In-Home Supportive Services (IHSS) provide people with low-income who have disabilities or are 65 years old or older with in-home and personal care services to help them live safely in their own homes. Services you can get include:
- Domestic services, such as sweeping, vacuuming, taking out the garbage, wheelchair cleaning and battery recharging, and changing bed linens
- Related services, such as meal preparation and cleanup, laundry, and shopping
- Personal care services, such as feeding, bathing, grooming, dressing, bowel and bladder care, and help with medications
- Transportation to medical appointments or alternative sources of services like day programs
- Removal and cleanup of yard hazards
- Heavy cleaning
- Protective supervision for cognitively or mentally impaired persons to safeguard from self-injury or hazard
- Paramedical services, as ordered by a physician, such as injections, range of motion exercises, and catheter insertion, and
- Help with personal care services at a disabled person’s workplace, but not with job-related services.
IHSS is often seen as an alternative to out-of-home placement, such as assisted living or nursing facilities.
If you need 24-hour care, you will need to make other arrangements for your non-IHSS hours, such as through a Home and Community-Based Waiver (HCBW). To learn more about HCBWs, contact the Department of Health Care Services In-Home Operations at 1-916-552-9105 (Northern California) or 1-213-897-6774 (Southern California).
Your Responsibilities with Your Care Provider
You are responsible for hiring, firing, and supervising your care provider. If your county has contracted IHSS providers, you can hire them to provide you with the necessary services. You can also hire a friend, relative, neighbor, or other care provider.
Wages for IHSS care providers vary from county to county. You and your care provider must submit timesheets for all authorized services provided. The state will handle payment of your care provider(s) unless you are getting advance pay.
The In-Home Supportive Services Consumer Training Handbook (PDF) offers detailed information about how to supervise a care provider, including issues like hiring, firing, communication, safety, and handling payment. There is more information about this on the California Department of Social Services’ website.
Advance pay means the state sends you funds before your In-Home Supportive Services are performed, so you can pay your care provider directly. To get advance pay, you must be considered “severely disabled,” meaning you need at least 20 hours per week in personal care services, meal preparation and cleanup, and/or paramedical services.
What You Pay
Many people get In-Home Supportive Services free of charge. This includes anybody who gets one of the following types of Medi-Cal:
- SSI-linked Medi-Cal
- Medi-Cal through SSI 1619(b) for people who used to get SSI cash benefits and now make up to $36,928 per year ($38,248 for people who are blind).
- California Working Disabled (CWD) Program Medi-Cal, which lets people with disabilities make up to $59,400 per year and pay an affordable premium for coverage.
Read more about these types of Medi-Cal in DB101’s article on Medi-Cal. People who do not get their Medi-Cal in these ways may need to pay a share of cost, which means that each month, they would pay a portion of the expenses for their IHSS.
Do You Have to Pay a Share of Cost?
If you do not get one of the above types of Medi-Cal, you may still be able to get no-cost IHSS if your countable monthly income is less than the SSI monthly benefits rate in California — $877.40 for an individual or $1,478.20 for a couple in 2014. (We’ll explain more about how countable income is calculated below.)
If your countable monthly income is above the SSI benefits rate, you can still get IHSS if you meet all other eligibility criteria. You may, however, would have to pay a share of cost.
Here are the most common groups of people who have to pay a share of cost for IHSS:
- People who get Social Security Disability Insurance (SSDI) and do not work at all, if their SSDI benefits are high enough to put their countable income above the SSI monthly benefits rate.
- People who get veterans benefits or other unearned income and do not work at all, if their unearned benefits are high enough to put their countable income above the SSI monthly benefits rate.
- People who get 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 SSI monthly benefits rate.
If you have a disability and you start working, you could probably qualify for no-cost IHSS, because you could sign up for Medi-Cal’s California Working Disabled (CWD) Program. Read more about CWD in DB101’s article about Medi-Cal.
Your share of cost is based on your countable income. Here’s a brief intro to the 2 types of countable income you may have:
- Unearned income includes monthly disability payments or other income you get without doing any work. Examples include disability benefits (SDI, SSDI, STD, LTD), income from a trust or investment, dividends, and profits or funds you get from any source other than work. Some unearned income is not counted, such as CalFresh (formerly Food Stamps).
- Earned income includes your monthly salaries, wages, tips, professional fees, and other pay for physical or mental work you do.
Use the following steps to figure out your IHSS share of cost (if any).
If you have monthly unearned income, subtract a $20 general income exclusion from it. (If you do not have unearned income, this exclusion is applied to any earned income.) The resulting number is your countable unearned income.
- Example: If you get $1,000 per month in SSDI benefits, you would have $980 in countable unearned income.
If you have monthly earned income, subtract a $65 earned income exclusion from it. Also subtract $20 if you didn’t have unearned income during the month. If you had any Impairment Related Work Expenses (IRWEs), you can also subtract the cost of these expenses from your earned income. Once you’ve done all of that, divide the remaining number by 2. The resulting number is your countable earned income.
- Example: In addition to your SSDI benefit, you made $500 at your job last month. First you subtract $65, leaving $435. Then, you divide this number by 2. Once you’ve completed this, your countable earned income would be $217.50.
- Note: If you are blind and have Blind Work Expenses (BWEs), you would subtract the cost of your BWEs after you divide by 2.
Add up your countable unearned and countable earned income to find your total countable income.
- Example: If you had $980 in countable unearned income and $217.50 in countable earned income, your total countable income would be $1,197.50.
Compare your total countable income to the 2014 SSI monthly benefits rate. If your total countable income is less than that rate ($877.40 for an individual and $1,478.20 for a couple), you do not have a share of cost. If it is greater than the monthly benefits rate, you will have share of cost.
- Example: If you are an individual with $1,197.50 in countable income, you would have to pay a share of cost (unless you were able to sign up for Medi-Cal’s California Working Disabled (CWD) program). Your share of cost would be $1,197.50 - $877.40 = $320.10 per month. That means you’d have to pay $320.10 each month for the in-home support services you get and the IHSS program would pay the rest.
If you are working and have a disability, you could probably qualify for no-cost IHSS, because you could sign up for Medi-Cal’s California Working Disabled (CWD) Program as long as you make less than $59,400 per year. Read more about CWD in DB101’s article about Medi-Cal.