California In-Home Supportive Services (IHSS)

In-Home Supportive Services (IHSS) is California’s large program that pays for in-home help so older adults and people with disabilities can live safely at home. It is run by counties and paid for mostly by Medi-Cal, and it is well known for letting people hire family members as their paid providers. It sits alongside our California Long-Term Care Medicaid guide, which covers the nursing home rules.

Figures change periodically. Double-check current amounts before relying on them.

At a glance

Item	Details
Type of program	Medicaid state plan personal care benefit
Who runs it	California Department of Social Services (CDSS) with county social services agencies; funded largely by Medi-Cal
Age	Any age, if 65 or older, blind or disabled
Care need	Needs help to stay safely at home (no nursing home level of care is required)
California 2026 income rule (long-term care)	No fixed cap for nursing home care (income above allowances goes toward the cost of care)
California 2026 asset limit (single applicant)	$130,000 in countable (nonexempt) property
Waiting list	No

IHSS in brief

In short, IHSS is run by California Department of Social Services (CDSS) with county social services agencies; funded largely by Medi-Cal. Its target group is any age, if 65 or older, blind or disabled; on care need, the rule is: Needs help to stay safely at home (no nursing home level of care is required). Waiting list status in 2026: No. More detail on each point follows, and the California state guide covers the shared financial rules. If IHSS is not the right fit, the related pages at the end point to other California programs and general guides.

What the program is

IHSS is administered by each county’s social services agency under state rules from the California Department of Social Services. A county social worker visits the home, assesses which tasks the person cannot do safely alone, and authorizes a number of hours per month for each task. The person (the “recipient”) chooses, hires and supervises their own provider, who can be a relative, and the state pays the provider. Recipients who need help finding a provider can use their county’s IHSS registry.

Personal care offered through the Medicaid “state plan” is an ordinary Medicaid benefit, not a waiver. State plan benefits generally cannot have enrollment caps, so a person who has full Medicaid and an assessed need for hands-on help can get the service without waiting for a slot. The trade-off is that state plan personal care is narrower: it focuses on help with daily activities and lacks the wider menu of supports a waiver offers. See In-home care.

Who qualifies in 2026

A person generally must meet all of these conditions:

Is 65 or older, blind or disabled
Has Medi-Cal (most recipients), or qualifies under IHSS rules
Lives in their own home or a relative’s home (not a licensed facility)
Is assessed by the county as needing help to remain safely at home
Lives in California and is a U.S. citizen or qualified non-citizen

Financial eligibility. Most IHSS recipients have full Medi-Cal. Medi-Cal’s income and asset rules for older adults are explained in our California guide. The table’s figures are California’s 2026 long-term care numbers, taken from our state guide. Exempt items generally include the home within the equity cap, a car, household goods and a modest burial fund. If only one spouse needs IHSS, spousal impoverishment rules protect assets and income for the other. See Spousal impoverishment rules.

What the care test means in practice. For IHSS, an assessor checks how much help the person needs with bathing, dressing, eating, toileting, mobility and medications, and whether memory loss calls for supervision. For IHSS, an assessor, usually a nurse or social worker, visits the person at home, in the hospital or in the facility. Before a IHSS assessment, it helps to line up a family member who can describe a typical bad day, and to have a list of diagnoses and medications ready. See Nursing home level of care and Activities of daily living.

What services it can pay for

The plan of care decides which services are used. IHSS can cover:

Personal care: bathing, dressing, bowel and bladder care, feeding, moving in and out of bed
Domestic services: cleaning, laundry
Meal preparation and clean-up
Grocery shopping and errands
Accompaniment to medical appointments
Protective supervision for some people with cognitive impairment
Paramedical services ordered by a licensed health professional

Not every participant gets every service; the plan reflects assessed need and the help family already gives. If needs change, ask for a new assessment.

Directing your own care and paying family

IHSS is self-directed: the recipient is the employer for day-to-day purposes and chooses the provider. Family members, including adult children, often serve as providers. The provider is paid an hourly wage set by the county, and timesheets are submitted electronically.

How to apply

Applying usually involves two decisions: one about money (financial eligibility for Medicaid) and one about care needs. In plain terms, the steps are:

Apply for Medi-Cal if not already enrolled, through the county or online.
Apply to your county IHSS office (by phone, online in many counties, or in person). A health care certification form signed by a licensed health professional is required.
A county social worker visits the home for an assessment.
The county sends a notice of authorized hours.
Choose and enroll a provider. The provider completes enrollment steps (including a background check) before being paid.

Our documents checklist and Applying for a waiver guide list the paperwork.

Waiting lists

IHSS has no waiting list. Counties must assess people who apply and authorize hours based on need. Delays usually come from the paperwork or provider enrollment.

See Waiver waiting lists for general tips.

How it relates to nursing home Medicaid

IHSS does not require a nursing home level of care, so it can help people earlier than nursing home Medi-Cal would. Medi-Cal’s rules for older adults changed in recent years: California reinstated its asset limit for older adults and people with disabilities on January 1, 2026, at $130,000 for one person, as shown in our state guide. People in a nursing home cannot receive IHSS. Those who need more support at home may combine IHSS with programs such as MSSP or CBAS, or the HCBA Waiver.

What is the same as nursing home Medicaid. Most money rules carry over from nursing home Medicaid. The five-year look-back for gifts generally applies, so a gift or transfer for less than fair value can cause a period when Medicaid will not pay for long-term care services. Medi-Cal can also use estate recovery to seek repayment for long-term care services received after 55. People who keep income above a set allowance may have to pay part of it toward their care each month.

If a nursing home becomes necessary. A California nursing home resident keeps a 2026 personal needs allowance of $35 a month, and most other income goes to the facility. Details are in our state guide.

Tips for families

Do not wait for a crisis. Lists and assessments for IHSS take time, and the start date is usually when you first request help.
Document everything, from forms and letters to who you spoke with at Medi-Cal and when.
Use your appeal rights. Notices that deny or reduce services explain how to request a fair hearing; acting quickly can protect current services.
Report changes promptly, including income, assets, a move or a new living arrangement.
Mark renewal dates. Eligibility and the care plan are usually reviewed annually; see Renewals.
Get help with complex IHSS cases, such as a spouse at home or past gifts. A certified Medicaid planner or a legal aid office can review how California’s rules fit a family’s situation.

Common questions

Can I be paid to take care of my mother? Yes. Adult children and other relatives can be IHSS providers. In some situations, a spouse or a parent of a minor child can also be paid.

Does IHSS pay for 24-hour care? Hours are capped by state rules and assessed need. Some people with severe needs receive the maximum, but IHSS is not usually 24-hour care.

Does IHSS work in assisted living? No. IHSS is for people living in their own home, not a licensed residential care facility.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.