IHSS in California: What Home Care Agencies Need to Know

In-Home Supportive Services (IHSS) is California’s Medi-Cal program that pays for non-medical help at home so eligible aged, blind and disabled residents can avoid a facility. It is consumer-directed: the county authorizes monthly hours, the recipient hires and supervises their own provider, and the state issues the paycheck. A licensed agency usually can’t bill IHSS directly. Agencies serve IHSS recipients by selling private-pay hours on top of the authorized ones, and in a few counties by holding a contract with the county.

How does IHSS actually work?

The county runs the front end and the state runs payroll. A county social worker visits the applicant at home, confirms Medi-Cal eligibility and assesses need, then authorizes a number of hours per month for each task (CDSS IHSS overview).

Hours are capped by statute. Recipients assessed as needing at least 20 hours a week of personal care can be authorized up to 283 hours a month; others are capped at 195 (Welfare and Institutions Code 12303.4). An individual provider may not work more than 66 hours in a workweek across all recipients, and hours over 40 are paid at time and a half (WIC 12300.4).

Can a home care agency bill IHSS?

Not in the usual individual-provider mode. The law lets counties deliver IHSS three ways: hire county homemakers, contract with agencies, or pay recipients directly to hire their own provider (WIC 12302). Nearly every county uses the third. If your county has a contract mode, the recipient may choose the contractor instead of hiring someone, and the agency is then the employer of the caregiver and bills the county at the contract rate. Ask your county IHSS office whether a contract exists.

Your caregivers can’t be IHSS providers on your payroll either. If a caregiver enrolls as an IHSS provider for a client, the recipient is her employer for those hours and the state pays her, not you.

Where do agencies fit with IHSS clients?

Mostly in the hours IHSS doesn’t cover. Three patterns are common:

• Supplementing hours. A recipient authorized 120 hours a month may need 200. The family buys the other 80 from you at your private-pay rate.
• Backup coverage. When the IHSS provider is sick or on vacation, the family pays an agency privately for the gap.
• Contract mode. In counties with a contract, your agency provides authorized hours and bills the county.

Track the IHSS authorization on the client record so the family knows what IHSS covers and what you bill. See authorization tracking and the Medicaid waiver directory.

How do you keep IHSS and private-pay hours separate?

Different payer, different visits, different records. Don’t schedule your caregiver and the IHSS provider for the same hours, and never bill the family for hours the IHSS provider claimed. If a family asks your caregiver to “also be the IHSS provider,” the caregiver is then working two jobs for two employers, and only her agency hours are yours to schedule, pay and bill.

Two checks keep you clean: the family’s monthly IHSS notice of action, which states authorized hours, and your own visit records, which show when your caregivers were in the home.

Does IHSS EVV apply to agency caregivers?

Only in contract mode. IHSS providers who don’t live with the recipient must check in and out each workday through the Electronic Services Portal, the telephone timesheet system or the IHSS EVV mobile app, and record whether care was given at home or in the community (CDSS EVV for recipients and providers). That system is for individual providers. Your private-pay visits aren’t subject to IHSS EVV, but GPS-verified visits are still your best proof of what the family bought. See does EVV apply to private pay.

What California rules still apply to your agency?

All of them. A Home Care Organization must be licensed by CDSS before providing care, and every affiliated Home Care Aide must be background checked and on the registry. The license fee is $5,603 for two years and aide registration is $35 for two years (CDSS fee schedule). CDSS makes unannounced visits (Home Care Services). See California Home Care Aide registration and California caregiver meal break rules.

How Caregiver Scheduling handles this

For a contract-mode client on Growth and up, IHSS authorized hours are checked as you schedule, so visits past the total are flagged before they happen. For a supplemented client, note the IHSS hours on the record, and your private-pay visits are GPS-verified at check-in and check-out; invoicing the family from those visits is coming soon. The caregiver app shows only your visits, so there’s no confusion about which hours are yours. $199/month for up to 10 caregivers or $299/month for up to 50, free for 30 days.

FAQ

Can an agency employ IHSS providers? Not in individual-provider mode; the recipient is the employer and the state pays. Only agencies with a county contract employ caregivers for IHSS hours.

Is IHSS the same as Medi-Cal home health? No. IHSS is non-medical help with daily living. Home health is skilled nursing and therapy under a doctor’s order.

How many hours can IHSS authorize? Up to 283 hours a month for recipients needing 20 or more hours a week of personal care, otherwise up to 195.

Can my caregiver also be the client’s IHSS provider? Yes, as a separate job with the recipient as employer. Keep those hours off your schedule and your invoices.

Does the HCO license matter if my clients are all IHSS recipients? Yes. Any hours you provide as an agency fall under the Home Care Services Consumer Protection Act.

This article is general information, not legal advice. Check with your county IHSS office and CDSS.