The California healthcare system includes a variety of programs designed to support individuals in need of assistance at home. Among these, the Personal Care Services Program (PCSP) stands out as a critical resource. Often discussed in conjunction with the In-Home Supportive Services (IHSS) program, PCSP offers vital services to eligible individuals. This article clarifies the specifics of the Personal Care Services Program (PCSP), detailing its operation, eligibility criteria, and how it differs from related programs like IHSS Residual. Understanding these distinctions is crucial for both recipients and those involved in administering these essential services.
PCSP: An Extension of In-Home Supportive Services
Before April 1, 1993, the In-Home Supportive Services (IHSS) program was the primary avenue for aged, blind, and disabled individuals in California to receive assistance at home as an alternative to institutional care. IHSS, authorized under Welfare and Institutions Code (W&IC) Section 12300 et seq., is jointly funded by the state (65%) and counties (35%).
The landscape shifted with the implementation of the Personal Care Services Program (PCSP) on April 1, 1993. PCSP was established under the Medi-Cal program (W&IC Section 14132.95) to provide services substantially similar to those under IHSS. A key difference is PCSP’s funding structure: as a Medi-Cal program, it benefits from 50% federal funding. Furthermore, while IHSS may involve a share of cost for recipients, those enrolled in IHSS generally receive no-cost Medi-Cal, meaning they typically have no Medi-Cal share of cost for standard medical services.
The California Department of Social Services (CDSS) and the California Department of Health Services (CDHS) view IHSS as an umbrella program encompassing both IHSS Residual and PCSP. IHSS Residual is designed to cover individuals whose needs are not met under PCSP.
It is essential to differentiate between IHSS and PCSP, particularly in administrative hearings. IHSS is categorized as a social services program, whereas PCSP is a Medi-Cal program. Individuals eligible for personal care or ancillary services under PCSP cannot receive these specific services through IHSS (MPP 30-757.1; W&IC 12300(f)).
Eligibility Criteria for PCSP
Prior to April 1, 1999, specific criteria determined whether a case fell under PCSP or IHSS Residual. A case was classified as PCSP if the individual:
- Received a categorical aid payment (Title 22 CCR 51350(b)).
- Had a disability expected to last at least 12 months or result in death (Title 22 CCR 51350(b)).
- Required at least one personal care service or paramedical service (Title 22 CCR 51350(a) and 51183).
- Had a service provider who was not a parent (if a minor) or a spouse (Title 22 CCR 51181).
- Was not receiving advance payment for services (MPP Handbook 30-780.4).
A significant change occurred on April 1, 1999, with W&IC 14132.95 expanding PCSP eligibility to include the medically needy aged, blind, and disabled recipients with a share of cost, including those with zero share of cost (ACWDL No. 99-13, March 29, 1999; ACL No. 99-25, April 19, 1999; AB No. 2779). This amendment eliminated the requirement for individuals to be categorically needy to qualify for PCSP.
Given that many hearings involve disabled adults with needs for personal care services, and often do not involve spouse providers or advance pay issues, these cases are generally correctly identified as PCSP or a combination of PCSP/IHSS, rather than solely IHSS. Cases involving service-related issues that fall under PCSP or combined PCSP/IHSS jurisdiction are typically reviewed by both CDHS and CDSS. Purely IHSS Residual cases are reviewed only by CDSS. Eligibility-only issues in PCSP cases (unrelated to service needs) are usually addressed by CDHS alone.
Navigating the Differences: IHSS Residual vs. PCSP
The distinction between IHSS as a social services program and PCSP as a Medi-Cal program is crucial for Administrative Law Judges to ascertain the correct program at issue in hearings. When an application denial is based on factors other than a lack of need for services (such as excess property or property transfer issues), counties must conduct a needs assessment. This assessment determines if the applicant requires at least one personal care service, which would then categorize the case under PCSP rather than IHSS.
Consider the example of a 65-year-old single man receiving Social Security disability benefits who applies for IHSS. If the county discovers a $20,000 transfer to his son prior to application, the process diverges based on program classification.
Before evaluating the property transfer, the county must determine if the case is IHSS (subject to IHSS and SSI rules) or PCSP (subject to Medi-Cal rules). Given the applicant’s disability and lack of a spouse provider, PCSP eligibility is possible. A needs assessment must precede property transfer evaluation.
If the needs assessment concludes no need for personal care services (like ambulation, dressing, or bathing), the case is considered IHSS Residual, and the property transfer is evaluated under IHSS and SSI rules (ACL No. 00-35 addresses ineligibility periods for improper property transfers).
Conversely, if a need for at least one personal care service is established, and no advance pay issue exists, the case is PCSP and governed by Medi-Cal rules. Under Medi-Cal, property transfers for individuals living at home are not disqualifying, rendering the transfer irrelevant.
Key Distinctions Summarized
Beyond funding, several key differences exist between IHSS Residual and PCSP, as outlined below:
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