Page Reviewed / Updated - April 18, 2020
The IHSS (In-Home Supportive Services) Program provides non-medical care to elderly or disabled Californians in their homes or places of residence. State policymakers designed the program to prevent the unnecessary placement of individuals in Medicaid (Medi-Cal) funded nursing homes. Services are not available in skilled nursing homes, assisted living residences, or adult foster care homes.
Program participants are assessed to determine their daily care needs with input from the participants, family members, caregivers, and medical professionals. After the in-person assessment, qualified applicants are approved for a collection of services for a specific number of hours per month. Unfortunately, caregivers are not permitted to work overtime by the state and federally funded program.
Once approved, participants are responsible for "self-directing" their care. Self-direction is also referred to as consumer direction and is based on the Medicaid concept of Cash and Counseling. Under IHSS, the care recipient is the boss and can hire, supervise, and terminate his/her caregiver’s employment. In addition to giving the participant greater control, this program is very popular with families because some family members, including the adult children can be paid to aid their elderly parents. In some circumstances, even spouses can be paid to provide care for their husband or wife.
There are four categories of recipients or sub-programs that make up IHSS:
1. IHSS Residual Program (IHSS-R) – provides personal care for persons not fully Medi-Cal eligible
2. IHSS Independence Plus Option Program (IPO) – pays spouses for providing personal care
3. Personal Care Services Program (PCS) - provides personal care for persons fully Medi-Cal eligible whose care is not provided by a spouse
4. Community First Choice Option Program (CFCO) – provides personal care and other in home supports for fully Medi-Cal eligible persons who would otherwise require a level of care consistent to that which is provided in a nursing home
The IHSS program is open to California residents who are 65 and over or younger individuals who are officially disabled or blind and qualify for Medi-Cal (California Medicaid). Applicants do not necessarily need to be on full Medi-Cal, but they must have applied and received a determination of their eligibility. Share of cost Medi-Cal beneficiaries can participate. Financial eligibility for Medi-Cal is nuanced and complicated and the state allows multiple pathways to gain eligibility.
A simplified view of eligibility, as of April 2020 (please note that the income limits change in April of each year), is as follows. Single, elderly state residents qualify if their countable monthly income is less than $1,294 per month, or annually, less than $15,528. A married couple is permitted monthly income up to $1,747, which is equal to $20,964 annually. (The income limits are 100% of the Federal Poverty Level plus a $230 income disregard for a single applicant and a $310 income disregard for a couple). Please note that an additional income increase is set to be implemented in August 2020. At this time, the income limit will be 138% of the Federal Poverty Level. This means a single applicant will be able to have income up to $1,486 / month ($17,832 / year) and a couple will be allowed income up to $1,983 / month ($23,796 / year). To be clear, there will no longer be an additional income disregard. However, there are exceptions, and persons with incomes over the above stated amounts can still be eligible.
There are also “countable asset” limits. Assets include essentially all of one’s resources except their home, household furnishings, vehicle, and certain other small personal items, such as engagement and wedding rings. In 2020, the asset limits remain unchanged from previous years, at $2,000 for an individual and $3,000 for a couple.
There are many exceptions and pitfalls to eligibility for Medi-Cal. Persons unsure of their Medi-Cal eligibility status should consult with a Medi-Cal Planning Professional prior to application.
The IHSS program provides non-medical assistance services. Program participants choose their "individual provider," the individual who provides these services, rather than the state choosing the provider on their behalf. As the services provided are largely unskilled services, participants are free to choose whomever they prefer to provide these services. As mentioned above, service providers can include family members, such as the adult children of aging parents and even spouses.
Service providers are paid an hourly rate set by Medi-Cal that is county dependent. As of 2020, these rates are between $13.00 and $16.50 / hour. In general, the value of the services provided through the IHSS program will not exceed $3,500 per month and typical recipients average closer to $2,200 per month. (Please note that updated figures for service amounts for 2020 could not be found, so these amounts may have changed). Legally, one can receive up to 283 hours per month of assistance, but in practice receiving that level of assistance is rare. Furthermore, there are hourly limits for the type of assistance. For example, one would not be approved to receive 40 hours of laundry assistance per month.
Possible benefits include the following:
The cost of services can be covered entirely by the state or program participants' may be responsible for a "share of cost," if their incomes exceed the monthly limit.
Additional information about the IHSS Program can be found here. This program is administered by each California county separately. Once the elderly individual has a Medi-Cal number, he/she can apply for the program by contacting their local IHSS office. Contact information for each county can be found here. Applicants will have their needs assessed and that assessment will likely require the candidate to provide medical information.