In-Home Supportive Services (IHSS) is a publicly funded Medi-Cal program that provides disabled, blind, and low-income elderly individuals with comprehensive in-home care so that they can safely remain in their homes. IHSS is funded by federal, California state, and California county governments. IHSS workers are hired to provide a wide range of services and supervision.
IHSS is considered a pertinent alternative to traditional nursing homes and care facilities. According to California State Social Services, California’s elderly population is expected to swell by the year 2030. Programs such as IHSS ensure that the state is well-equipped to assist in the needs of aging, blind, and disabled individuals.
According to the latest IHSS data, the IHSS program is currently serving thousands of individuals. Thanks to this program, many California residents have been able to remain in their homes and communities instead of being assigned to nursing homes and live-in instutions.
Types of In-Home Supportive Services
A state-appointed social worker is hired to interview and assess all Medi-Cal-eligible individuals. Services offered by IHSS include hands-on and verbal assistance for the following services:
- Accompaniment to alternative resources
- Accompaniment to medical appointments
- Paramedical services
- Bathing, oral hygiene, grooming
- Rubbing skin, repositioning
- Bowel and bladder care
- Care and assistance with prosthesis
- Menstrual care
- Heavy cleaning
- Meal prep and cleanup
- Protective supervision
Keep in mind that while IHSS offers extensive monthly service hours for severely and non-severely disabled individuals, their coverage is not akin to 24-hour care. If a recipient requires round-the-clock coverage, they will need to access supplemental care through alternative programs.
One affordable supplement is the DHCS’s Home and Community-Based Waiver (HCBW) program. This program allows individuals to access at-home care for the same cost as institutional care. In doing so, it allows at-risk individuals to stay in their homes regardless when their income would otherwise restrict it.
You can read more about the 1915(c)Home and Community-Based Service waivers here https://www.dhcs.ca.gov/services/Pages/HCBSWaiver.aspx.
IHSS Eligibility Requirements
Recipients should familiarize themselves with the eligibility and application requirements of IHSS before applying. You have a better chance of being accepted into this program when you have a comprehensive understanding of it.
IHSS recipients must be blind, aged, or disabled. Aged recipients must be over the age of 65 and unable to perform essential tasks.
A recipient must be a U.S. Citizen or have qualifying immigration status. Recipients must also be California residents.
Recipients must live at home. That home can be a house, apartment, or abode of their choice. Recipients may not live in nursing homes or long-term care facilities. However, individuals who are being discharged from out-of-home care may apply for IHSS services.
A recipient does not need to live in their own home. A home can be a rented apartment or room. Only individuals living in institutional settings do not qualify for IHSS services. This is because institutions usually offer comprehensive in-house care and assistance.
According to the California Department of Social Services, applicants must be eligible for Medi-Cal or SSI-SSP benefits in order to qualify for IHSS services.
To qualify for Medi-Cal, recipients must meet the basic income requirements listed here http://www.canhr.org/factsheets/medi-cal_fs/PDFs/FS_Community-Based-Medi-Cal-Programs.pdf. Individuals are eligible for full-cost coverage if:
- Nonexempt assets are less than $2,000 if you are an individual and less than $3,000 if you are a couple
- Their total monthly income must be below $1,271 if you are an individual and less than $1,720 if you are a couple
In order to calculate your countable monthly income, you must:
- Deduct $20 from your unearned income
- Deduct your health insurance premiums
- Deduct an additional $65
- Deduct an additional $20 if applicable
- Then, deduct half of your remaining earned income
- Deduct your work expenses related to your disabilities
With that said, IHSS also boasts a Share-of-Cost program that is geared toward needy individuals who have an income above the state’s poverty threshold. Share-of-Cost recipients must pay for a portion of the IHSS services they receive.
The portion that they are required to pay is like a monthly health insurance deductible. It must be paid off before IHSS can pay their portion.
If an IHSS applicant is not a Medi-Cal recipient, they can file a Medi-Cal application at the same time that they submit their IHSS application. These applications will be processed one after another. Once an applicant is found to be eligible for Medi-Cal, the IHSS portion of their submission will be processed.
Working Disabled Recipients
Many of the aforementioned deductions are put in place to ensure that working disabled individuals can keep a portion of their earnings without losing their IHSS services. On that note, IHSS’s 250% Working Disabled Program offers IHSS services for a low monthly premium. It is available to recipients who are disabled and have income that is lower than 250% of the federal poverty level.
Applicants must also be unable to perform essential daily tasks independently. Such tasks may include:
- Using the restroom
- Perform personal hygiene tasks
Furthermore, IHSS prevents most applicants’ needs for out-of-home care.
A licensed health care professional must fill out and submit a two-page health care certification form on behalf of an applicant. A licensed health care professional may be a physician, occupational therapist, psychiatrist, etc. On the form, the provider must attest to a recipient’s need for extended (12 months or more) in-home supportive services.
An IHSS recipient’s enrollment in Social Security Disability Income (SSDI) or Supplemental Security Income (SSI) would help to confirm that they have an ongoing disability and need for financial assistance.
Health Care Certification
All IHSS applicants must submit a complete Health Care Certification (https://www.cdss.ca.gov/cdssweb/entres/forms/English/SOC873.pdf) form. The information on this form is used in conjunction with reports from health care providers in order to determine an applicant’s need for specific in-home supportive services. The form authorizes Health and Human Services to access an applicant’s health care information.
Interview and Assessment by Social Worker
After a health care form and supporting documentation are submitted, IHSS will schedule an IHSS worker from the applicant’s local social services department to perform a comprehensive in-home interview and assessment of the applicant.
The county social worker will use the information they gather to determine which IHSS services are needed by the recipient. If they determine that a recipient needs specific services, they will also authorize a certain number of hours that these services may be provided through the IHSS program.
Once an individual becomes a recipient of the IHSS program, they will continue to be monitored by a county social worker. The social worker will visit them regularly (at least once every 12 months) to ensure that all of the recipient’s needs are being met. County social workers use the following programs to assess the IHSS recipients they are assigned to:
- Functional Index Rankings
- Annotated Assessment Criteria
- Hourly Task Guidelines
Functional Index Rankings
CDSS’s Hourly Task Guidelines provides information on how social workers determine how much time should be allotted for each service category. As you can see, tasks are broken down right down to the closest approximate minute. More time is allotted for tasks performed on higher-ranked recipients.
For example, a low Rank 2 recipient may be allotted 3 hours and 1 minute of monthly provider support to prepare a meal. Meanwhile, a high Rank 5 IHSS recipient would be allotted 7 hours per month for the same task. All IHSS have strictly timed service guidelines.
The Function Index Rankings are a bit different for minor children. Monthly time allotments vary depending on a child’s age. All minor IHSS recipients receive a level one rank for housework. Other services, such as ambulation, dressing, and respiration, have more variable ranking determination.
Annotated Assessment Criteria
County social workers also use the IHSS program’s Annotated Assessment Criteria as a tool for ranking the service needs of an IHSS recipient.
The assessment contains general questions that may be posed to an applicant during an in-home interview. See https://www.cdss.ca.gov/Portals/9/IHSS/ITA/Attachment%20B%20-%20Annotated%20Assessment%20Criteria.pdf?ver=2017-12-18-172838-687 for examples.
The assessment also recommends which information and explanations should be shared with a recipient. Per the assessment, the social worker is required to notify a recipient of their role and responsibilities with the IHSS program.
Finally, the Annotated Assessment Criteria contains detailed interview questions and ranking judgment guidelines for various IHSS services. This information is followed by detailed and pertinent ranking examples. Applicants may want to familiarize themselves with the Annotated Assessment Criteria before an interview or routine assessment. This will make it easier for them to relay their needs to their assigned social worker and potentially get the most out of the IHSS program.
The county social worker will also go over the following information before authorizing specific services:
- The recipient’s medical history
- A list of medications that the recipient takes
- The recipient’s emergency contacts
- The recipient’s physicians’ information
- The composition of the recipient’s household
- The results of a mini-mental health assessment
- Referrals or Adult Protective Services (APS)
- Referrals for Child Protective Services (CPS)
- Any alleged fraud on the recipient’s behalf
- Language and interpretation needs
- Full biopsychosocial assessment of recipient
The IHSS social worker will request documentation that a recipient has functional limitations. These limitations may be physical or mental. They will also request an “Hourly Task Guideline Comparison,” an “IHSS Assessment Criteria Worksheet,” and an “IHSS Self-Assessment Worksheet.”
These documents are presented by Disability Rights California.
During an interview/assessment, a county social worker will rank an applicant’s ability to perform the following tasks:
- Meal prep/cleanup
- Oral hygiene
- Dressing/prosthetic devices
- Bowel and bladder care
They will also access the applicant’s memory, orientation, and judgment. They do this to determine if the applicant requires adult protective supervision.
Behind the scenes, the county social worker will work on developing a narrative that is backed up by information from these sources and their assessment. This narrative will be used to justify the social worker’s service authorization.
The county social worker will use IHSS’s Functional Index Rank to rank an applicant’s ability to perform each of the previously mentioned functions. Rankings are rated from one to five, with a Rank 1 function being something that an applicant can perform without assistance and a Rank 5 function being something that a recipient cannot perform without assistance.
IHSS requires a completed Health Care Certification (SOC 873) before they authorize payment and approval of services.
Applicants must submit an IHSS application. The application is eight pages long. It is available on the State of California’s Health and Human Services Agency’s website: https://www.cdss.ca.gov/Portals/9/FMUForms/Q-T/SOC295.pdf.
A health care provider must submit a completed Health Care Certification Form to an IHSS worker. The applicant must physically reside in the United States and be a resident of California, be eligible for Medi-Cal, and reside in their own home.
If you believe that someone you know needs In-Home Supportive Services, you can submit a referral for them.
Low-income aged applicants must be at least 65 years old. They must live in a house, apartment, or abode of their own.
If you are legally blind, you should be able to provide IHSS with a Health Care Certification to prove that you need in-home support.
Blind recipients who used to get SSI benefits and earn up to $39,350 per year are eligible to receive all approved in-home supportive services free of charge.
Blind IHSS recipients who receive Blind Work Expenses (BWE,) such as service animal expenses, transportation, or visual aids, may exclude the cost of these services from their monthly earned income.
Recipients who are severely and non-severely disabled may be eligible for 185 to 283 hours of service per month. This includes protective supervision.
Protective Supervision consists of services designed to protect cognitively and mentally impaired people. Protective Supervision recipients are at-risk without outside care and supervision.
Paramedical services are included in the IHSS program. These include but are not limited to:
- Catheter insertion and care
- Ventilator and oxygen care
- Medicine administration
- Wound treatments
Appealing a Denial or Determination
After you apply for IHSS, you will receive a determination letter that says whether you have been approved or denied. If you have been denied, you have “the right to appeal” the decision.
Who to contact:
The Department of Health Care Services: The Office of the Ombudsman https://www.dhcs.ca.gov/services/medi-cal/Pages/MMCDOfficeoftheOmbudsman.aspx
The Medi-Cal Automated Phone Center: (800) 786-4346
CDSS AARU: (916) 651-3488
Applicants must submit appeals within 60 days of receiving an IHSS denial letter. Applicants must fill out and sign the form called “To Request Appeal of Provider Enrollment Denial.” This form must be accompanied by an applicant’s denial letter. It should also be accompanied by documentation that supports the applicant’s appeal. The form and additional documents may be mailed to:
California Department of Social Services Fiscal, Appeals and Benefit Programs
Branch Appeals, Administrative Review and Reimbursement Bureau
Attn: AARU, MS 9-11-04
P.O. Box 944243
Sacramento, CA 94244-2430
An applicant’s appeal application will be accepted and reviewed by the California Department of Social Services (CDSS), Appeals and Administrative Review Unit (AARU). They will read through the application’s appeal application, denial letter, supporting documentation, and any other information provided by social services or other valid institutions. Then, they will once again decide whether to approve or deny the applicant’s application.
Appealing a Determination
Sometimes applicants disagree with the services or services hours they are offered through the IHSS program. When this is the case, that recipient can submit an IHSS Notice of Action Appeal. Recipients may request online, phone-based, or in-writing hearings. Requests can be submitted to:
California Department of Social Services
State Hearings Division
P.O. Box 944243
Mail Station 9-17-37
Sacramento, California 94244-2430
The address of the county social services department who issued a recipient’s Notice of Action.
To Request a Hearing by Phone: (855) 795-0634
To Request an Online Hearing:
Visit the CDSS (California Department of Social Services) online portal to access the Appeals Case Management System. You may need to create an account.
IHSS for Minors
IHSS can be approved for minors with disabilities. Minor IHSS recipients may be eligible for a variety of IHSS programs. In some cases, parents may be paid to perform IHSS services if they:
- Do not have full-time employment because of their minor dependent’s IHSS needs
- There are no other suitable IHSS providers
If a minor IHSS recipient lives with at least one parent, they can also opt to hire an outside IHSS provider if their parent(s) cannot offer services directly because:
- They are absent because of a job, education, or vocational training.
- They are physically or mentally unable to perform the services.
- They are receiving medical, dental, or other health-related treatments
- They need to perform tasks, such as shopping, caring for other dependents
One parent may be paid for IHSS if the other parent is preoccupied with one or more of the previously mentioned activities.
There are currently four IHSS programs.
IHSS Residual Program (IHSS-R)
The IHSS Residual Program is available to recipients who need in-home care services but are not eligible for full Medi-Cal.
Personal Care Services Program (PCS)
PCSP recipients are eligible for federal funding. These services are funded by the federal, state, and county governments. PCSP is the largest IHSS program. According to Social Services, ICSP makes up 53% of the IHSS population. Recipients who are eligible for the PCS program must also be recipients of Medi-Cal. They must also be aged, blind, or disabled.
IHSS Plus Option (IPO)
This program is also funded by the Federal Financial Participation (FFP) program. It is used by parents-of-minor and spouse providers who care for IHSS individuals in their families. Recipients must qualify for Medi-Cal services to qualify for IPO.
Community First Choice Option (CFCO)
The Community First Choice Option is part of the Affordable Care Act. This is the second-largest IHSS program. It consists of community-based attendant services and support. CFCO recipients risk out-of-home placements if they did not receive IHSS.
Becoming an IHSS Provider
If you wish to enroll as an IHSS provider, the first thing that you need to do is to attend a provider orientation. You will need to reach out to a representative of your county’s IHSS program. You can find a list of county IHSS offices here https://www.cdss.ca.gov/inforesources/county-ihss-offices. They will be able to provide you with a list of upcoming provider orientations in your county.
Next, you will need to fill out and submit an In-Home Supportive Services (IHSS) Program Provider Enrollment Form. Take note that applicants who have been convicted of certain crimes (see the application) in the last 10 years are not eligible to become IHSS providers.
Applicants also need to fill out and submit an In-Home Supportive Services Program Provider Enrollment Agreement. Applicants will be given information about becoming an IHSS provider as well as information about an IHSS provider’s responsibilities.
Lastly, applicants must be fingerprinted and subjected to a background check by the California Department of Justice.
Applicants must have a good understanding of their responsibilities, including:
How to Communicate with a Recipient
How to Read a Provider Notification of Recipient Authorized Hours and Service and Maximum Weekly Hours (SOC 2271)
How to Use the Telephone Timesheet System
How to Use the IHSS’s Electronic Service Portal
IHSS Provider Resources
Once you are approved as an IHSS provider, you can access numerous provider resources through the California Department of Social Services website. Check out the following information or visit https://www.cdss.ca.gov/inforesources/ihss/ihss-providers/resources:
IHSS Training Academy (IHSSTA)
IHSS schedules regular in-person courses and interactive webinars for prospective and current IHSS providers. Besides that, providers may reach out to their local IHSS county office for orientation and training materials.
The IHSSTA is designed to introduce caregivers to the In-Home Supportive Services program. It goes over the program’s requirements and framework. It also sheds light on disability awareness and medical implications. Plus, it explains how IHSS complies with the Fair Labor Standards Act (FLSA).
Electronic Visit Verification (EVV)
Providers must log electronic records with information about the services that they performed. These records include service start times, end times, and locations. You can find more information on EVV here https://www.cdss.ca.gov/inforesources/cdss-programs/ihss/evvhelp. EVV is currently on schedule to roll out in all California counties. You can see the CDSS EVV Implementation Schedule here https://www.cdss.ca.gov/Portals/9/Adult-Programs/Electronic-Visit-Verification/EVV_Implementation_Schedule.pdf?ver=2020-01-10-143227-307.
Electronic Services Portal
Since IHSS providers work remotely, they must use the CDSS’s Electronic Services Portal to submit their payroll information. Providers must have a smartphone, computer, or another internet-ready device to access the ESP. The portal allows providers to log their hours, sick claim leaves, and direct deposit information.
Live-In IHSS/WPCS (Waiver Personal Care Services) Providers
If a provider lives in the same home as the recipient they care for, they can use the Live-In Self-Certification program to qualify for wage tax exemptions. If that provider meets live-in qualifications, they will be able to exclude their wages from their gross income when filing their federal and state income tax.
Finding, Hiring, and Paying an IHSS Provider
If a recipient is approved for In-Home Supportive Services, they will receive a letter of approval that contains the type of services and number of hours that their IHSS provider is authorized to perform those services. With this authorization in hand, a recipient is set to hire an IHSS-authorized provider.
Some counties hire IHSS homemakers, while others contract out IHSS providers. In other cases, recipients may hire an IHSS provider directly. These providers are called Independent Providers (IP).
All providers must be registered as IHSS providers. They must be registered through the recipient’s county’s IHSS program.
Otherwise, recipients are required to partially pay providers out of their own pockets. The same thing goes for services that are not approved by IHSS. When IHSS recipients do not qualify for full IHSS cost benefits, they may be required to pay a small fee each month. Their contributions are called Share-of-Cost (SOC). They are like health insurance deductibles. They are the portion of IHSS fees that are paid by the recipient. They must be paid out in full before IHSS releases any funds.
When a recipient opts to use an Independent Provider, they are responsible for hiring, firing, supervising that worker. However, the worker is still paid through IHSS online payroll program.
An IHSS social worker will use supportive evidence to determine a recipient’s monthly service hour allotment. State limits do not permit more than 195 service hours for non-severely disabled individuals. Meanwhile, the monthly limit of service hours for severely disabled adults is 283. Of course, the social worker will perform regular reevaluations to determine if a recipient’s service needs have changed. Reevaluations occur at least once every 12 months. Or else, they are ordered when a recipient’s functions have reportedly changed.
Paying for IHSS Services
IHSS Wages vary from county to county. You can check out the most up-to-date IHSS wages by county by visiting https://www.cdss.ca.gov/agedblinddisabled/res/CoIPWages/IPWages.pdf. Some providers may be exempt from typical disability insurance and Social Security tax paycheck withholdings. All IHSS provider payments are issued by the state. They are issued under set service limits and information logged on IHSS electronic timesheets.
Recipient may pay for some or none of the IHSS services that they receive. Individuals who receive IHSS free of charge include:
- Those who maintain a SSI-linked Medi-Cal membership status
- Those who receive Medi-Cal through the SSI program
- Those that are recipients of Medi-Cal’s WDP program
One exception to the rule:
Recipients who are part of Medi-Cal’s Working Disabled Program have higher gross income limits.
Other recipients will need to share the cost of their IHSS services. These individuals include:
- Medi-Cal recipient whose countable gross income is above IHSS’s gross income threshold
- People with SSDI benefits that are above the IHSS’s gross income level
- People who receive SSDI benefits but have retirement benefits that are above IHSS’s gross income threshold
Recipients have lots of rights within the IHSS program. They can request a reassessment of their allotted service hours. They can opt to hire or fire their provider.
Important IHSS Contact Information
IHSS Helpline: (888) 822-9622 (Monday-Friday 8 a.m. to 5 p.m.)
Americans with Disabilities Act (ADA): (844) 586-5550
Provider Registry: (877) 565-4477
IHSS Provider Self-Service Line: (844) 800-9095
California IHSS Service Desk: (866) 376-7066