Understanding IHSS and How the Program Works

What IHSS Is and Why It Exists

In-Home Supportive Services, or IHSS, is a California program that pays certain people to help with care and household tasks for individuals who have disabilities, are elderly, or have health conditions that make daily living difficult. Think of it this way: instead of moving into a care facility, someone can stay in their own home and have a paid caregiver—often a family member—help them with things like bathing, dressing, meal preparation, and cleaning.

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The program started because many people prefer to age or recover at home rather than in institutions. IHSS recognizes this preference and structures itself around paying for that care to happen. The state of California funds most of the program through Medicaid (called Medi-Cal in California), with the federal government covering a portion and counties handling some costs too.

The program serves roughly 700,000 people across California, making it one of the largest in-home care programs in the country. Recipients range from a 25-year-old with a spinal cord injury to an 85-year-old managing multiple chronic conditions. Some people receive just a few hours of care per week; others get 24-hour support.

One important distinction: IHSS is not a program you go to for money directly. It's a program through which the state pays caregivers on behalf of people who need help. The person receiving care doesn't receive a paycheck—instead, the caregiver they hire (or whose hire they arrange) receives one.

Key takeaway: IHSS exists to keep people in their homes while ensuring they get paid care for necessary daily tasks. Understanding this purpose helps clarify how the program's rules and processes work.

Who Can Receive IHSS Services

IHSS serves people in specific situations, and California has clear criteria for who may be eligible. First, a person must be a California resident. This typically means they live in the state and plan to stay, though the definition has some nuances for people in transition.

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The person receiving care must also have a qualifying condition. This includes:

• Being age 65 or older
• Having a disability recognized by Social Security (which includes physical disabilities, mental health conditions, developmental disabilities, and many others)
• Being blind (including legally blind, as defined by California)

Beyond these basic categories, there's another critical piece: the person must have a medical need for the services. This isn't about having any condition—it's about having specific functional limitations. For example, someone with arthritis might not be able to bathe safely, or someone recovering from surgery might temporarily need help with household tasks. A doctor or nurse assesses these needs.

There are also financial limits. IHSS recipients must have limited income and assets. In 2024, income limits are roughly $1,700 per month for a single person (though this changes yearly and varies by family size). Assets like property, vehicles, and savings also factor in, but the rules are complex—for instance, the home where someone lives typically doesn't count against the limit.

One detail that surprises people: IHSS serves people regardless of citizenship or immigration status, as long as they meet the other requirements. This has been true since the mid-1990s when California separated IHSS from other welfare programs.

Key takeaway: IHSS isn't automatic for anyone with a disability or age. The program looks for three things: residency in California, a qualifying condition or age, and documented functional needs that make certain daily tasks difficult.

How the IHSS Assessment Process Works

Once someone contacts their local IHSS program (usually through the county social services or welfare department), a series of steps begins. The first step is usually paperwork and an intake interview. A caseworker asks about the person's situation: where they live, who lives with them, what tasks they struggle with, what income they have, and what assets.

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Next comes the critical medical assessment. A nurse or other health professional visits the person's home or meets with them to understand their condition and functional limitations. This isn't a diagnosis visit—the assessor isn't determining what's wrong with the person. Instead, they're documenting what the person can and cannot do. Can they bathe themselves? Can they prepare meals? Can they manage their medications? Can they clean and do laundry?

The assessor also looks at the person's living situation. Is the home safe? Are there stairs, mobility issues, or other physical barriers? Does the person live alone? These factors influence how many hours of care might be needed and what type of tasks the caregiver should handle.

Based on this assessment, the program determines an "hours authorization"—essentially, how many hours per month a caregiver can work for that person. For example, someone might be authorized for 200 hours per month, while another person gets 80 hours. This number reflects the assessed needs, not the person's preference or the caregiver's schedule.

It's worth noting that this authorization isn't permanent. IHSS periodically recertifies people, usually every 12 months for younger recipients and less frequently for people over 75 who are stable. If someone's condition changes—they get worse or improve—the hours can be adjusted.

Key takeaway: The IHSS assessment isn't quick or simple, but it's designed to match the person's actual needs with the care hours available. This process protects both the recipient and the program from mismatches between need and service.

How Caregivers Get Paid and What Roles They Play

Here's where IHSS differs from typical employment: the caregiver doesn't work for IHSS or the government directly. Instead, the program pays the caregiver through a process that feels like employment but has some unique features.

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The caregiver is typically hired by the person receiving care (or a representative of that person if they're unable to hire independently). The caregiver can be a family member—a spouse, adult child, parent, or sibling. They can also be an unrelated person hired through an agency or found independently. However, certain restrictions apply: you generally can't hire a spouse if you have an adult child available, and if you have a non-disabled spouse in the home, that spouse usually can't be paid through IHSS.

Once hired, the caregiver must go through some setup steps. They need to provide Social Security information and pass a background check. IHSS contracts with third-party agencies (called "public authorities" in some counties or "payroll providers" in others) to handle the actual payment. The caregiver reports hours worked, and the payroll agency processes payment. Payment rates vary by county but typically range from roughly $16 to $20 per hour, though rates continue to change as California adjusts them.

The caregiver's role covers personal care tasks and household help. Personal care includes bathing, dressing, grooming, toileting, and mobility assistance. Household help includes meal preparation, laundry, cleaning, and shopping. The caregiver does not provide medical care like injections, wound care, or medication administration—that requires a licensed nurse. They also generally don't provide childcare, pet care (with some exceptions), or transportation.

Importantly, the caregiver works flexible hours within the authorized amount. If someone is authorized for 200 hours per month, that could be 5 hours per day, 7 days a week, or 8 hours on weekdays only—whatever the recipient and caregiver arrange. This flexibility is one reason families find IHSS appealing compared to agency-based care.

Key takeaway: IHSS caregiving is like independent contracting rather than traditional employment. The person needing care directs what happens, hours are flexible within limits, and payment goes through a government payroll system that handles taxes and worker records.

The Financial Picture: What IHSS Costs and Who Pays

Understanding IHSS costs matters for both recipients and the people considering becoming caregivers. The total cost of the program statewide is substantial—California spends roughly $22 billion annually on IHSS, making it one of the state's largest Medicaid programs.

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For the recipient receiving care, IHSS is free. The person doesn't pay for the caregiver's wages, and there's no