ESC
⚠ Sample Report — For Illustration Purposes Only · IHSSHours.com
IHSSHours.com · Appeal Package

Your IHSS Appeal
Action Plan

A complete, documented package to challenge your county's authorization decision
Recipient
Eleanor Vasquez
County
Los Angeles
Prepared
June 11, 2026
90-Day Deadline — Act Immediately
Your Notice of Action was dated May 28, 2026. You have until August 26, 2026 to request a State Hearing. If you request it before June 7, 2026 (within 10 days), you may be entitled to continue receiving your current service level while the appeal is pending — known as "aid paid pending."
1
Your Dispute Summary
What the county authorized vs. what you should qualify for
County Authorized
87
hours/month
Estimated Qualified
142
hours/month
Gap to Dispute
55
hours/month

The following tasks were either denied entirely or authorized at a lower rank than your functional limitations support. Each disputed task is documented below with supporting rationale based on California's CDSS Hourly Task Guidelines.

Task Your Rank County Auth. Expected Gap / Month Status
Bathing & Oral Hygiene
4 3.5 hrs 6.0 hrs +2.5 hrs Reduced
Bowel & Bladder Care
5 0 hrs 14.0 hrs +14.0 hrs Denied
Ambulation
4 4.0 hrs 8.0 hrs +4.0 hrs Reduced
Protective Supervision
5 0 hrs 120.0 hrs +120.0 hrs Denied
Repositioning & Rubbing Skin
4 2.0 hrs 6.5 hrs +4.5 hrs Reduced
Medication Management
3 0 hrs 3.5 hrs +3.5 hrs Denied
Meal Preparation
3 4.5 hrs 6.5 hrs +2.0 hrs Reduced
Note on Protective Supervision: PS was denied entirely. Based on Eleanor's diagnosis of Alzheimer's disease (moderate stage), documented wandering incidents, and inability to recognize danger or call for help when alone, PS authorization is supported under CDSS policy. The denial will be the primary focus of this appeal.
2
Appeal Narrative Language
CDSS-aligned statements for each disputed task — use these in your hearing
Protective Supervision — Denial Appeal
Highest Priority

Eleanor Vasquez has been diagnosed with Alzheimer's disease, moderate stage, as documented by her neurologist Dr. Hernandez at UCLA Medical Center (see attached records). As a result of this diagnosis, Eleanor is unable to recognize danger, is unable to call for help in an emergency, and cannot safely manage her behavior when left alone — all qualifying criteria for Protective Supervision under California Welfare & Institutions Code §12300(b) and CDSS policy.

Eleanor has exhibited the following documented unsafe behaviors when left without supervision: On March 4, 2026, Eleanor left the home at approximately 11:30 PM and was found by a neighbor two blocks away. She was disoriented and unable to identify her address. Los Angeles County Sheriff's Department was called (incident report #LA-2026-0304-7842 attached). On April 17, 2026, Eleanor turned on the gas stove and was unable to light it, leaving the gas on for an estimated 40 minutes before her daughter arrived. On May 2, 2026, Eleanor fell attempting to use the stairs unassisted, resulting in an emergency room visit at Cedars-Sinai (records attached).

The county's denial of Protective Supervision fails to account for these documented incidents and is inconsistent with CDSS guidelines, which recognize that a recipient who is both mentally impaired and nonself-directing may require a 24-hours-a-day protective component. The authorized IHSS hours shall reflect the hours Eleanor cannot safely be left alone that are not already covered by other authorized services.

Bowel & Bladder Care — Denial Appeal (Rank 5)
Denied — High Priority

Eleanor requires complete assistance with all aspects of bowel and bladder care due to urinary and fecal incontinence resulting from her Alzheimer's diagnosis. She is totally dependent (Rank 5) and cannot perform any component of this task independently. Eleanor is unaware when she needs toileting assistance and cannot communicate the need. The county's authorization of zero hours for this task is not supported by the CDSS Hourly Task Guidelines for a recipient with a Rank 5 dependency level.

Per California's official HTG, a Rank 5 dependency for Bowel & Bladder Care supports an authorization of approximately 14.0 hours per month. We request that the county reconsider this determination at the State Hearing.

Bathing & Oral Hygiene — Reduced Hours Appeal (Rank 4)
Reduced

Eleanor was assessed at Rank 4 (Substantial Assistance) for Bathing & Oral Hygiene, requiring hands-on physical assistance for all bathing and hygiene tasks. The county authorized 3.5 hours per month for this task. Per CDSS Hourly Task Guidelines, a Rank 4 dependency for Bathing & Oral Hygiene supports 6.0 authorized hours per month. The county's authorization of 3.5 hours appears to reflect an error in applying the HTG to Eleanor's assigned rank. We request correction to the full 6.0 hour authorization consistent with the assigned Rank 4 dependency level.

3
State Hearing Request Letter
Send this letter immediately — keep a copy for your records
Appeal Package · Prepared for Eleanor Vasquez
June 11, 2026

California Department of Social Services
State Hearings Division
P.O. Box 944243
Sacramento, CA 94244

RE: Request for State Hearing — IHSS Notice of Action

Recipient Name: Eleanor Vasquez
Date of Birth: August 14, 1942
County: Los Angeles
Notice of Action Date: May 28, 2026
Case Number: [Your IHSS Case Number]

Dear State Hearings Division,

I am writing to formally request a State Hearing regarding the Notice of Action issued by the Los Angeles County Department of Public Social Services dated May 28, 2026, which reduced and denied certain In-Home Supportive Services for Eleanor Vasquez.

I dispute the county's determination on the following grounds:

1. Protective Supervision was denied in its entirety. Eleanor has a documented diagnosis of Alzheimer's disease (moderate stage) and has exhibited multiple unsafe behaviors when left alone, including wandering incidents, falls, and inability to recognize danger. The denial is inconsistent with CDSS eligibility criteria and applicable law.

2. Bowel & Bladder Care was denied (Rank 5). Eleanor is totally dependent for this task due to incontinence resulting from her Alzheimer's diagnosis. The county's authorization of zero hours is not consistent with the CDSS Hourly Task Guidelines for her assigned dependency level.

3. Multiple additional tasks were authorized at fewer hours than supported by the assigned Functional Index Rank. The authorized hours for Bathing, Ambulation, Repositioning, Medication Management, and Meal Preparation do not reflect the hours prescribed by the official HTG for Eleanor's assessed dependency ranks.

I request that this hearing be conducted at the earliest available date. I am also requesting that services continue at the previously authorized level while this appeal is pending (aid paid pending), as this request is made within 10 days of the Notice of Action date.

Please contact me at the address or phone number below to schedule the hearing.

Respectfully submitted,

Maria Vasquez
Daughter and Authorized Representative
123 Main Street, Los Angeles, CA 90001
(213) 555-0100 · maria.vasquez@email.com

4
Evidence & Documentation Checklist
Gather these before your hearing — stronger evidence = better outcome
5
Your Appeal Timeline
Key deadlines from your May 28, 2026 Notice of Action
!
June 7, 2026 · Day 10
Aid Paid Pending Deadline
Request your hearing before this date to maintain current service levels while the appeal is pending. After this date you may still appeal but cannot request aid paid pending.
2
Now → June 21, 2026
Gather Your Evidence
Collect all medical records, incident documentation, physician letters, and supporting statements. Request records from providers as soon as possible — some may take 1-2 weeks.
3
Typically 30–60 days after request
State Hearing Scheduled
The State Hearings Division will contact you to schedule your hearing. Hearings are conducted by phone or in person. You will receive a hearing packet in advance.
4
At your hearing
Present Your Case
An Administrative Law Judge will hear your appeal. Present your evidence, read your appeal narratives (Section 2), and ask the county to justify the specific ranks and hour authorizations they assigned.
5
August 26, 2026 · Day 90
Final Filing Deadline
Absolute deadline to request a hearing. After this date no appeal is possible for this Notice of Action.
6
Free Legal Help & Resources
You don't have to do this alone — these organizations provide free assistance
Disability Rights California
Provides free legal representation for IHSS appeals. Can attend your State Hearing and advocate on your behalf.
1-800-776-5746 · disabilityrightsca.org
State Hearings Division
File your hearing request here. Can be done by phone, mail, or online through BenefitsCal.com.
California IHSS Public Authority
Each county has a Public Authority that can provide guidance on the appeal process and connect you with advocates.
Contact your county IHSS office
Bet Tzedek Legal Services
Free legal help for seniors and people with disabilities in Los Angeles County, including IHSS appeals.
1-323-939-0506 · bettzedek.org
Tip: Contact Disability Rights California as soon as possible. They provide free legal representation and can significantly improve your outcome at a State Hearing. Having legal representation at your hearing is strongly recommended for complex appeals involving Protective Supervision.
Get your personalized Appeal Package
This sample shows what your package would look like — built around your specific authorized hours, your denied services, and your documentation.
Get Your Appeal Package — $59
One-time · Instant PDF · All 58 California counties