In Home Supportive Services (IHSS) Program
The In-Home Supportive Services (IHSS) program provides in-home assistance to eligible aged, blind and disabled individuals as an alternative to out-of-home care and enables recipients to remain safely in their own homes. IHSS currently serves over 550,000 recipients by over 460,000 providers. To learn how to apply for services: Get Services IHSS.
Services covered by the IHSS program include domestic and related services (e.g. housework, meal preparation and clean-up, laundry, shopping for food/running errands); non‑medical personal care services (such as bathing, ambulation, and bowel/bladder care); transportation services (such as accompaniment to medical appointments); paramedical services (necessary health care activities that recipients would normally perform for themselves were it not for their functional limitations); and protective supervision.
Important Program information:
The administration of IHSS is a complex partnership that includes the following entities: program recipients, the California Department of Social Services (CDSS), Department of Health Care Services (DHCS), counties, public authorities, program advocates, providers, and employee unions.
IHSS is currently comprised of four programs:
- The original IHSS program, now named IHSS-Residual (IHSS-R), began in 1974 and is a state-and-county funded program with 65% State and 35% county dollars of the non-federal share. IHSS-R recipients make up less than 2% of the overall IHSS population.
- The Personal Care Services Program (PCSP) began in April 1993, and was the first IHSS program to obtain federal funding for recipients. PCSP recipients are eligible for full-scope Federal Financial Participation (FFP), and these Medi-Cal services are funded with 50% Federal, 32.5 % State, and 17.5% County dollars. PCSP recipients make up about 55% of the overall IHSS population.
- The IHSS Plus Option (IPO) began in September 2009 and replaced the IHSS Plus Waiver (IPW) demonstration program (more information below on the IPW). Recipients are also eligible for full-scope FFP Medi-Cal. IPO provides assistance to recipients who have parent-of-minor or spouse providers, or who receive Advance Pay (AP) and/or Restaurant Meal Allowance (RMA). Since the inception of the Community First Choice Option (CFCO) in 2011 (more below), the IPO recipients make up a little over 2% of the overall IHSS population.
- The Community First Choice Option (CFCO) was established through the Affordable Care Act of 2010 (enacted March 23, 2010) as a new State Plan option. CFCO provides home and community-based attendant services and supports for individuals who are eligible for medical assistance under the State Plan who meet specific income criteria and meet the Nursing Facility Level of Care (NF LOC). CFCO provides States with 6% additional federal funding for services and supports. CFCO was approved with an implementation date of December 1, 2011. CFCO recipients make up about 41% of the overall IHSS population.
IHSS assessments are completed during home visits at the initial intake assessment and annual reassessments. Recipients may request for a reassessment of need at any time if their needs or circumstances change. County social workers continuously monitor recipients’ cases and have frequent contact with recipients to ensure their needs are appropriately met through program services. IHSS social workers complete a needs assessment for each applicant or recipient using the following criteria: the Functional Index Rankings, the Annotated Assessment Criteria, and the Hourly Task Guidelines (HTGs).
Service authorizations are assessed during the needs assessment, which is a comprehensive review of the recipient’s medical history/diagnosis, medications/purpose, emergency contacts, physicians’ information, household composition, functional index rankings, mini-mental health assessment, necessary referrals to Adult Protective Services (APS), Child Protective Services (CPS), Fraud, community services, etc., language preferences and whether an interpreter is needed, and a full biopsychosocial assessment. The social worker needs to document all service needs and justify service authorizations in the case narrative.
IHSS Provider Enrollment Process
Upon approval of the recipient’s service authorizations, the social worker will assist the recipient in obtaining an IHSS care provider.Care providers may include, but are not limited to, family members, friends, neighbors, or registered providers through the public authority.
Time Sheet Processing
After the care provider has been successfully enrolled and is approved as the IHSS provider, s/he will receive time sheets in the mail retroactive to the date of application. The IHSS program has two pay periods from the 1st through the 15th and the 16th through the end of the month. Care providers will complete these time sheets based on the hours they have provided care to the IHSS recipient.Care providers and recipients will sign the time sheets and submit them to the county to process payments through the statewide Case Management, Information, and Payrolling System (CMIPS).