In-Home Supportive Services (IHSS): The Essentials of Eligibility

Published: Jun. 28, 2021Updated: Oct. 18, 2023

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. The IHSS program will help pay for certain services for an eligible child with a disability to remain safely in their own home. In order to receive IHSS services, your child must be enrolled in Medi-Cal. Here’s what you should know about other eligibility requirements.

Does my child qualify for IHSS?

IHSS hours are awarded for allowable services to the extent that a child’s needs exceed those of a typically developing child of the same age. Technically, there is no minimum age to receive IHSS hours, but hours for infants and young toddlers are typically limited to paramedical services and accompaniment to disability-related specialist visits and therapies. This is because babies require total care from their parents regardless of ability.

A child who is two years old, for example, will not receive toileting hours because many typically developing children are still toilet-training at that age. A child who is four years or older may receive toileting hours, since most typically developing children are toilet-trained by age four. Exceptions may be made for younger children whose toileting needs fall under the umbrella of paramedical services, such as a baby or toddler who requires catheterization to urinate or who uses an ostomy bag.

In this clip, our Public Benefits Specialist Lisa Concoff Kronbeck explains what to know about age and IHSS:

As your child gets older, you might be awarded “personal care hours” from IHSS. These are services for feeding, dressing, ambulation, toileting, bathing and hygiene, menstrual care, and other age-appropriate self-care tasks that typically developing children usually carry out themselves.

How many IHSS hours can my child receive?

The maximum allowable IHSS hours vary depending on whether the recipient is deemed “severely impaired” or “non-severely impaired.”

An IHSS recipient is classified as severely impaired if they are authorized for 20 or more hours per week of non-medical personal services, paramedical services, and meal preparation. A severely impaired IHSS recipient can be authorized for up to 283 hours per month. If the recipient needs more than the maximum allowable hours per month, this overage, referred to as “unmet need,” should be documented in the Notice of Action, which is the form you get from IHSS that explains whether or not you were awarded hours, how many hours, and for which tasks.

An IHSS recipient who is non-severely impaired (NSI) may be authorized for up to 195 hours per month. If a child qualifies for protective supervision, they will receive their monthly hours plus 195 hours for protective supervision.

Ranking Scale

IHSS uses a ranking scale to determine the number of hours awarded for each service. The agency maintains a “functional index ranking” for age-appropriate skills based on the Adapted Vineland Social Maturity Scale. IHSS will not ask you to rank your child’s skill level based on these numbers, as these are their internal measures. The best way to inform your caseworker is to give details about the extent to which your child needs assistance with various tasks.

The functional index ranking can also be a useful tool for determining when you feel your child may require IHSS services, if paramedical services and protective supervision are not applicable. If you look at the row that corresponds to your child’s age, you can see in what categories IHSS services may be completely unavailable (rank 1), possibly available (ranks 1–5), or available if the service is paramedical in nature (ranks 1 or 6).

The ranks are defined as follows:

Rank 1 would usually mean the client can do a task independently. For minors, many tasks are automatically assigned to rank 1 because the parent would be expected to perform the task for a typically developing child.
Ranks 1–5: For tasks that a typically developing child would be expected to do independently, the recipient’s independence level is ranked based on how much assistance they need to complete the task. Rank 1 is total independence, and rank 5 is total reliance on assistance. Often, each type of task has its own scale for each ranking level.
Rank 6 means that all functions of the task are met by paramedical services. For example, meal preparation for most minors is either a 1 or a 6 — either a parent would be expected to perform the task for a typically developing child, or preparing the child’s meal falls under paramedical services, such as setting up the formula and pump for a tube-fed child, or pureeing or chopping food into small pieces for a child who is a choking risk due to their medical condition.

IHSS will not ask you to rank your child’s skill level based on these numbers, as these are their internal measures. The best way to inform your caseworker is to give details about the extent to which your child needs assistance with various tasks.

In this clip, Lisa Concoff Kronbeck explains the importance of accurately describing your child’s needs: