From the State
updated December 30, 2020
In-Home Supportive Services (IHSS) provide people with low-income who have disabilities or are 65 years old or older with in-home and personal care services to help them live safely in their own homes. Services you can get include:
- Domestic services, such as sweeping, vacuuming, taking out the garbage, wheelchair cleaning and battery recharging, and changing bed linens
- Related services, such as meal preparation and cleanup, laundry, and shopping
- Personal care services, such as feeding, bathing, grooming, dressing, bowel and bladder care, and help with medications
- Transportation to medical appointments or alternative sources of services like day programs
- Removal and cleanup of yard hazards
- Heavy cleaning
- Protective supervision for cognitively or mentally impaired persons to safeguard from self-injury or hazard
- Paramedical services, as ordered by a physician, such as injections, range of motion exercises, and catheter insertion
- Help with personal care services at a disabled person’s workplace, but not with job-related services.
IHSS is often seen as an alternative to out-of-home placement, such as assisted living or nursing facilities.
IHSS does not provide 24-hour care. If you need 24-hour care, you will need to make other arrangements for your non-IHSS hours, such as through a Home and Community-Based Waiver (HCBW). To learn more about HCBWs, contact the Department of Health Care Services In-Home Operations at 1-916-552-9105 (Northern California) or 1-213-897-6774 (Southern California).
Your Responsibilities with Your Care Provider
You are responsible for hiring, firing, and supervising your care provider. If your county has contracted IHSS providers, you can hire them to provide you with the necessary services. You can also hire a friend, relative, neighbor, or other care provider.
Wages for IHSS care providers vary from county to county. You and your care provider must submit timesheets for all authorized services provided. The state will handle payment of your care provider(s) unless you are getting advance pay.
The In-Home Supportive Services Consumer Training Handbook (PDF) offers detailed information about how to supervise a care provider, including issues like hiring, firing, communication, safety, and handling payment. There is more information about this on the California Department of Social Services’ website.
Advance pay means the state sends you funds before your In-Home Supportive Services are performed, so you can pay your care provider directly. To get advance pay, you must be considered “severely disabled,” meaning you need at least 20 hours per week in personal care services, meal preparation and cleanup, and/or paramedical services.
What You Pay
Many people get In-Home Supportive Services free of charge. This includes anybody who gets one of the following types of Medi-Cal:
- SSI-linked Medi-Cal
- Medi-Cal through SSI 1619(b) for people who used to get SSI cash benefits and now make up to $37,994 per year ($39,350 for people who are blind).
- Medi-Cal’s Working Disabled Program (WDP), which lets people with disabilities make up to $64,820 per year and pay an affordable premium for coverage.
Read more about these types of Medi-Cal in DB101’s article on Medi-Cal. People who do not get their Medi-Cal in these ways may need to pay a share of cost, which means that each month, they would pay a portion of the expenses for their IHSS.
Do You Have to Pay a Share of Cost?
If you do not get one of the above types of Medi-Cal, you may still be able to get no-cost IHSS if your countable monthly income is less than the SSI monthly benefits rate in California — $954.72 for an individual or $1,598.14 for a couple in 2021. (We’ll explain more about how countable income is calculated below.)
If your countable monthly income is above the SSI benefits rate, you can still get IHSS if you meet all other eligibility criteria. You may, however, would have to pay a share of cost.
Here are the most common groups of people who have to pay a share of cost for IHSS:
- People who get Social Security Disability Insurance (SSDI) and do not work at all, if their SSDI benefits are high enough to put their countable income above the SSI monthly benefits rate.
- People who get veterans benefits or other unearned income and do not work at all, if their unearned benefits are high enough to put their countable income above the SSI monthly benefits rate. Note: Many veterans do not have a share of cost.
- People who get Social Security or other retirement benefits and do not work at all, if their retirement benefits are high enough to put their countable income above the SSI monthly benefits rate.
If you work, you may not have to pay a share of cost.
If you have a disability and you start working, you could probably qualify for no-cost IHSS, because you could sign up for Medi-Cal’s Working Disabled Program (WDP). Read more about WDP in DB101’s article about Medi-Cal.
How to Calculate Your Share of Cost
Your share of cost is based on your countable in