In-Home Supportive Services (IHSS)


Jack's Story

Jack is 56 years old and has cerebral palsy. He has been living alone for 30 years and is having an increasingly difficult time taking care of himself and his home. Tasks like cooking, bathing, and getting dressed in the morning take far more energy than they used to.

Jack has become depressed about the situation. He is very independent and has always prided himself on his ability to take care of his affairs on his own. The last thing he wants to do is move into an assisted care facility. He explains his situation to his friend Henry over lunch one day. Henry suggests that Jack look into In-Home Supportive Services (IHSS) as an alternative to moving into an assisted care facility.

“What’s In-Home Supportive Services?” asks Jack.

“Well, I don’t know a whole lot about it,” says Henry, “but I’ve heard it helps people with disabilities remain in their homes safely. I think they help you with the kinds of things you’re talking about — cooking, cleaning, getting in and out of bed.”

“How much does it cost?” asks Jack.

“I think it depends on your income level. If your income is low enough, I think it’s free. It’s a public program,” says Henry.

“Hmmmm. Sounds like it could be really helpful,” Jack says.

“Why don’t you call the county In-Home Supportive Services (IHSS) office,” says Henry. “I bet they’ll have information on it.”

So Henry and Jack search online to find the phone number of the nearest IHSS office. Jack calls and is transferred to an IHSS intake coordinator named Ms. Smith. Jack briefly explains his situation to her.

“I think the In-Home Supportive Services Program could be exactly what you need,” says Ms. Smith. “Let me ask you a few questions first. So you said you have cerebral palsy, correct?”


“OK,” says Ms. Smith. “IHSS is available to people with disabilities, if they need it. I’ve got a few more questions. Are you a California resident?”

“Yep. I’ve lived here my whole life.”

“Good. Are you getting Medi-Cal?” asks Ms. Smith.

“Yes, I am.” Jack says.

“Excellent!” says Ms. Smith. “That means you may qualify for IHSS if you need it. Are you on any other public benefits programs?”

“Nope, just Medi-Cal,” says Jack.

“OK,” says Ms. Smith. “Do you work?”

“I sure do,” Jack says. “Part-time as an accountant for a local manufacturing company. I make $1,600 per month,” says Jack.

“OK,” says Ms. Smith. “Do you have any other sources of income? Earned or unearned?”

“Nope. That’s it.”

“Well, you definitely qualify for the program,” Ms. Smith says. “Now we'll check if it's free of cost to you.”

“What do you mean?” asks Jack.

“Well, sometimes people with countable income above $1,133.73 per month might have to pay something for Medi-Cal and IHSS,” says Ms. Smith.

“$1,600 is more than $1,133.73, so I’m going to have to pay something, right?” asks Jack.

“Not necessarily – let me do the math here. So you have $1,600 per month in earned income. First, we’ll need to subtract $65 from that — that’s your earned income exclusion — and another $20 — that’s your general income exclusion. So that leaves us with $1,515. Do you have any impairment related work expenses?”

“Well, I couldn’t work if I wasn’t taking my medication. And I pay $40 a month in copayments for that. Does that count?” asks Jack.

“It sure does,” says Ms. Smith. “So let’s see, we subtract $40 from $1,515. That’s $1,475. $1,475 divided by 2 is $737.50. So actually, you only have $737.50 in countable income each month, which is lower than $1,182.94. That means, you qualify for no-cost In-Home Supportive Services,” says Ms. Smith.

“That’s some pretty weird math, but it’s great news for me!” exclaims Jack.

“It sure is,” says Ms. Smith. “Why don’t you come in tomorrow and fill out an application to get the process started.”

So the next day, Jack goes down to the county In-Home Supportive Services (IHSS) office office and fills out an IHSS application. Several days later, a county worker named Ms. Jones comes to visit him at his home. She is there to do a needs assessment so she can figure out what Jack needs help with and how many hours of assistance IHSS will pay for. She asks him a series of questions about his physical and mental abilities and limitations to figure out which tasks he can safely perform on his own and which tasks he needs help with.

Clearly, Jack has a sharp mind but needs assistance with things like cooking, cleaning, getting dressed, and getting in and out of bed.

“How about work,” Ms. Jones asks Jack. “Do you need any assistance there?”

“Not currently. Why? Can I use IHSS there too?”

“Yes, you can. We’d have to transfer some of the hours assigned for in-home support to the workplace, but it can be done. You can use IHSS to help you get, keep, and return to work.”

“Well, that’s good to know,” says Jack. “I probably don’t need that now. But I’ll keep it in mind for the future.”

Ms. Jones completes the needs assessment and informs Jack that he will get a Notice of Action in the mail letting him know if he has been approved or denied In-Home Supportive Services. She also tells Jack that if he is approved for services, he will be responsible for hiring and supervising his care provider. He will need to complete a Provider Enrollment Agreement form with his provider and make sure all timesheets are done properly.

Two weeks later, Jack gets a Notice of Action in the mail with good news. He has been approved for 60 hours of IHSS each month. Jack won’t have to pay anything and all of his authorized services will be covered by IHSS. Jack is thrilled and hires Wendy, a retired neighbor and long-time friend, to provide the services. Wendy comes by every day to help Jack in and out of bed. She prepares meals for him, cleans, and does some of his laundry. She also provides personal care services like dressing, grooming, and bathing. When necessary, she drives Jack to his doctor’s appointments.

It turns out to be a great arrangement. Wendy enjoys the part-time work and Jack is extremely grateful for the help. His depression has lifted, he has more energy than he used to, and he is thrilled to be able to remain in his own home. It’s a win-win for everyone involved.

Learn more