During County Government Month in April, CSAC is presenting blogs and short video features on 13 award-winning programs from nine counties that demonstrate effective, original and cost-conscious ways counties are serving their citizens.
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In Home Supportive Services (IHSS) has a noble and practical purpose: help the most vulnerable Californians with significant health issues stay as long as possible in their homes by providing some level of caregiving assistance. These individuals are eligible for Medi-Cal, which means their income is typically less than $1,000 a month. IHSS is unique to California, is administered by counties and is funded with a mix of county, state, and federal funds. It is much less costly for both the state and counties to provide hands-on care for frail and vulnerable people in their homes, rather than relegating them to more costly nursing homes. Research has shown that the quality of life for these individuals is higher when they can remain safely at home, in familiar surroundings.

Yet the system, designed with the best intentions, is still susceptible to fraud from persons who prey on the sick and elderly. In response to concerns about fraud, Los Angeles County instituted a model IHSS Anti-Fraud effort developed by the Department of Public Social Services in partnership with the District Attorney and State Investigative Section.

The structure of the IHSS program is fairly straightforward: Eligible recipients are assessed by a social worker who determines the type of caregiving services are needed and the amount of hours appropriate to provide these services. The recipient then hires an individual to provide in-home care. For a large percentage of clients, the person hired is a family member, and the vast majority of IHSS recipients are claiming and receiving services appropriately. But there are individuals who file false claims – either as providers, or in some cases, as recipients.    For Los Angeles County – which has the largest number of IHSS recipients in the nation – even a small portion of fraud can add up to big numbers.

By putting system-wide checks into place, such as fingerprinting and criminal background checks for providers and verifying client hospitalization or death, which suspends IHSS payments, Los Angeles County has seen a drop in fraud and in costs. County officials have also collaborated with a public assistance crime enforcement team to root out other types of criminal activity since perpetrators of IHSS fraud often have attempted welfare fraud. Through these collaborative efforts, Los Angeles County has been able to see their anti-fraud efforts serve as a deterrent in other programs and has led to more than 100 fraud convictions involving nearly $2 million in fraudulently obtained funds.

County government works, which is why Californians prefer to have programs and services managed and operated at the local level. The county programs featured by CSAC during County Government Month are 2011 CSAC Challenge Award recipients. These awards recognize the innovative and creative spirit of California county governments as they find new and effective ways of providing programs and services to their citizens. The Call for Entries for the 2012 CSAC Challenge Awards is being distributed this month.

Erin Treadwell is CSAC’s Communication Coordinator. She can be reached at etreadwell(at)counties.org.