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.
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 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 a program beneficiary requires and the number of monthly service hours a program beneficiary can receive. Maximum hours are approximately 195 / month for those without 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 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. Note: Persons who reside in long-term care facilities and have a planned discharge to return home can apply for IHSS prior to being discharged.
Eligibility Requirements for In-Home Supportive Services
The IHSS Program is for California residents who are elderly (aged 65+), blind, or disabled. While additional eligibility requirements may vary based on the program within IHSS, general criteria follows.
Financial Criteria: Income & Assets
Income
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 4/1/25, the income limit for the IHSS program for a single applicant is $1,801 / month, and for a married couple, it is $2,433 / month.
There is an exception as to how income is treated for IHSS’ Community First Choice Option (CFCO). 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 $1,801/ month. Furthermore, up to $3,948 / month (in 2025) can be transferred from the applicant to their non-applicant spouse as a Spousal Income Allowance. Also called a Monthly Maintenance Needs Allowance, it 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 $3,948 / month are not entitled to a Spousal Income Allowance.
Assets
Currently, there is no asset limit (eff. 1/1/24). An applicant’s assets, regardless of value, are not considered in the eligibility process. However, California is reinstating their asset limit eff. Jan. 1, 2026. At this time, the asset limit will be $130,000 for an individual and $195,000 for a couple.
With the asset reimplementation eff. 1/1/26, assets of a married couple with just one spouse applying for IHSS’ Community First Choice Option will be treated differently. While the couple’s assets will still be considered jointly owned, the applicant spouse will be able to keep $130,000 in assets and the non-applicant will be allocated a larger portion of the assets to prevent spousal impoverishment. This is called a Community Spouse Resource Allowance and will allow the non-applicant spouse to keep up to approximately $157,920 in assets.
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 on 1/1/24, assets transferred on or after this date 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. Note: With the reimplementation of the asset limit eff. 1/1/26, Medi-Cal will reinstate their 30-month Look-Back Period for Nursing Home Medicaid. Learn more.
While Medi-Cal has a Medicaid Estate Recovery Program (MERP), it is not applicable to IHSS.
Medical Criteria: Functional Need
An applicant must have a medical need for care services and be at risk of institutionalization (nursing home care) without program assistance. For the Community First Choice Option, however, the functional need requirement is stricter. 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, is 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 (i.e., paying their IHSS caregiver). 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”.
With the reimplementation of the asset limit eff. 1/1/26, Medicaid Planners can also be extremely instrumental in implementing planning strategies to lower one’s countable assets. 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.
Applicants will need to gather documentation to be submitted with their application. 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 simultaneously.
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.
More on 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.