Inter-Departmental Correspondence

Health System



February 27, 2009


March 31, 2009







Honorable Board of Supervisors

Acting as the In-Home Supportive Services Public Authority



Jean S. Fraser, Chief, Health System
Lisa Mancini, Director, Aging and Adult Services



In-Home Supportive Services Independent Provider Service Hours


Approve an Appropriation Transfer Request increasing funding for the In-Home Supportive Services Public Authority in the amount of $589,138 in Realignment funds and $48,184 in State funds for a total increase of $637,322 for a revised total program cost of $10,927,022 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.


Aging and Adult Services (AAS) strives to provide services to at-risk individuals in order to help them remain in the most independent setting possible. The provision of these services to this targeted population is a division-wide performance measure. With the assistance of the services provided to In-Home Supportive Services (IHSS) recipients by the IPs, we have met this measure as a Division.


Performance Measure:


FY 2007-08

FY 2008-09

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 2008-09 Adopted Budget is based on 3,813,542 IP hours. AAS has been experiencing a significant increase in IP hours since the second half of FY 2006-07 as a result of an increase in the number of eligible clients applying for and receiving services.



At the end of FY 2007-08, there were approximately 2,658 clients receiving IHSS services in San Mateo County. It is projected that this number will increase to 3,111 (17.1%) by the end of FY 2008-09. The corresponding IP hours were 3,630,330 by the end of FY 2007-08 and this number is projected to increase to 4,080,490 (12.4%) by the end of FY 2008-09.


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 independent providers 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 increase in IP hours in San Mateo County by 266,948, from 3,813,542 to 4,080,490 (7% over the budgeted number of hours) 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 for FY 2008-09. A 12.4% annual growth in IHSS is not sustainable. AAS will continue to strive to manage the growth of the IHSS program.



The 7% increase over what is currently budgeted for in IP service hours will increase the County share of cost for the IHSS program by $576,935, from $10,350,087 to $10,927,022. The County share of the budgeted cost for the IHSS program is covered by the IHSS PA General Fund ($4,487,523) and Realignment and Federal Waiver funds ($5,862,564). The cost of the IHSS program is projected to increase by an estimated $3,391,383, of which $2,814,448 (82.9%) will come from state and federal reimbursement and the balance of $576,935 (17.1%) is from Realignment reserves. 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.