What is IHSS?

IHSS is a statewide program administered by each county under the direction of the California Department of Social Services. It provides in-home care services to help those with limited income who are disabled, blind, or over 65 remain safely at home.

The four different IHSS programs

There are four different IHSS programs: The Community First Choice Option Program (CFCO), the Medi–Cal Personal Care Services Program (PCS), the IHSS Independence Plus Option Program (IPO), and the Original or Residual IHSS Program (IHSS–R). Each of these programs provides the same services but has different eligibility criteria based, in part, on whether they are funded with federal money.

CFCO—Recipients are eligible because they have qualified for Medi-Cal and would otherwise need nursing home-level care. Most IHSS recipients are in the IHSS-CFCO program.
PCS – Recipients are eligible because they have qualified for Medi–Cal based on age, blindness, or disability. Most IHSS recipients who do not qualify for the IHSS-CFCO program are part of the Medi-Cal PCS program.
IPO—Recipients are eligible because they have qualified for Medi–C and are also part of one of the following groups: parent providers for a minor child, spouse providers, advance pay cases, or meal allowance cases.
IHSS–R– Recipients do not meet PCS or IPO requirements and are usually persons with Satisfactory Immigration Status, which denies them federal reimbursement. Very few people fall into this category.

What services does IHSS provide?

Services include, but are not limited to:

Domestic and Related Services: meal preparation, cleaning, laundry, and garbage removal.
Personal Care Services/non-medical care: bathing, feeding, dressing, grooming, and toileting.
Paramedical Tasks: assistance with medications, injections, bowel and bladder care.
Protective Supervision: monitoring persons with cognitive or mental impairments to prevent injury.
Transportation and accompaniment to medical appointments.

Who is eligible for IHSS?

Any California resident is eligible for IHSS if they:

Are SSI/SSP or Medi–Cal eligible?
Are blind, disabled, or 65 years of age or older?
Are you living in a home, apartment, or abode of your choosing (not including a hospital, nursing home, assisted living, or licensed care facility)?
Are unable to live safely at home without care.

Note: Residents of long-term care facilities may not receive IHSS in the facility, but they may apply if they are expected to be discharged so that IHSS is in place when they return to their homes.

What are the financial requirements for IHSS?

To be eligible for IHSS, a person must be enrolled in Medi-Cal. For more information on financial eligibility for Medi-Cal, see CANHR’s fact sheet on Community-Based Medi-Cal programs. Individuals who receive Medi-Cal with no share of cost (SOC) through SSI-linked Medi-Cal, the 250% Working Disabled Program, Disabled Program (income limit of $1,564 for an individual and $2,106 for a couple as of April 1, 2022), or expansion Medi-Cal, will also be entitled to IHSS with no SOC.

Individuals whose income is too high to qualify for IHSS with no SOC may still be eligible for IHSS and Medi-Cal with a SOC under the Blind-Disabled Medically Needy Program (ABD-MN). If so, they will have to pay their SOC to their IHSS provider (or other Medi-Cal providers) before getting covered IHSS.

Those who qualify for IHSS and Medi–Cal with a SOC will receive two Notices of Action (NOA). One NOA from the Medi–Cal program will state the SOC amount, and the other NOA from IHSS will state that they are eligible for benefits.

How Do I Calculate My Share of the Cost?

Share of Cost is based on countable income, including earned income and unearned income. Earned income includes salaries, wages, tips, professional fees, and other pay for physical or mental work. Unearned income includes social security, disability payments, and other income one receives without doing any work. Examples include disability benefits, income from a trust or investment, and profits or funds from any source other than work.

In determining the Share of Cost, Medi-Cal deducts a Maintenance Needs Allowance (MNA) of $600 for a single person from the total countable earned and unearned income.

The following amounts are also deducted each month:

$20 from unearned income
Health insurance premiums
Earned income deductions:
$65
An additional $20 can be deducted from earned income if there is no unearned income.
Work expenses related to disability (cost of items related to impairment that are necessary to becoming or remaining employed—maintenance of a van that fits your needs, certain clothing, attendant care services, transportation, medical devices, work-related equipment, etc.).
Half of the remaining earned income.

helping senior with best medical services

Who provides IHSS services?

Each county can choose different service delivery modes: Contract, County Homemaker, or Independent Provider (IP). However, it is up to the individual to decide what mode of service delivery they wish to receive. In the Contract mode, the County contracts with an outside agency that employs IHSS caregivers. In the County Homemaker mode, the County trains and employs caregivers. Most IHSS clients use the IP service mode, where the client hires, fires, and supervises caregivers.

Public Authorities have been established in most counties to improve IP service delivery. IHSS pays IPs hired and supervised by the recipient or the recipient’s guardian/authorized representative. Many IPs are relatives of the client. Payments are issued by the State Controller’s Office, directly to the IP. Wages for IHSS caregivers vary from county to county. For a list of IHSS caregiver wages by county, please visit https://www.cdss.ca.gov/inforesources/ihss/county-ihss-wage-rates. In the Bay Area Counties, Public Authorities have been able to negotiate higher wages and comprehensive health and dental benefits.

How to Apply for IHSS

Step 1: Contact Your Local Department of Social Services

Call or visit your local Department of Social Services to complete an IHSS application. You can find the contact information for your county office here: County IHSS Offices.

Step 2: Application Submission

Once IHSS receives your application, a social worker will visit your home for a needs assessment. During the needs assessment, the social worker will ask questions about your physical and mental capacity to determine the types of services you need and the number of hours for each service.

Step 3: Medical Certification Form

As part of the application process, you must have your health care provider fill out a medical certification form (SOC 873). This form is available at SOC 873 Form. The form must state that you cannot do some activities of daily living (ADLs) on your own and that without IHSS, you would be at risk for out-of-home placement.

Step 4: Needs Assessment

Your living situation will also be evaluated. After the needs assessment, the IHSS worker will contact you and let you know if you have been approved or denied the service.

Step 5: Approval and Service Hours

If approved, the IHSS worker will tell you how many hours were authorized for each service, and how many total monthly hours have been approved.

Additional Resources

The Disability Rights California In-Home Supportive Services (IHSS) Advocates Manual provides detailed information about how to apply for IHSS and receive the most hours possible.
We provide detailed information about how to apply to IHSS and receive the most hours possible.

How does IHSS calculate how many hours I get?

The State has limited monthly service hours to 195 hours per month for non–severely impaired applicants and 283 hours per month for the severely impaired. The County Social Services Agency is responsible for doing a needs assessment for each client at the time of application, every twelve months thereafter, and whenever the county has information that the recipient’s physical/mental condition or living/social condition has changed. The number of hours authorized may change with each evaluation.

The assessment evaluates:

The client’s physical/mental condition, living/social situation, and ability to perform various daily life functions.
The client’s statement of need.
Medical records/physicians’ statement of need.
The case manager may consider other information necessary and appropriate to assess the need.