Medi-Cal In-Home Supportive Services/Community First Choice Option

Program Description

The IHSS (In-Home Supportive Services) Program provides non-medical care to elderly or disabled Californians in their homes or places of residence. State policymakers designed the program to prevent the unnecessary placement of individuals in Medicaid (Medi-Cal) funded nursing homes. Services are not available in skilled nursing homes, assisted living residences, or adult foster care homes.

Program participants are assessed to determine their daily care needs with input from the participants, family members, caregivers, and medical professionals. After the in-person assessment, qualified applicants are approved for a collection of services for a specific number of hours per month. Unfortunately, caregivers are not permitted to work overtime by the state and federally funded program.

Once approved, participants are responsible for “self-directing” their care. Self-direction is also referred to as consumer direction and is based on the Medicaid concept of Cash and Counseling. Under IHSS, the care recipient is the boss and can hire, supervise, and end his/her caregiver’s employment. In addition to giving the participant greater control, this program is very popular with families because some family members, including the adult children, can be paid to aid their elderly parents. In some circumstances, even spouses can be paid to provide care for their husband or wife.

There are four categories of recipients or sub-programs that make up IHSS: 
1. IHSS Residual Program (IHSS-R) – provides personal care for persons not fully Medi-Cal eligible
2. IHSS Independence Plus Option Program (IPO) – pays spouses for providing personal care
3. Personal Care Services Program (PCS) – provides personal care for persons fully Medi-Cal eligible who are aged, blind or disabled and who often do not qualify for CFCO
4. Community First Choice Option Program (CFCO) – provides personal care and other in home supports for fully Medi-Cal eligible persons who would otherwise need a level of care consistent to that which is provided in a nursing home

Eligibility Guidelines

General Requirements

The IHSS program is open to California residents who are 65 and over or younger individuals who are officially disabled or blind and qualify for Medi-Cal (California Medicaid). Applicants do not necessarily need to be on full Medi-Cal. But they must have applied and received a determination of their eligibility. Share of cost Medi-Cal beneficiaries can participate. Financial eligibility for Medi-Cal is nuanced and complicated and the state allows multiple pathways to gain eligibility.

Financial Requirements

Income Limits
A simplified view of financial eligibility for 2024 is as follows. Single, elderly state residents qualify if their countable monthly income is less than $1,732, or annually, less than $20,783. A married couple is permitted monthly income up to $2,351, which is equal to $28,207 annually. (The income limits are 138% of the Federal Poverty Level, abbreviated as FPL, and are updated in April for California).

There are exceptions, and persons with incomes over the above stated amounts can still be eligible.

Asset Limits
California no longer has any asset limits.

Over the Financial Limits?

There are many exceptions and pitfalls to eligibility for Medi-Cal. Persons unsure of their Medi-Cal eligibility status should consult with a Medi-Cal Planning Professional before application.

Benefits and Services

The IHSS program provides non-medical assistance services. Program participants choose their “individual provider,” the individual who provides these services, rather than the state choosing the provider on their behalf. As the services provided are largely unskilled services, participants are free to choose whomever they prefer to provide these services. As mentioned above, service providers can include family members, such as the adult children of aging parents and even spouses.

Service providers are paid an hourly rate set by Medi-Cal that is county-specific. Legally, one can receive up to 283 hours per month of assistance, but in practice, receiving that level of help is rare. Furthermore, there are hourly limits for the type of assistance. For example, one would not be approved to receive 40 hours of laundry help per month.

Possible benefits include the following:

• Assistance with the activities of daily living, such as bathing, dressing, mobility, and transferring
• Housekeeping
• Laundry
• Meal preparation / clean-up
• Personal care
• Shopping assistance for essential items, such as groceries
• Supervision
• Medical appointment transportation assistance
• Paramedical tasks, such as assistance with injections / medications

The cost of services can be covered entirely by the state or program participants’ may be responsible for a “share of cost,” if their incomes exceed the monthly limit.

How to Apply / Learn More

IHSS is administered by each California county separately. Once the elderly individual has a Medi-Cal eligibility determination, he/she can apply for the program by contacting their local IHSS office. Contact information for each county can be found here, and an online application can be found here. Applicants will have their needs assessed and that assessment will likely require the candidate to provide medical information.

Additional information about the IHSS Program can be found here.