In-Home Supportive Services (IHSS)

The Benefit

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.

If you get IHSS, you will be a recipient and get services from providers. You can hire your own providers and have them sign up to get paid by IHSS. You can also find providers through your county’s IHSS registry, which lists providers who may want more work.

Services you can get through IHSS 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 live at home, these services are important to stay in the community. If you are currently in out-of-home placement, you may be able to apply for IHSS and move to your own home.

IHSS has a maximum number of hours and does not provide 24-hour care

IHSS provides services for a maximum of 283 hours per month, which is about 9.5 hours per day. If you need more help each day, you need to make other arrangements for your non-IHSS hours, such as through a Home and Community-Based Waiver (HCBW). HCBWs can add extra hours per day, up to full 24-hour care for recipients who need providers all the time. To learn more about HCBWs, contact the California 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

In many ways, being a recipient is like running a small business. You are responsible for hiring, firing, and supervising your care provider.

You can hire a friend, relative, neighbor, or other care provider. IHSS offices also have “registries” of providers who may want more work. If your county has contracted IHSS providers, you can hire them to provide you with the necessary services. You can work with one provider or have a team for different days and times. New providers must enroll with IHSS to get paid by the state; they must also go through a training and background check.

You can find the Individual Provider Wage Rate for IHSS care providers in your county online. You and your care providers must submit timesheets for all authorized services provided. The state will manage the payment and taxes for your care providers. Providers that work enough hours can also get benefits such as health insurance and overtime pay.

The In-Home Supportive Services Consumer Training Handbook 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.

Timesheets and Electronic Visit Verification (EVV)

Providers must submit timesheets twice per month to IHSS. IHSS uses a system called Electronic Visit Verification (EVV) where your provider tells IHSS what time they started and stopped working and the total hours worked each day. The California Department of Social Services has EVV training materials, webcasts and webinars.

You should also track the time that each provider starts working and when they stop. Then, each provider will fill out a timesheet and you will approve it. You and your providers can fill out paper timesheets and mail them to the IHSS office, or you can use IHSS’s online timesheet service.

Make sure that every timesheet is filled out correctly. If timesheets show that two providers worked at the same time, you could get a warning from IHSS. If your provider’s timesheets show that they worked for you and somebody else at the same time, your provider could get a warning from IHSS. If you or your provider get too many warnings, you or your provider may be put on probation. You may want to use a paper calendar, spreadsheet, or other system to track the hours so they are accurate.

How Your Providers Get Paid

Your IHSS providers may get paid through arrears or with advance pay:

  • Arrears means the state sends paychecks to your provider after the provider submits a completed timesheet. IHSS pays providers with a paper check or through a direct deposit to a bank account. If providers use an online timesheet and get direct deposit, it’s fast. Paper timesheets and checks take extra time to go through the mail and be processed by the state.
  • Advance pay means the state sends you funds at the beginning of the month, so you can pay your care provider directly from your bank account. You and your providers must still submit timesheets and the hours you submit must match the amount of money IHSS gives you. 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.

Note: With advance pay, the money the state sends each month will be at least $1,000 and could be much higher, depending on the number of IHSS hours you get each month. To make sure that this money does not count against any resource limits, you must pay your providers in the same month you deposit the advance pay.

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
  • Income-based Medi-Cal (also called "Medi-Cal expansion")
  • Medi-Cal through SSI 1619(b) for people who used to get Supplemental Security Income (SSI) cash benefits and now make up to $54,082 per year ($55,439 for people who are blind).
  • Medi-Cal's Working Disabled Program (WDP), which lets people with disabilities make up to $65,420 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 — $1,040.21 for an individual or $1,765.64 for a couple in 2022. (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 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. Note: Many veterans do not have a share of cost.
  • 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 work, you may not have to pay a share of cost.

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 Working Disabled Program (WDP). Read more about WDP in DB101’s article about Medi-Cal.

How to Calculate Your Share of Cost

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 (State Disability Insurance, SSDI, Short-Term Disability Insurance, Long-Term Disability Insurance), 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).

  1. 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.
  2. 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.
  3. 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.
  4. Compare your total countable income to the 2022 SSI monthly benefits rate. If your total countable income is less than that rate ($1,040.21 for an individual and $1,765.64 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 Working Disabled Program (WDP)). Your share of cost would be $1,197.50 - $1,040.21 = $157.29 per month. That means you’d have to pay $157.29 each month for the in-home support services you get and the IHSS program would pay the rest.
If you work, you probably do not need to pay a share of cost, even if your income exceeds $1,040.21!

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 Working Disabled Program (WDP) as long as you make less than $65,420 per year. Read more about WDP in DB101’s article about Medi-Cal.

Learn more