Inter-Departmental Correspondence

Health Department



February 14, 2008


February 26, 2008







Honorable Board of Supervisors

Acting as the In-Home Supportive Services Public Authority



Charlene A. Silva, Director, Health Department
Lisa Mancini, Director, Aging and Adult Services



In-Home Supportive Services Independent Provider Service Hours


Approve an Appropriation Transfer Request (ATR) increasing funding for the In-Home Supportive Services (IHSS) Public Authority (PA) in the amount of $904,498 in Realignment funds and $82,092 in State funds for a total increase of $986,590 for a revised total program cost of $9,910,491 to cover the cost of additional clients.



Commitment: Ensure basic health and safety for all.

Goal 8: Help vulnerable people—the aged, disabled, mentally ill, at-risk youth and others—achieve a better quality of life.


This increase in Independent Provider (IP) hours contributes to this commitment and goal by providing services to assist individuals with the greatest needs to maintain their independence and dignity within the least restrictive setting possible.


Performance Measure:


FY 2006-07

FY 2007-08

Percentage of at-risk individuals maintained in a least restrictive setting through case management





In September 1993 by ordinance of the San Mateo County Board of Supervisors, a Public Authority was established to administer the provider components of the IHSS program. The enabling ordinance designated the Board of Supervisors as the Governing Board of the Public Authority.


The FY 2007-08 Adopted Budget is based on 3,154,034 IP hours, which has been the budgeted number of hours for the past several years. Aging and Adult Services (AAS) began to see an increase in IP hours during the second half of FY 2006-07 and later that year received approval from your Board to realize additional revenue to cover the cost of the additional IP wages. The IHSS program continues to experience a significant increase in the number of eligible clients applying for and receiving services.



At the end of FY 2006-07, there were approximately 2,540 clients receiving IHSS services in San Mateo County. It is projected that this number will increase to 2,800 (10.3%) by the end of FY 2007-08. The corresponding IP hours were 3,229,840 by the end of FY 2006-07 and this number is projected to increase to 3,564,058 (10.4%) by the end of FY 2007-08.


The County is seeing a shift in demographics to an older population, where those who suffer from disabilities but have maintained their independence in the past are now in need of assistance with their activities of daily living. There is no benefit through Medi-Cal for assisted living in the community. The only affordable option for this population to remain safely in their homes is to hire attendants to assist with their care. These are among the factors impacting the significant growth in IHSS.


The increase in clients applying for and receiving IHSS services in San Mateo County is consistent with trends throughout the State. The California Department of Social Services experienced a 9.5% increase in the number of clients receiving IHSS services between October 2006 and October 2007.


The increase in IP hours in San Mateo County by 334,218, from 3,229,840 to 3,564,058 will result in an increase in the cost of IP wages, which is applied across the current sharing ratio of federal, state, and county funds. An annual growth at 10% is unsustainable. AAS is working on a strategy to ensure the growth in 2008-09 does not exceed 7%. This strategy will be reflected in the AAS FY 2008-09 recommended budget.



The 10.4% increase in IP service hours will increase the County share of cost for the IHSS program by $904,498, from $9,005,993 to $9,910,491 The County share of cost for the IHSS program is covered by the IHSS PA General Fund ($4,487,523) and Realignment funds ($5,422,968). The cost of the IHSS program is projected to increase by an estimated $5,117,890, of which $4,213,392 (82.4%) will come from state and federal reimbursement and the balance of $904,498 (17.6%) is from Realignment. The necessary funding and corresponding expenditures for the increase in IP hours are included in the ATR. There is no impact on the Net County Cost as a result of this action.