In-Home Supportive Services: California’s Personal Caregiving Program for Older Adults and People with Disabilities – Justice in Aging

What is IHSS?

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 costly institutional settings, like nursing facilities. The program is critical to fulfilling California’s obligation to ensure older adults and people with disabilities receive necessary supports in integrated community settings, rather than in institutional facilities as set forth by the Supreme Court in Olmstead v. L.C. Born out of the independent living and disability rights movement, IHSS serves as a national model for self-directed personal care.

Who Does IHSS Serve?

Eligibility for IHSS is based on the participant’s functional and care needs rather than a diagnosis. The program is available for individuals who are

• aged (65+) OR blind OR disabled;
• are unable to perform certain tasks safely on their own; and
• require help with IHSS-covered tasks to remain at home.

As a state plan benefit, IHSS is the most ethnically and linguistically diverse Home and Community-Based program in California.

• 56.6% are women
• 55% are 65 years or older
• 46% speak a language other than English
• 37.8% have a visual impairment
• 33.4% are Hispanic
• 13% are Black

Over half of IHSS consumers need nursing facility-level of care, which they choose to receive in their homes with IHSS support.

Where is IHSS Available?

IHSS is only available to individuals who live in their own home, which can include:

• 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?

The IHSS program offers consumers a variety of personal care, homemaking, and other support including:

• 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)
• Housework and laundry
• Meal preparation and cleanup
• Shopping and errands
• Heavy cleaning (when initially authorized)
• 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

To receive services, IHSS applicants must first undergo a standardized needs assessment by a county social worker, who visits a person’s home to determine each person’s specific service needs and approve the appropriate number of service hours based on a person’s functional limitations. Assessments can also be done at skilled nursing facilities prior to discharge to ensure IHSS is in place when a resident moves back to the community.

The county social worker uses standardized state guidelines to determine how many hours per week a person needs of each type of IHSS service. Nearly 38% of program participants are assessed as severely impaired and can receive up to 283 hours, while the remaining 62% who are non-severely impaired can receive up to 195 hours a month.^[1]

Assessments are needed before IHSS services can begin, and IHSS recipients must have their needs reassessed once every 12 months or sooner when there is a change in circumstances. 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]

IHSS Providers

The IHSS program uses a consumer-directed model of care. This means that IHSS recipients choose, hire, and manage their own providers. Recipients can receive services from multiple providers and adjust their care arrangements as their needs change.

• 72.7% providers are relatives
• 60.4% live with the IHSS user
• 28% speak a language other than English
• 21.4% are parents
• 5.2% is a spouse

Today, approximately 73% of IHSS recipients have a provider that is related to them. IHSS recipients may choose any provider they want as long as the person they select meets certain criteria, including being eligible to work in the United States, passing a criminal background check, and attending an in-person county IHSS training.

Providers must be enrolled as authorized IHSS providers to be paid by IHSS, and those that do not live with the IHSS recipient are required to check in and out of work through the state’s GPS-enabled Electronic Verification System.

IHSS providers are paid hourly wages that vary by county, and receive overtime wages for hours exceeding 40 hours per workweek. In 2023, the Department of Social Services established a back-up provider registry for individuals who need another provider when their regular providers are unavailable.^[3] IHSS recipients can either identify their own caregiver, hire a family member, or access the local provider and backup provider registries administered by local Public Authorities.

IHSS is Always Under Threat

The success of the IHSS program in supporting the growing number of older adults and people with disabilities in California has also made it a repeated target for budget cuts in difficult years of deficit. In 2009 and again in 2011, the state attempted to cut IHSS hours by 20%.

The cut was challenged in court, and an 8% cut to hours was agreed to in the resulting settlement in 2013. The cut was permanently restored in 2021. IHSS was again targeted for cuts in 2024 in a proposal to limit access for undocumented immigrants in 2024 and proposed cuts to overtime hours in 2025 – both of which were abandoned as a result of advocacy.

Currently, in 2026, there is a proposal to shift costs of program growth to the counties that would likely result in counties cutting recipient hours to contain costs. These proposals are shortsighted, leading to higher long-term costs as older adults increase hospital and nursing home use when facing no in-home alternative.

Resources

Endnotes

1. 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. ↑
2. 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.) ↑
3. 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. ↑