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.

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:

• Personal care services
• Meal preparation
• Paramedical services
  • These are services prescribed and supervised by a medical professional, such as the administration of meds, home therapy programs, tube-feeding, blood sugar monitoring, and wound care.
• Accompaniment to your child’s disability-related medical appointments
• Protective supervision
  • This is for children whose severely impaired judgment, orientation and/or memory puts them at risk of self-injury or injuring others.
  • Protective supervision cannot be provided to monitor for spontaneous medical emergencies, such as seizures or blood sugar crashes. However, it may be awarded to avoid a medical emergency caused by the recipient’s cognitive impairments - for example, when a recipient uses life-sustaining medical equipment (IV, port, trach, g-tube, oxygen, etc.) and is at risk of interfering with the equipment due to their cognitive impairment. In this clip, Undivided's Public Benefits Specialist Lisa Concoff Kronbeck explains the difference:

View the CDSS guide to see the full variety of services that IHSS will fund. However, 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.

Tip: Some caseworkers will tell parents that they cannot get accompaniment to/from and wait time during medical and therapy appointments because parents are ordinarily expected to provide transportation and wait with their children. They may also say that children can get transportation through Medi-Cal, so IHSS will not provide time for it.

All County Letter 17-42 provides clarity on this point. Medical accompaniment for a minor can be authorized when:

1. The child has an extraordinary need that is due to a disability-related functional impairment and is beyond what would be expected of a child of the same age without the impairment;
2. The appointment is in a specialty care discipline (medical specialty, PT/OT/speech, etc.) and the appointment is related to the disability; and
3. An authorized IHSS task is needed during travel to/from or at the appointment.

When all three conditions have been met, the service can be authorized, and both transportation and wait time should be included in the authorization. If your caseworker tells you that your child is not eligible for this service and you believe your child meets the eligibility criteria, you can provide the caseworker with a copy of All County Letter 17-42.

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. However, you will not be awarded additional time to allow these tasks to take place outside the home, with the exception of accompaniment and wait time for doctor visits in some cases (see the above section “What services are provided by IHSS?”).

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.

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 eligible to be paid as an IHSS provider. See our article on finding or acting as an IHSS provider.

In this clip, Lisa Concoff Kronbeck explains some recent updates on who can be your child's IHSS provider:

Please see All County Letter 23-106 for more information on the recent changes.

Until February 20, 2024, to be eligible as a paid parent provider, there cannot be another suitable legal guardian available to care for your child. If your family lives in a two-parent household, the non-provider parent must be unavailable to care for your child due to full-time work, full-time enrollment in college or vocational training, or disability.

Parent providers must be eligible to work in the United States, and you will be 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.

For more information about IHSS, see our decoder with links to articles about how to apply, how to choose a provider, and how to appeal a denied application. You can also learn more about accessing IHSS with this advocacy guide published by Disability Rights California (it’s available in sixteen languages!).

If you're in LA County, you can access the IHSS Helpline chat or call (888) 822-9622.