California Medicaid (Medi-Cal) In-Home Supportive Services (IHSS) Program: Benefits, Eligibility & Application Process

Last updated: March 26, 2024


Overview of Medi-Cal’s In-Home Supportive Services Program

The In-Home Supportive Services (IHSS) Program is a statewide Medi-Cal program that provides long-term services and supports for California residents who are aged, blind or disabled and at risk of nursing home placement. Available benefits include personal care assistance and homemaker services to assist these individuals in living safely and independently in their home or the home of a loved one. Program participants have the option to self-direct their care, which allows them to choose and hire their own caregivers, including friends and relatives.

Within IHSS, there are 4 programs, the first two of which serve the majority of IHSS program beneficiaries.

– Community First Choice Option (CFCO) – for Medi-Cal eligible persons who require a Nursing Home Level of Care.
– Personal Care Services Program (PCSP) – for Medi-Cal eligible aged, blind or disabled individuals who require personal care assistance, but do not require the level of care that is provided in a nursing home.
– IHSS Plus Option Program (IPO) – provides payment to spouses or parents of Medi-Cal eligible persons who do not need a Nursing Home Level of Care, but require care assistance, and receive it from a spouse or parent. Prior to becoming a Medi-Cal State Plan Option, this program was called the IHSS Plus Waiver.
– IHSS Residual Program (IHSS-R) – provides a pathway of eligibility for persons who are not eligible for Medi-Cal, but require In-Home Supportive Services.

The In-Home Supportive Services Program is available through California’s Regular State Medicaid Plan. In California, the Medicaid program is called Medi-Cal.

 HCBS Medicaid Waivers versus HCBS State Plan Medicaid?
While home and community based services (HCBS) can be provided via a Medicaid Waiver or a state’s Regular Medicaid plan, HCBS through Medicaid State Plans are an entitlement. Meeting the program’s eligibility requirements guarantees an applicant will receive benefits. On the other hand, HCBS via Medicaid Waivers are not an entitlement. Waivers have a limited number of participant enrollment slots, and once they have been filled, a waitlist for benefits begins. Furthermore, HCBS Medicaid Waivers require a program participant require the level of care provided in a nursing home, while State Plan HCBS do not always require this level of care.


Benefits of the In-Home Supportive Services Program

Follows is a list of the benefits available via the In-Home Supportive Services Program. Program beneficiaries only receive the services required to safely remain in their homes. A needs assessment determines the services required and the number of monthly service hours a program beneficiary can receive. Maximum hours are approximately 195 / month for those who do not have severe impairments, while persons severely limited in their functional ability can receive up to approximately 283 hours of care per month.

– Homemaker Services – housecleaning, laundry, shopping, errands, and cooking
– Paramedical Services – wound care, catheter care, injection assistance, blood sugar checks
– Personal Care Services – non-medical assistance with daily living activities, such as bathing, dressing, toileting, and eating
– Protective Supervision – supervision for cognitively or mentally impaired persons to help prevent accidents and injuries
– Teaching / Demonstration Services – provider taught tasks to teach beneficiary to do housework, prepare meals, bathe, etc.
– Transportation Assistance – escorting to & from medical appointments

IHSS services may be received in one’s home or the home of a family member. Persons cannot live in a community care facility or long-term care facility. This includes assisted living residences and adult foster care homes.

 Another option that California residents might want to consider is the Medi-Cal Community-Based Adult Services Program. Although not available statewide, this program offers out-of-home daytime care and supervision at designated CBAS centers.


Eligibility Requirements for In-Home Supportive Services

The IHSS Program is for California residents who are elderly (65+), blind, or disabled. While additional eligibility requirements may vary based on the program within IHSS, follows is the general criteria.

Financial Criteria: Income & Assets

The applicant income limit is equivalent to 138% of the Federal Poverty Level (FPL). While this figure increases annually in January, for California Medicaid, the income limits increase each April. Effective 4/1/24, the monthly income limit for the IHSS program for a single applicant is $1,732. When both spouses are applicants, there is a couple income limit of $2,352 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $1,732 / month. Furthermore, in some cases, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance. In 2024, the maximum amount that can be transferred is $3,854 / month and is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. Non-applicant spouses who have their own income equal to or greater than this amount are not entitled to a Spousal Income Allowance.

There is no asset limit (effective 1/1/24). An applicant’s assets, regardless of value, are not considered in the eligibility process.

There is a Look-Back Period during which Medi-Cal scrutinizes past asset transfers of persons applying for nursing home care, but it is not applicable to persons applying for the In-Home Supportive Services Program. However, if one may require Nursing Home Medicaid in the near future, it may be applicable. With the elimination of the asset limit, assets transferred on or after 1/1/24 are not considered. Assets transferred prior to 1/1/24 are still being scrutinized, but the 30-month “look back” is being phased out month-by-month and will no longer exist by July of 2026.

While all assets are disregarded when determining Medi-Cal eligibility, one’s assets are not necessarily safe from the Medicaid Estate Recovery Program (MERP). Following the death of a long-term care Medicaid beneficiary, the state attempts reimbursement of long-term care costs for which it paid for that individual via their remaining estate. This may include one’s home. With the utilization of proper planning strategies, one can protect their home and other assets from being used as reimbursement and instead go to loved ones as inheritance. Contact an Experienced Medi-Cal Planner for assistance.


Medical Criteria: Functional Need
 A Nursing Home Level of Care is not necessarily a requirement to receive care services via Medi-Cal’s In-Home Supportive Services Program

An applicant must have a medical need for care services and be at risk of institutionalization (nursing home care) without program assistance. Recall that within the In-Home Supportive Services Program there are 4 subprograms. To be eligible for the Community First Choice Option, an applicant must require a Nursing Facility Level of Care (NFLOC). Upon application for the IHSS program, a needs assessment is completed by the social services agency in one’s county. As part of the assessment, an applicant’s care needs are ranked from 1 to 6. A ranking of 1 indicates that an individual can function independently, while a ranking of 6 indicates an individual requires the greatest level of care available through the program. An applicant’s ability to independently complete Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, eating, toileting) is one area that is considered during the assessment. Relevant to some persons with Alzheimer’s disease or a related dementia, cognitive functioning, such as one’s capacity to retain information or problem solve, are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.


Qualifying When Over the Limits

Having income over Medicaid’s limit does not mean an applicant cannot still qualify for the In-Home Supportive Services Program. Medi-Cal has a Share of Cost program, also called a Medically Needy Program. With this program, an applicant with income over Medi-Cal’s income limit qualifies for the program by paying a “share of cost” for their care services / medical expenses. This can be thought of as a deductible and is based on one’s monthly income. Once one has paid their share of cost for the month, the IHSS Program will pay for services and supports the remainder of the month. Professional Medicaid Planners can assist persons in lowering their “share of cost”. Find a Medi-Cal Planner.


How to Apply for In-Home Supportive Services Program

Before You Apply

Prior to submitting an application for the IHSS Program, applicants need to ensure they meet the eligibility criteria. Applying when over the income limit may be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.

s part of the application process, applicants will need to gather documentation for submission. Examples include proof of income and copies of Social Security and Medicare cards. Unfortunately, a common reason applications are delayed is required documentation is missing or not submitted in a timely manner.


Application Process

To apply for the In-Home Supportive Services Program, applicants should contact the IHSS office in their county and submit an Application for In-Home Supportive Services (SOC 295). Persons not currently enrolled in Medi-Cal must apply via the Application for Health Insurance. Persons can apply for Medi-Cal independently of applying for the IHSS Program or at the same time. As part of the IHSS application process, an in-home functional needs assessment is completed by a county social worker to determine if services are required to safely live at home, and if so, the level of assistance required. A Health Care Certification Form (SOC 873) must be completed and submitted by a licensed health care professional prior to services being provided. Program applicants will receive a notice of action (NOA) indicating whether they have been approved or denied for IHSS services. If approved, the authorized services and total monthly hours of services permitted will be included.

Learn more about the In-Home Supportive Services Program. Alternatively, persons can contact their local IHHS county office.

The In-Home Supportive Services Program is administered by the California Department of Health Care Services (DHCS) and the California Department of Social Services (CDSS).


Approval Process & Timing

The Medi-Cal application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further.

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