Analysis of the California In-Home Supportive Services (IHSS) Plus Waiver Demonstration Program. Waiver and Non-Waiver Program Recipients


IHSS Plus Waiver recipients include individuals age 3-17 who have a parent as a paid IHSS provider, those age 18 and over who have a spouse as a paid provider, and recipients in either the Advance Pay or Restaurant Meals voucher programs. Table 1 shows the number of IHSS recipients by age, provider type (including Advance Pay and or Restaurant Meals voucher payments, and those having a Share of Cost requirement. Separate tabulations are shown for IHSS recipients who continued into 2005, and those recipients entering IHSS in 2005. Those age 65 and over account for almost 60% of IHSS recipients in 2005. Those age 3-17 in contrast account for just over 4%. The remaining one-third are non-aged adults. The type of provider varies substantially across IHSS recipient age groups. Parents, who are allowed to be paid providers for minor children under the IHSS Plus Waiver, account for more than 70% of the providers for those age 3-17. Parents, who can be paid providers under the regular IHSS program for adult-aged IHSS recipients, are much less prominent caregiver resources: for recipients age 18-64 (15%), and essentially non-existent among recipients age 65+.

Reliance on Other Relatives (i.e., adult children, siblings, and relatives other than spouses) increases exponentially (as measured across age cohorts) with the age of the recipient. The proportion grows from 13% among minor children to more than half of all paid providers for those age 65+. The proportion of Non-Relative providers is relatively similar to that of Other Relatives among minor children recipients, and about 45% of the providers among adult age IHSS recipients. Spouses are the third major group of providers. Spouses can be paid as providers under the IHSS Plus Waiver, but their proportion is relatively small among recipients age 18-64 and 65+, and too few for analysis among those under age 18.

These patterns are generally stable comparing the adult recipients continuing from 2004 with those joining the program in 2005. Among minor children, there was a modest decrease in Parent and a modest increase in Non-Relative providers among the new recipients in 2005.

Share of Cost is included in the table as an indicator of the extent to which the program may have widen or narrowed its income screening between 2004 and 2005, a period in which county and state costs for program entry were reduced by 50% for the “waiver” programs. Share of Cost means that the recipient is required to make cash payments to financially qualify for IHSS participation. Relatively few recipients, usually less than 3% were required to make such payments in 2005. The rate is lowest among minor children, and somewhat higher among those 65+; and for those with a spouse paid as an IHSS provider. Within this low range, slightly more of the adult recipients entering the program had a Share of Cost than was true of continuing recipients. Whether this is typical in comparisons of new versus continuing recipients, a reflection of fewer restrictions on entry, or tighter eligibility processes in 2005 is not known.

The remaining IHSS Plus Waiver programs are those of Advance Pay and Restaurant Meals voucher. Participation rates are low. Fewer than 1,700 recipients statewide (about 0.5%) used one or the other of these programs during 2005. Adults age 18-64 were the main users (with fewer than 500 recipients) of the Advance Pay program. Those age 65+ (about 600 recipients) accounted for 60% of Restaurant Meals voucher users. Participation was higher among continuing versus new recipients. Participation in these programs can vary from month to month, but among those participating, most recipients received these benefits for three-quarters of the year or more.

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