In-Home Supportive Services (IHSS) 101

In-Home Supportive Services (IHSS) is a Medi-Cal program that provides home-based personal care and related services so that people with disabilities can remain safely in their communities instead of institutions. Part of a broader network of Medi-Cal-funded supports, the IHSS program will help pay for certain services for an eligible child with a disability to remain safely in their own home.

Get an overview of IHSS from Lisa Concoff Kronbeck, Undivided Public Benefits Specialist:

Children with disabilities may be eligible for IHSS to the extent that their disability-related care needs exceed those of a typically developing child of the same age. (Note: it's a myth that children under age 5 can't qualify for IHSS!) See this article for more information on the eligibility criteria and how many hours of services your child might receive if eligible.

Note that your child must be enrolled in Medi-Cal before you apply for IHSS. If your family's income exceeds the Medi-Cal threshold, you may be able to enroll in Medi-Cal using the institutional deeming waiver.

Authorized services may include the following:

Personal care services

Personal care services assist the individual with activities of daily living, such as walking, eating, toileting, grooming, bathing, etc. It’s important to note that hours will only be awarded for services that exceed what a parent would usually be expected to provide to a typically developing child of the same age. For example, it would not be uncommon that a typically developing five-year-old might still need their parent’s help with bathing. But by age eight, a typically developing child would not be expected to still need assistance.

Domestic services

These services may include grocery shopping, meal preparation, cleanup, and laundry. Note that it's rare for children to receive hours for these tasks unless they have extraordinary support needs beyond what a typically developing child would require, but teens and young adults may receive domestic service hours as they are building skills for independence.

Paramedical services

An IHSS paramedical service is a task that requires authorization and training by a medical professional before the caregiver can provide that service. Some examples include wound care, suctioning, g-tube feeding, and anything that requires sterile treatment, puncturing the skin, or inserting something into the body (e.g. enema, catheter, etc.) Administration of medication can also be considered a paramedical service. Learn more in our full article here.

Protective supervision

Protective supervision is a service for children who need 24/7 monitoring because their severely impaired judgment, orientation, and/or memory puts them at risk of self-injury or injuring others because they do not understand the risk of danger. Parents need to demonstrate that their child needs more supervision than a typically developing child of the same age. Learn more in our full article here.

Accompaniment and wait time

If a child is expected to need any of the above services on the way to or from a disability-related medical appointment or during the appointment, they can receive hours for accompaniment.

If your child’s extensive disability-related needs at home require more care than a typically developing child of the same age, and you currently provide that care, you may be paid to serve as your child's IHSS provider. You can also hire a third party, such as another family member, a friend, or a trained professional found through an agency. For more information, see our article on finding or acting as an IHSS provider.

All IHSS providers must be eligible to work in the United States and are required to complete a background check and fingerprinting (there is a LiveScan fee for this requirement) as well as an orientation session.

Your parent provider income is tax exempt and cannot be deemed to your child due to their income-based eligibility assessments for other benefits like SSI or Regional Center co-pay assistance.

IHSS services generally must be provided in the recipient’s home (aside from exceptions such as accompaniment to doctor visits). However, IHSS recipients are not required to remain in their homes at all times. If your child is allotted a certain amount of time for diapering or g-tube feeding, for example, that doesn’t mean that every single diaper change or tube-feeding you carry out must take place in the home.

IHSS providers cannot be paid for services rendered at the recipient’s home while the recipient is away on vacation, out of the country, or in the hospital. IHSS providers also cannot be paid for providing direct care to the recipient during a hospitalization. If your child is hospitalized, you should notify your child’s caseworker. You cannot bill for IHSS services on a day that your child spent fully inpatient, but you can bill for services performed at home on the day of admission and for services performed at home on the day of discharge.

If your child is out of the state or country for more than 30 days, their eligibility for IHSS may be impacted due to state residency rules. If your family is traveling out of state, you may wish to speak with your service coordinator ahead of time and get written approval to bill hours during this time, and, if you will be traveling for an extended period, to make sure that IHSS eligibility itself is not disrupted. You can review the Manual of Policy and Procedures, sections 30-770 for further details.

The application process for IHSS will include providing documentation about your child's support needs, including forms that your child's doctor must fill out. An IHSS case worker will then visit your home to evaluate the care your child requires. Afterward, IHSS will send you a Notice of Action (NOA) that states the number of hours your child is authorized to receive and in what categories.

Here's a bit about what to expect from the application process:

For more information about IHSS, see our articles about how to apply, how to choose a provider, and how to appeal a denied application.

We know that documenting all the support your child needs can get tricky, which is why we've written step-by-step walkthroughs to help you apply for IHSS, paramedical services, protective supervision, and more, with templates and expert tips. Undivided members can also access our IHSS video training series featuring Lisa Concoff Kronbeck, which gives a detailed overview of everything you need to know about IHSS.