STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
IN-HOME SUPPORTIVE SERVICES (IHSS) PROGRAM
NOTICE TO APPLICANT OF HEALTH CARE CERTIFICATION REQUIREMENT
State Law (Welfare and Institutions Code section 12309.1) requires that each person applying for IHSS
provide a health care certification from a licensed health care professional (LHCP) before they can get
The certification must be completed by a LHCP, such as a physician (doctor), physician assistant,
regional center clinician or clinician supervisor, occupational therapist, physical therapist, psychiatrist,
psychologist, optometrist, ophthalmologist, public health nurse, etc.
The certification must state that you are not able to do some activities of daily living (ADLs) on your own
and that without help to do these activities you would be at risk of placement in out-of-home care.
Basic ADLs are: eating, bathing, dressing, using the toilet, walking, and getting out of bed or a chair.
Other ADLs are: housekeeping, preparing meals, shopping for food or other necessities, taking
Attached is a blank copy of the Health Care Certification Form (SOC 873) that you can give to your
LHCP to complete. If you want, the county can send it to the LHCP for you but you will have to give the
county the LHCP’s name and address.
The county may accept alternative documentation in place of the SOC 873 as long as it meets all of the
1. Indicates that you are not able to do one or more ADLs on your own and without services you are
at risk of placement in out-of-home care,
2. Describes the medical or other condition that makes you unable to do ADLs on your own and
causes you to need IHSS, and
3. Has been signed by a LHCP within the last 60 days.
Whether you give the SOC 873 to the LHCP yourself or the county sends it for you, you are
responsible for making sure it is completed and returned to the county within 45 days from the date the
county worker requested it.
If you do not provide the SOC 873 or alternative documentation to the county within 45 days,
your application for IHSS will be denied. As with any county action taken on your case, you
may request a state hearing if you do not agree with the county’s decision.
Under certain limited circumstances, such as when services are requested because you are being
discharged from a hospital or nursing facility and you need services to return safely to your home, or the
county determines that you are at risk of placement in out-of-home care, the county may grant an
exception that would allow you to get IHSS on a temporary basis before the county receives the
completed SOC 873 or alternative documentation. However, even if an exception is granted, you will still
be required to provide one of these documents for the county within the 45-day timeframe to determine
if you can continue getting IHSS. If you have been granted an exception but you are not able to get the
SOC 873 from your LHCP within 45 days, call your social worker before the due date to tell him/her why
you are not able to meet the due date and ask if the county can grant you more time.
If you have questions about the health care certification requirement, ask the social worker who has
been assigned to your case.
DUE BY: ____/____/____
SOC 874 (10/16)