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Findings 6 findings
F01
State and federal laws regarding the administration of the IHSS program are complex, overlap and contain many loopholes that could lead to fraud and/or abuse and prevent the County from validating that services are delivered to consumers.
F02
Eligibility criteria for IHSS services are imprecise and may not be interpreted uniformly by all counties.
F03
The IHSS program regulations and the enormous caseloads carried by IHSS caseworkers do not allow close monitoring of consumers and caregivers to assure services are 9 delivered appropriately, especially to those consumers receiving the maximum care hours and funding. Such large caseloads may result in the caseworker failing to detect a consumer is being physically or financially abused and/or neglected.
F04
Sheriff’s investigators do not have access to IHSS consumer records to conduct criminal investigations.
F05
The County is required to seek a federal “Medicaid waiver” and state approval to implement a comprehensive, coordinated long-term care program that provides a system of care rather than uncoordinated, stand-alone programs delivering only one mode of care, such as in- home care.
F06
County officials recognize the shortcomings of the IHSS model and have taken steps to improve it within the limitations permitted by state and federal law. This includes instituting the new state-mandated Public Integrity unit to prevent, detect and prosecute fraud, and ensure all caregivers completed a background check by December 31, 2010. However, the state’s failure to provide working protocols for the investigators inhibits the unit’s ability to discover or prevent fraud.
Recommendations 9
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11-21Page 10Write legislation, in collaboration with local state legislators, which revises
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11-22Page 10Write legislation, in collaboration with local state legislators, which revises
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11-23Page 10Direct the Health and Human Services Agency to develop a plan to
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11-24Page 10Direct the Health and Human Services Agency to form a County task
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11-25Page 11Provide evidence that the County has requested a "Medicaid waiver" that
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11-26Page 11Develop a paid or unpaid internship with local universities that educate
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11-27Page 11Develop an interagency agreement with the San Diego County Sheriff to
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11-28Page 11Collaborate with the Health and Human Services Agency to form a County
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11-29Page 11Develop an interagency agreement with the Health and Human Services
Agency Responses 1
Government agencies' official responses to this report's findings and recommendations. Click on a response to see the structured breakdown.
No Responses Found 3
Government entities assigned to respond to this report. No response documents have been linked in our database.
County Service Area No. 26 (San Diego)
Special District
San Diego County Board of Supervisors
Elected County Office
San Diego County Sheriff
Elected County Office