IHSS, or In-Home Supportive Services, is a California program that pays a caregiver to help you with daily tasks so you can stay in your own home instead of moving to a care facility. The program covers everything from cooking and cleaning to bathing and medical tasks, and you get to choose your own caregiver, including a family member or spouse. Here’s how the entire process works, from qualifying to getting services in your home.
Who Qualifies for IHSS
IHSS serves people who are aged, blind, or disabled and need help with everyday activities. To qualify, you must meet all of these requirements:
- California residency. You must live in the state.
- Medi-Cal eligibility. You need an active Medi-Cal determination. If you don’t already have Medi-Cal, you can apply at the same time you apply for IHSS.
- Living in your own home. You must live in a home or a residence of your choosing. Hospitals, nursing homes, and licensed community care facilities don’t count.
- Medical certification. A licensed health care provider must complete a Health Care Certification form documenting your abilities and limitations and confirming your need for in-home help.
On the financial side, Medi-Cal does look at assets for people who are 65 or older or have a disability. The asset limit is $130,000 for one person, with an additional $65,000 for each extra family member. Your primary home, your main vehicle, household items like furniture and clothing, and retirement funds you’re drawing payments from don’t count against that limit. Cash, bank accounts, second homes, and second vehicles do count.
What Services IHSS Covers
The program covers a broad range of tasks, broken into several categories. Your authorized services will depend on what you specifically need help with, not a one-size-fits-all package.
Domestic tasks include mopping floors, cleaning the bathroom and kitchen, vacuuming, sweeping, dusting, emptying trash, making beds, and changing linens. Meal preparation and cleanup are covered separately, as are laundry (washing, drying, folding, and putting clothes away) and shopping for groceries or running other errands.
Personal care covers the more hands-on help that many recipients need: dressing, bathing, grooming, oral hygiene, bowel and bladder care, menstrual care, help with walking, getting in and out of bed, transferring to a chair or vehicle, repositioning, skin care, and assistance with prosthetic devices or medications.
Paramedical services go a step further and include tasks like blood sugar checks and injections. These require authorization from your doctor and are performed under their direction.
Accompaniment covers travel to medical appointments and to alternative resource sites, so your provider can go with you when you need help getting there safely.
How the Assessment Works
After you apply, a county social worker visits your home to assess your needs. This isn’t a pass/fail test. It’s a detailed evaluation of how much help you need with each specific task.
The social worker uses a Functional Index Scale that ranks your ability in each area on a 1-to-5 scale: 1 means you’re fully independent, 2 means you just need verbal cues, 3 means you need some physical help, 4 means you need a lot of help, and 5 means you cannot perform the task at all. They score you across 14 categories, including housework, meal prep, laundry, shopping, bathing, dressing, feeding, walking, transfers, bowel and bladder care, and even cognitive areas like memory, orientation, and judgment.
Each ranking corresponds to a set number of minutes per task per month. A higher functional ranking means more authorized time for that task. The social worker combines all of your individual task scores to calculate your total monthly hours. They’ll also observe you during the visit, ask questions about your daily routine, and review the medical certification form your doctor submitted.
How Many Hours You Can Get
The number of hours you receive depends entirely on your assessment. There’s no standard amount. Some people get a few hours a week, while others receive close to full-time coverage.
The maximum is 283 hours per month for people with severe disabilities. That works out to roughly 9 hours a day. For people whose disabilities are classified as not severe, the cap is 195 hours per month, or about 6.5 hours daily. Which cap applies to you depends on both the severity of your impairment and the specific IHSS program you’re enrolled in. Some program tracks, like the Community First Choice Option, allow up to 283 hours regardless of severity level.
Protective Supervision for Cognitive Impairments
If you or a family member has a mental impairment that creates a risk of injury without constant monitoring, IHSS offers a category called protective supervision. This is designed for people who are non-self-directing, confused, or mentally impaired and could accidentally hurt themselves if left alone.
Qualifying requires documentation from a licensed medical professional covering the diagnosis, prognosis, and the severity of deficits in memory, orientation, and judgment. The doctor must also confirm that the person has the physical ability to put themselves in a dangerous situation, because the risk has to be real, not theoretical. Protective supervision is not available when the safety concern stems from a physical condition rather than a mental one, and it doesn’t cover medical emergencies like seizures, social companionship, or managing aggressive behavior.
Depending on severity and program type, protective supervision can add up to 195 or 283 hours per month to a recipient’s authorization.
Choosing and Hiring Your Provider
One of the defining features of IHSS is that you are the employer. You choose who provides your care, you set their schedule, and you can let them go if they’re not working out. This applies whether you hire a stranger, a friend, or a family member, including a spouse or parent of a minor child.
The state treats you as the employer of record, which means you’re responsible for finding, interviewing, and managing your provider. You can hire more than one person if a single provider can’t cover all your authorized hours or tasks. Before hiring, you should review your authorized services and hours so you can clearly explain the job during interviews.
Providers must complete an enrollment process through your county IHSS office that includes attending a provider orientation, getting fingerprinted, and passing a background check. During interviews, it’s a good idea to ask candidates for identification, discuss their availability and experience, go over your expectations for work behavior and schedule, and give them a chance to ask questions. The state recommends having a friend or family member sit in on interviews to help you evaluate candidates.
How Providers Get Paid
IHSS providers are paid hourly, and all wage rates are set by individual counties, not the state. This means pay varies depending on where you live in California. The hourly rate includes the base wage plus amounts for taxes, benefits, administrative costs, and sick leave. Providers submit timesheets for the hours they work, and the state processes payment. You don’t pay your provider out of pocket, and the services cost you nothing as a recipient since they’re funded through Medi-Cal.
How to Apply
You start by contacting your county social services office. You can find your local office through the California Department of Social Services website or by calling 211. You’ll need to submit an application and the Health Care Certification form, which your doctor fills out. If you’re not already on Medi-Cal, you’ll need to apply for that as well, though both applications can happen simultaneously.
Once your paperwork is in, the county schedules the in-home assessment visit. After the social worker completes the evaluation, you’ll receive a Notice of Action telling you how many hours you’ve been authorized and for which services. If you disagree with the assessment, you have the right to request a state hearing to appeal the decision. From there, you hire your provider, they enroll with the county, and services begin.