This factsheet is a shortened version of Justice in Aging’s In-Home Supportive Services (IHSS) Advocate Guide, and meant to provide basic program information to IHSS consumers, providers, and their family members. For a detailed resource for lawyers and advocates, you can download the full Advocate Guide here.
What is In-Home Supportive Services (IHSS)?
Medicaid-covered home and community-based services (HCBS) are services that support older adults and people with disabilities with activities of daily living in settings of their choice, including their homes, assisted living facilities, and adult day health centers.
The In-Home Supportive Services (IHSS) program is California’s largest Medi-Cal HCBS program, providing personal care services to nearly 900,000 seniors, adults with disabilities, and children so they can live safely in their own homes rather than in an institutional setting, like a nursing facility.
I don’t think I could be on my own without IHSS. I wouldn’t be safe and I don’t know how long I would last without an injury. And I wouldn’t be able to work. I would not be able to get ready for the day, or to eat, or to go to in-person work events. Because IHSS allows me to work, I don’t depend on SSI anymore and our life is decent. We don’t have a lot, but we have enough—we have a cat, bird feeders, a decent living room that’s wheelchair accessible, furniture. We have the basics, everything we need to be happy.
Theresa, CA IHSS recipient
To qualify for IHSS, an individual must meet four basic requirements:
- Medi-Cal eligible (California’s Medicaid program)
- Aged (65+), blind, or disabled as defined by Social Security standards
- Have a functional need for services—must be unable to perform certain tasks safely on their own and require these services to remain at home.
- Live in their own home including:
- Rented house, apartment, or room in someone else’s home
- A friend’s couch
- RVs
- Congregate shelters
- Recuperative care settings
- Residences of family members
- Tribal homes with alternative heat and water sources
IHSS is not available in settings that already provide personal care services and where services cannot be provided safely, such as:
- Residential Care Facilities for the Elderly
- Nursing facilities
- Hospitals
- Unsheltered settings
What Services Does IHSS Provide?
County social workers visit a person’s home to determine each person’s specific needs and approve the appropriate number of service hours based on a person’s functional limitations.
The county social worker uses standardized state guidelines to determine how many hours per week a person needs of each type of IHSS service (see below). People who are assessed as severely impaired can receive up to 283 hours a month of these services. People who are assessed as non-severely impaired can receive up to 195 hours a month.[1]
Assessments are needed before IHSS services can begin. IHSS users must have their needs reassessed once every 12 months, but can request more frequent reassessments if needs or circumstances change. Every other year, individuals with stable care needs may choose to have a reassessment by phone or video call, but may choose to have an in-person assessment instead.[2]
Types of IHSS Services
Personal Care
- Bathing, grooming, and oral hygiene
- Dressing and undressing
- Bowel and bladder care
- Feeding assistance
- Mobility and transfers
- Paramedical services (medication administration, wound care, catheter care)
Domestic & Related Services
- Housework and laundry
- Meal preparation and cleanup
- Shopping and errands
- Heavy cleaning (when initially authorized)
Other
- Protective supervision for those who require 24-hour supervision because a memory, judgment or orientation impairment puts them at risk of harm.
- Accompaniment to medical appointments
- Yard clean-up & heavy cleaning needed for health and safety
- Teaching and demonstration services
IHSS Providers
The IHSS program uses a consumer-directed model of care. This means that IHSS user choose, hire, and manage their own providers. Recipients can receive services from multiple providers and adjust their care arrangements as their needs change.
Today, approximately 73% of IHSS users have a provider that is related to them. IHSS users may choose any provider they want as long as the person they select meets certain criteria and is enrolled as an authorized IHSS provider.
Providers must:
- Be eligible to work in the United States
- Pass a criminal background check or qualify for and receive an exemption to the background check
- Complete the county’s enrollment process within 90 days
- Attend their county’s IHSS provider orientation
IHSS providers are paid hourly wages that vary by county. The Department of Social Services publishes annual wages here. Providers receive overtime pay (1.5x regular rate) for hours exceeding 40 per workweek.
In 2023, the Department of Social Services established a back-up provider system for individuals who need another provider when their regular providers are unavailable.[3] Back-up providers can be accessed through local registries administered by local Public Authorities.
How to Apply for IHSS
Application Process
- Contact county IHSS office by phone, in person, or in writing
- If not already enrolled in Medi-Cal, apply for Medi-Cal
- Submit a Health Care Certification form (SOC 873) from a licensed health care provider
- Schedule and complete in-home assessment with county social worker
After these steps are completed, the county will send a Notice of Action with approved IHSS services and hours.
Application Timeline
Counties must process applications within 30 days, though delays are common. Federal Medicaid standards require processing within 90 days for disability-based applications and 45 days for all others.
Appeal Rights
IHSS recipients have strong due process protections. Individuals can appeal any county decision that denies or terminates services, reduces hours, or if an application is delayed.
Appeals must be filed within 90 days of receiving a Notice of Action. If an appeal is filed before the effective date of a reduction or termination, recipients can continue receiving services at current levels while awaiting a hearing decision (this is called “aid paid pending”).
Additional Resources:
Endnotes
Individuals who require more than the maximum available hours should consider applying for the Home and Community Based Alternative Waiver, which allows up to 24 hours a day of personal care. ↑
CDSS, All-County Letter 24-72, (Oct. 8, 2024). (To have stable needs, an IHSS recipient must be (a) 19 years old or older; (b) with no incidents involving Adult Protective Services or other agencies responsible for health and safety, since the last reassessment; (c) have not been hospitalized or admitted to a facility for 24 hours or more and have not had multiple emergency or urgent care visits in the last three months; (d) have not had a gap in provider services in the last 6 months; (e) have not changed residence since the last reassessment; (f) lives with others when needing assistance with impairment of memory, judgment or orientation; (g) does not have an authorized representative that directs the recipient’s care; (h) does not require an assessment or reassessment for protective supervision; (i) does not have complex paramedical needs.) ↑
The 2026-27 January Governor’s budget proposes to eliminate the back-up provider system. Please check with your local IHSS office or public authority to see if there have been changes to the back-up provider system. ↑
