial plan for implementation" of the new IHSS worker requirements and the "…impact on continuity of services for a fragile population, and the lack of resources available to ensure that program integrity measures are in place as designed."
She wrote that the County has received its IHSS allocation and "…includes funding for caseload growth and provider sign-up/enrollment, but does not include the funding for the other new State requirements - provider orientation and background checks, recipient fingerprinting, etc. The additional allocation to cover these new requirements has not yet been provided, nor have counties received all the necessary State instructions to implement the many new requirements."
Given these concerns, Smith said the County was urging the State to delay implementation until January 1, 2010.
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
SAN LUIS OBISPO COUNTY
Dated October 22, 2009, Donna Clipperton, supervisor of the IHSS Public Authority of San Luis Obispo County, wrote that her county "…will not be able to implement the new provider enrollment mandates by the deadline of 11/1/09" because the county has not "…received all of the necessary directives that we need in order to proceed…have not been provided with all the materials needed for the mandated provider orientation, i.e., copies in Spanish..."  She noted that "serious legal questions" regarding the new state requirements "have not been addressed", saying there are conflicting statements on the new provider enrollment form that an individual with a record of "any" felony or a "serious" misdemeanor cannot be an IHSS worker.  
She wrote that the November 1st deadline is not "realistic" period of time in which to determine their staffing needs and to restructure the agency to comply with the new requirements, even without the other problems and concerns she listed out.  She said that "…this is particularly true, given the decreases in both staff and funding that been necessary in our local Public Authority, due to massive cuts by the state to our administrative funds." [CDCAN Note: the Governor, using his line item veto power, reduced funding significantly for IHSS Public Authority Administration, and other areas in the budget because the Legislature did not approve other parts of the budget deal that included off-shore oil drilling, etc.]
She concluded her letter saying that "At such time as San  Luis Obispo County is provided with all of the documentation, authorizations, and materials necessary, and the enrollment mandates have been legally vetted, we will be able to proceed in our efforts to comply with provider enrollment mandates."
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
SANTA BARBARA COUNTY
Letter dated October 27, 2009, Kathy Gallagher, director of the Santa Barbara County Department of Social Services, wrote to "…strongly urge that the implementation date be delayed so that counties may ensure the vulnerable elderly and disabled who access our program receive assistance in a timely manner."  She noted that the October 1, 2009 All County Letter from the State left out "critical implementation information. As of this date," she wrote, that the California Department of Social Services "has not issued full instructions necessary to implement the Provider Enrollment process. We regret to inform you that Santa Barbara County will be unable to meet the November 1, 2009 implementation date."
After noting several specific issues of concern, Gallagher noted that the "…absence of translated notices, instructions, orientations, and directives in threshold languages does not meet any reasonable standard of informed consent on behalf of those affected….Unfortunately, these issues are in addition to all the confusion that is occurring amongst our providers and clients regarding the changes that are being implemented…"
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
SANTA CLARA COUNTY
Letter dated October 28, 2009, Will Lightbourne, director of the Social Services Agency of Santa Clara County wrote that "…Santa Clara County will be unable to implement the new IHSS provider enrollment mandates by the November 1, 2009 deadline" citing several specific reasons.  Among the reasons listed was that the county "…has not received all of the necessary directives to comply with the required elements including fingerprint/background check process and provider orientation now has the county received necessary translated materials in languages including Vietnamese, Spanish and Russian representing our diverse provider population."
Lightbourne echoing other county officials across the state wrote that his county is "…routinely stymied in discussions how to implement the various mandates due to draft instructive documents, contradictory instructions, and newly required forms still in draft form [all from the California Department of Social Services].  
He concluded his letter saying that budget reductions to the Santa Clara County Public Authority will limit "our ability to comply" with the new law and that his county will be able to comply with the new IHSS requirements when "…Santa Clara County is provided with all the documentation, authorizations, and translated materials necessary, and the enrollment mandates [requirements] have been legally vetted…"
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 1 PAGE LETTER - PDF FILE)
SANTA CRUZ COUNTY
Letter dated October 26, 2009, Cecilia Espinoia, director of the County of Santa Cruz Human Services Department, wrote that "…it is not possible for Santa Cruz County to meet the November 1, 2009 deadline to implement the extensive range of new requirements for enrolling IHSS care providers…..Unfortunately instructions and materials have not been provided timely enough [from the State] to integrate with existing procedures."  She identified a list of specific reasons, including time needed to change existing orientation materials, finding a facility for orientation, training county staff, time needed for outreach, the need for additional support staff and more.
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
SOLANO COUNTY
Dated October 23, 2009, Patrick Duterte, director of the Solano County Health and Social Services Department, expressed concerns regarding the "directives provided in All County Letter (ACL) 09-52…which outlines new In-Home Supportive Services (IHSS) provider requirements…to be implemented by the counties effective November 1, 2009. Accordingly, Solano County has made diligent efforts to comply with all applicable directives…However, Solano County is very concerned about the short implementation timeframe and the lack of information and instructions provided" [from the State].  
He continued listing out specific concerns saying that the California Department of Social Services "…has placed the County in an untenable position by requiring changes be made and providing incomplete and inadequate directions for implementation.  It is impossible for the County to provide responsible and thorough customer service to a critically important segment of our population under these circumstances." He closes saying that Solano County is "…in urgent need of clarifications and answers regarding the unresolved issues stated in this letter in order to move forward with implementation."
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
TRINITY COUNTY
In letter written on October 23, 2009, Linda Wright, director of Trinity County Health and Human Services, wrote to "strongly urge" the California Department of Social Services "to extend the implementation date until there are clear and definitive instructions and support systems in place to meet the new mandates."
Wright wrote that the County "…will not be able to meet all the new In-Home Supportive Services (IHSS) provider requirements mandated by the legislature and to be implemented by November 1, 2009."
Wright mentioned that the County would need time to set up a background check system independent of the one the County uses for employees.  Wright had questions of the impact of providers having to pay for the background checks and fingerprinting writing that "In our small County that is quite a considerable amount of money and we fear we will lose many of our current providers because of the extreme cost [to pay for the background checks and fingerprinting].  
She mentioned that few residents of the County receive mail at their street addresses and the State's new requirement for street addresses "…is another workload issue as we must call all of those that we have received in order to get their mailing addresses." 
She raised concerns about the appeal process for IHSS providers and said that the County had not yet received its orientation video or supporting documents and that "It concerns us that they are in no other languages besides English at this time," 
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 2 PAGE LETTER - PDF FILE)
YOLO COUNTY
Dated October 26, 2009, Pamela Miller, director of the Yolo County Department of Employment and Social Services wrote saying that Yolo County would be at this point "…unable to implement this process [IHSS worker (provider) criminal background check, IHSS worker (provider) enrollment form and orientation]" because "…we have not yet received sufficient instructions regarding these issues or a funding allocation" and that the November 1st implementation date is "unrealistic for us" given those reasons.  
(CLICK HERE TO VIEW OR DOWNLOAD COPY OF 1 PAGE LETTER - PDF FILE)