In-Home Supportive Services

What Is the In-Home Supportive Services Program?

The flagship program, under California’s Department of Social Services, provides essential personal-care services to hundreds of thousands of low-income Californians. It enables them to live safely and independently so they don’t have to go into an institutionalized setting.2

Many seniors prefer in-home care because they prize their freedom, are more comfortable in a familiar environment, and want to retain a sense of autonomy.

The types of services the IHSS program provides include:

• Housekeeping, cleaning, and laundry services
• Meal preparation and cooking
• Grocery shopping
• Personal-care services such as dressing, feeding, and grooming
• Transportation and accompaniment to medical appointments
• Paramedical services such as injections, catheters or feeding tube insertion, oxygen care, medicine administration, and wound treatment
• Aid with personal care services at a disabled person’s workplace; IHSS can also help you get, keep, or return to work (conditions apply so check with the experts at IHSS)

What Are the Eligibility Requirements?

In order to be considered for the program, you must:

• Be a California resident
• Be 65 or older, blind, or disabled
• Have a Medi-Cal eligibility determination
• Complete a Health Care Certification form

In-home services are not available to people who live in an acute care hospital, long-term care facilities, or community care facilities. That’s because the program is designed to help people already in homes stay there. Another important thing to note: IHSS does not provide 24-hour care. If that’s something you need, you will need to find another program that can serve you.

The IHSS provides caps on the number of hours per task. Whoever you choose as your provider will have to keep track of their time, since the program requires submitted timesheets in order for your helpers to be paid. They must also adhere to the rules, which say they can’t spend more than one hour per week food shopping for you. Another rule says they can’t devote more than six hours every month to domestic services.

What Is the Process?

If you or a loved one can benefit from the IHSS program, the first step is to complete the application and submit it to the appropriate county IHSS office. The next step will be welcoming a county social worker into your home for an interview. During the intake assessment, the social worker will talk to you and perhaps your family and physician about the tasks you can safely perform on your own and which ones require help.

The social worker will conduct a comprehensive review that includes your medical history, medications, household information, and a short mental health assessment. At that time, the social worker will also document if additional services — such as adult protective services, child protective services, and community or language services — may be needed.

From there, the social worker will determine which services you qualify for and for how many hours per week can be authorized for services. The social worker will then submit their findings. The completed Health Care Certification form must also be submitted to the Department of Social Services before any services can be authorized.

If you are denied coverage through the program, you can appeal and request a hearing. Assuming you are approved, you will next find out how many hours per month are covered and at what pay rate. Then you (or a family member) can hire people to help you. You’re viewed as the employer, so you are the one responsible to hire, train, and oversee the providers. If the workers you hire don’t work out, it’s up to you to fire them as well.

Check to see your county registry and which IHSS providers they contract with so you can choose from their list.

Do I Need to Pay Anything Out of Pocket for IHSS?

In some cases, you may have to pay out of pocket for part of the expense. That determination is made based upon your Social Security benefits. If they are above a certain dollar amount, you may be forced to pay a portion of the IHSS benefits. The following people typically have to pay a portion of IHSS costs:

• People who receive Social Security Disability Insurance and do not work at all, if their benefits are high enough to put their countable income above the Social Security monthly benefits rate.
• Those who get veterans benefits or other unearned income and do not work at all and whose unearned benefits are high enough to put their countable income above the SSI monthly benefits rate. Note that most veterans do not have to pay a share of the cost.
• People who receive 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 Social Security monthly benefits rate.

Those are just some instances in which people may have to pay. Each individual case is different, so it’s best to find out more from your county office.

Reminders About the IHSS Program

If you are considering applying for the IHSS program, remember the following:

• The number of hours a provider can perform a certain task is limited.
• You cannot use the IHSS program if you live in a nursing home or assisted living facility.
• You can hire family members to carry out the duties provided by the IHSS program.
• Depending on your eligibility, you may receive as many as 283 hours of help from the IHSS program per month.
• You will need to keep track of hours, and so will your workers in order to be paid.

The IHSS program is open to people on Medi-Cal, which is what the Federal Medicaid program is called in California. The intention is to help low-income older adults remain in their homes as long as possible by having caregivers help them with specific daily functions.

If you require more comprehensive services for the treatment of a chronic condition or disease, for example, you may want to consider a nursing home or assisted living program. Those options may better help older adults who need access to skilled nurses and 24/7 assistance.

How Do I Apply for IHSS?

To begin the process of eligibility for IHSS, complete an application and submit it to your county IHSS office or call your local office for more information.

Do Other States Offer Similar In-Home Supportive Services?

Yes, but the programs have different names and are under the administration of various agencies and departments. All of them have the goal of helping seniors remain in their homes and avoid going to expensive nursing homes.

Eligibility for seniors in the following programs usually applies for residents ages 60 and above. (Massachusetts’ program also helps those under age 60 who have dementia or Alzheimer’s, and Texas’ program begins for those over 18 years old.) The following states’ in-home services and care programs all serve varying functional needs and have various income requirements. Check out their websites or contact them for more information.

• New York: Expanded In-Home Services for the Elderly Program (EISEP) from the New York State Department of Health
• Massachusetts: Home Care Program from the Executive Office of Elder Affairs
• Texas: Community Care for Aged/Disabled (CCAD) program from Texas Health and Human Services
• Florida: Home Care for the Elderly (HCE) program from the Florida Department of Elder Affairs
• Illinois: Community Care Program (CCP) from Illinois Department on Aging