CA In-Home Supportive Services Waiver

The In-Home Supportive Services (IHSS) Waiver is a Medicaid program that allows eligible recipients to receive personal care and domestic services in their homes instead of being institutionalized in a nursing home or other facility. The program also allows recipients to hire and supervise their caregivers, family members, friends, or other individuals. The IHSS Waiver pays caregivers an hourly wage that varies by county and provides them with health benefits and paid sick leave.

Overview of IHSS Waiver

The IHSS Waiver is one of the Home and Community-Based Services (HCBS) Waivers offered by the California Department of Health Care Services (DHCS). HCBS Waivers are programs that allow states to provide Medicaid services to individuals who would otherwise require institutional care. The IHSS Waiver was established in 1993 and is currently approved by the Centers for Medicare and Medicaid Services (CMS) until June 30, 2027. The IHSS Waiver aims to promote the independence and well-being of recipients who need assistance with activities of daily living (ADLs) and instrumental activities of daily living (IADLs), such as bathing, dressing, eating, housekeeping, and transportation. The IHSS Waiver's target population is individuals 65 years or older, disabled or blind, and who meet the medical and financial eligibility criteria for Medi-Cal. Medi-Cal is California's Medicaid program that provides health care coverage to low-income and needy residents.

Eligibility Requirements

To qualify for the IHSS Waiver, an individual must meet the following requirements:

• Be a California resident and a U.S. citizen or a qualified alien
• Be eligible for Medi-Cal with no share of the cost
• Have a Medi-Cal eligibility determination.
• Live at home or an abode of their choosing (not in an acute care hospital, long-term care facility, or licensed community care facility)
• Submit a completed Health Care Certification form.
• Be assessed by a county social worker to determine the need and amount of IHSS services.
• Have a functional impairment that limits their ability to perform ADLs or IADLs without assistance.
• Be at risk of institutionalization without IHSS services.

Services and Supports

The IHSS Waiver provides services and supports to help recipients remain safely in their homes. These include:

• Personal care services: assistance with ADLs such as bowel and bladder care, bathing, grooming, dressing, feeding, mobility, transferring, and paramedical services
• Domestic services: assistance with IADLs such as housecleaning, meal preparation, laundry, grocery shopping, and errands
• Protective supervision: constant observation and monitoring for recipients who have mental impairments or dementia and are at risk of injury or harm
• Accompaniment services: assistance with transportation to medical appointments or alternative resources
• Advance pay: an option for recipients who have difficulty managing their IHSS payroll due to a mental or physical impairment
• Restaurant meals allowance: an option for recipients who are unable to prepare meals at home due to a lack of cooking facilities or a medical condition
• Home modifications: minor physical adaptations to the home environment that are necessary to ensure the health and safety of the recipient

Compensation for Caregivers

One of the unique features of the IHSS Waiver is that it allows recipients to choose their caregivers, who can be family members (except spouses), friends, neighbors, or other individuals. This gives recipients more control over their care and enables them to receive services from people they trust and prefer. Caregivers who work under the IHSS Waiver are called individual providers (IPs) and are considered employees of the waiver recipient. IPs are responsible for:

• Applying for IHSS employment through the county IHSS office
• Completing a background check and a health screening
• Attending an orientation and a training session
• Submitting timesheets and other required documents
• Following the recipient's care plan and instructions

IPs are paid an hourly wage that varies by county, depending on the collective bargaining agreement between the county and the union representing IPs. The state minimum wage for IPs is $14 per hour as of January 1, 2021, and will increase to $15 per hour as of January 1, 2022. IPs can work up to the maximum number of hours authorized by the county social worker for each recipient based on the recipient's assessed needs and preferences. IPs can also receive health benefits and paid sick leave if they meet specific eligibility criteria.

A Note from Givers

If you are interested in applying for the IHSS Waiver or finding out more about caregiver compensation, please complete this form.