IHSS (In-Home Supportive Services) helps Medi-Cal members remain safely at home, avoid unnecessary facility placement, and receive care from someone they know and trust. However, obtaining IHSS isn’t immediate. Between physician certification requirements, in-home assessments, and growing application volumes, approvals can take three to six months.
For high-risk members, that delay can place additional strain on family caregivers and increase the risk of emergency room visits, hospitalization, or loss of independence at home.
Navigating IHSS can be complex, especially when members need support right away. This guide walks through the application process step by step, how to prepare members for each stage, and what options may be available to help bridge gaps in care while they await approval. We’ll cover:
- What IHSS is and who qualifies?
- IHSS application roadmap
- Preparing for the in-home assessment
- What happens after you’re approved or denied
- How 24 Hour Home Care can help while awaiting approval
What is IHSS and Who Qualifies?
IHSS (In-Home Supportive Services) is a California Medi-Cal benefit that provides funding for in-home care, helping eligible seniors and people with disabilities remain safely in their homes rather than transitioning to institutional care. Services may include assistance with Activities of Daily Living (ADLs), such as bathing and dressing, meal preparation, light housekeeping, and supervision.
To qualify for IHSS, applicants must be:
- Aged 65 or over, blind, or disabled
- A California resident living at home (not a licensed care facility)
- Be enrolled in Medi-Cal or in the process of applying
- Have a documented functional need for assistance with daily activities
As IHSS is a Medi-Cal program, financial eligibility is also a factor. Medi-Cal has income and asset limits, though Share of Cost options may allow clients who exceed those limits to still qualify. Share of Cost is a monthly amount the recipient must pay for services before Medi-Cal covers the rest, similar to a deductible.
For a full breakdown of income limits, asset limits, and eligibility by population type, visit our IHSS Eligibility Requirements guide >
IHSS Application Roadmap: 4 Essential Steps
Applying for IHSS approval has four essential steps:
- Apply for Medi-Cal: Applications can be submitted online at BenefitsCal.com, by phone at 1-800-300-1506, or in person at your county’s social services office. This is a crucial first step as only individuals eligible for Medi-Cal can apply for IHSS.
- Complete the IHSS application : Once Medi-Cal eligibility is confirmed, submit a completed application form (SOC 295) in person or through the mail. Find your County IHSS Office here for more information.
- Complete the health care certification: The certification form (SOC 873) is completed by the member’s primary care physician or a licensed health professional. It documents medical conditions and the need for in-home assistance.
- Complete the in-home assessment: A county social worker visits the member at home to observe and document how they function across Activities of Daily Living (ADLs). The authorized hours the member receives are determined by this assessment, which makes preparation critical.
Preparing for the In-Home Assessment
The purpose of the in-home assessment is to help the county understand the member’s functional limitations and determine the number of authorized care hours. To help ensure an accurate assessment:
- Document everything: Keep records of challenges with bathing, dressing, meal preparation, and other daily activities. Gather supporting documentation such as physician notes, IEPs, ABA reports, or records related to Protective Supervision needs.
- Be honest: Describe the member’s typical day as well as their most challenging days. Be sure to discuss any behaviors or limitations that may impact health, safety, or independence.
- Provide examples: Rather than speaking in general terms, explain exactly where assistance is needed. For example, a member may be unable to safely use a knife to prepare meals or may require help putting on shoes due to limited mobility.
Taking time to prepare for the assessment can help ensure the member’s needs are accurately represented and reduce delays in the authorization process.
It’s important to note that scheduling an in-home assessment can take weeks or even months, depending on county demand. For members with immediate care needs, there may be options to access support before IHSS is approved (see the “While You Wait” section below). With the right preparation, you can be prepared for the in-home assessment, reduce the stress involved, and get your loved one the care they need.
What Happens Next? Approved vs. Denied
Once the assessment is complete, the county will review the information provided and issue a Notice of Action (NOA) outlining the outcome of the application.
If approved, the NOA will specify the number of authorized IHSS hours the member is eligible to receive each month. Members can then select a caregiver of their choosing, including a family member, friend, neighbor, or another qualified provider available through the county’s public authority registry.
The ability to choose a trusted caregiver is one of the most valuable aspects of the IHSS program. Familiar caregivers often provide greater consistency, stronger relationships, and more personalized support.
Learn more about caring for a family member through IHSS or how to become an IHSS caregiver >
If denied, or if the member believes the authorized hours do not adequately meet their needs, they have the right to appeal the decision and request a State Hearing. Additional documentation may help support the appeal and ensure the member’s needs are fully considered.
While Members Wait: How 24 Hour Home Care Can Help
IHSS approval can take weeks or even months. For members with immediate care needs, that delay can increase the risk of falls, medication non-adherence, caregiver burnout, hospitalization, and avoidable transitions into higher levels of care.
Fortunately, some Medi-Cal members may be eligible for support while awaiting IHSS approval. Through CalAIM’s Community Supports initiative, 24 Hour Home Care provides Personal Care and Homemaker and repiste that can bridge gaps in care during the application process. Services may include assistance with bathing, dressing, meal preparation, medication reminders, companionship, and other daily activities.
As a trusted partner to California’s leading Medi-Cal health plans, 24 Hour Home Care delivers Community Supports services to eligible members across the state, helping individuals remain safe, independent, and supported at home.
Learn more about CalAIM Community Supports >
Why 24 Hour Home Care?
What sets 24 Hour Home Care apart is our Agency With Choice model. Rather than assigning an unfamiliar caregiver, we empower members and families to choose someone they already know and trust, such as a family member, friend, or neighbor. We handle the rest, including hiring, onboarding, training, background checks, and payroll.
The result is care that feels familiar from day one, helping members start services faster and maintain greater consistency and continuity of care.
Rated 4.65 out of 5 stars by members. We partner with California’s leading Medi-Cal health plans across 58 counties.
How to Refer a Medi-Cal Member for Care
For care coordinators, working with 24 Hour Home Care means:
- Referrals processed quickly: We verify eligibility and manage authorization directly with the health plan
- Consistent communication: We work directly with your members, walking them through every step to get care started quickly
- A trusted, established partner: We have years of experience navigating the CalAIM system alongside health plans, care coordinators, members, and families
How to Refer
Referring your client to 24 Hour Home Care for Personal Care and Homemaker Services or Respite Care takes just a few minutes. Here is how it works:
- Submit a referral: A care coordinator, social worker, or health plan submits a referral on the member’s behalf.
- Eligibility and authorization: Our team works directly with the health plan to verify eligibility and obtain authorization for services.
- Caregiver onboarding: We onboard the families chosen caregiver; taking care of hiring, training, background checks, and payroll.
- Care begins: Care begins with a caregiver who is familiar to the member, helping create a smoother transition into care.
