In-Home Supportive Services (IHSS): Learn the Essentials
IHSS is a Medi-Cal program that provides and funds home-based personal care and related services so that people with disabilities of all ages can live safely in their home communities. For children, authorized services may include personal care services, meal preparation, paramedical services (medical services that are prescribed and monitored by a medical provider), accompaniment to medical appointments, and protective supervision (24/7 supervision to prevent injury to themselves or others due to severe impairments in judgment, orientation, and/or memory). Hours are awarded only for services that exceed what a parent would usually be expected to provide to a typically developing child of the same age. It’s important to know that — if eligible — a parent can be paid as their child’s IHSS provider.
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; learn more about the waiver here.
How do I know whether my child qualifies for IHSS services?
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 almost exclusively limited to paramedical services and accompaniment to disability-related specialist visits and therapies, since 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.
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 it 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.xample, 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.
What types of services will IHSS pay for?
IHSS typically authorizes services in the following categories:
- Domestic services
- Non-medical personal care services
- Accompaniment to medical appointments
- Protective supervision
- Paramedical services
- Yard hazard abatement
View the CDSS guide to see the variety of services that IHSS will fund.
For children, the range of services is more narrow, since parents would usually be expected to perform certain tasks for their children regardless of disability. Minor children who live with their parents will not receive hours for domestic services such as house and yard work and grocery shopping. They may receive hours for “related services” in the domestic services category, such as meal preparation and laundry in some situations, depending on the child’s age and/or whether the service is provided through paramedical services. Children may also receive hours for personal care services, paramedical services, accompaniment to/from and wait time during appointments, and protective supervision.
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.
How many 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.
Where are IHSS services provided?
IHSS services generally must be provided in the recipient’s home (aside from exceptions, such as accompaniment to doctor visits). IHSS providers cannot be paid for services rendered while the recipient is away on vacation, out of the country, or in the hospital. 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 family is taking a vacation, you may wish to speak with your service coordinator ahead of time and get written approval to bill hours during this time. If your child is out of state for more than 30 days, their eligibility may be impacted.
Can I be paid as my child’s provider?
Yes! If you are eligible. If you are ineligible to be a parent provider, you must hire someone to perform the authorized services.
A parent can be paid as their child’s IHSS provider only if the parent is prevented from working full-time (40 hours per week) due to the child’s extraordinary needs, and there is not another suitable provider available with a legal obligation to care for the child. In a two-parent household, the non-provider parent must be unavailable 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 will be required to complete background checks and fingerprinting (there is a LiveScan fee for this requirement) as well as an orientation session.
According to All County Letter 15-45, the parent who works full-time is not considered to be a suitable provider if they’re only available to care for the child during non-work hours, such as nights, weekends, and holidays. If your social worker tells you that you cannot be paid for services provided during non-work hours because a second parent is available at that time, provide them with a copy of ACL-15-45, and direct them to the Q&A section, which reads as follows:
“Q. MPP Section 30-763.455 states "A parent provider.........shall be paid for performing authorized services regardless of the presence of the parent in the home, including non-work hours, weekends and holidays." In a two-parent home with one parent being the IHSS provider, is the other parent, who is employed outside the home, considered a suitable provider when they are available during non-work hours, weekends and holidays?
A. No, a parent, who is employed full-time, is not considered a “suitable provider” if he/she is only available during non-work hours, weekends, and holidays. “IHSS may be purchased from a parent under the condition that the parent has left full-time employment or is prevented from full-time employment because no other provider is available…” (MPP Section 30- 763.451). This section refers to the presence of the other parent/non-provider parent in the home and should not affect payment to the parent provider.”
Parent-provider income is tax-exempt per IRS Notice 2014-7, and also cannot be deemed to the child for purposes of income-based eligibility assessment for the child, such as for SSI or for Regional Center co-pay assistance. You should speak with your tax advisor regarding how to report IHSS income.
If you are ineligible to be a parent provider, you must hire someone to perform the authorized services. If you need assistance locating a provider, call the Personal Assistance Services Council (PASC), the Public Authority for Los Angeles County IHSS providers. PASC operates a Provider Registry and will provide you with referrals to providers. Contact PASC at (877) 565-4477 or visit their website.
You may also have a family member or family friend become authorized to provide IHSS services. As with parent providers, third-party providers must be eligible to work in the United States, and will be required to complete background checks, fingerprinting and orientation.
How do I apply for IHSS?
Read our informative article that outlines the steps, How to Apply for In-Home Supportive Services.