This publication explains how In-Home Supportive Services’ (IHSS) monthly hours are calculated.1 This publication assumes you have already applied for IHSS, gone through the in-home assessment with the IHSS Worker, and received an IHSS Notice of Action (NOA) approving hours. For more information about IHSS and how to advocate for any additional IHSS services you may need, please visit DRC's IHSS Self-Advocacy Resource Webpage.

1. IHSS Funding

IHSS is funded through four subprograms. Each program has different eligibility criteria and maximum monthly hours available. The number of hours you get are based on the subprogram you are in and what IHSS services you need. The maximum amount of IHSS hours an individual can get is 283 hours per month.

These programs are:

1. Personal Care Services Program (PCSP)
2. Community First Choice Option (CFCO)
3. IHSS Plus Option (IPO)
4. IHSS Residual (IHSS-R)

You can find out what subprogram you are in by looking at your IHSS Approval Notice of Action or by asking your IHSS Worker.

You can get 283 hours (the maximum) per month if:

1. You are in the PCSP program and get protective supervision, or
2. You are in the CFCO, IPO, or IHSS-R subprogram, you get protective supervision, and you are “severely impaired,” or
3. You need at least 283 hours per month in IHSS services. For example, you get non-medical personal care, related, paramedical, and/or other IHSS services.

The following chart lists the four IHSS subprograms and the maximum monthly IHSS available for people who get Protective Supervision:

Subprogram	If you are considered Severely Impaired (SI) – up to:	If you are considered Non- Severely Impaired (NSI) – up to:	Citation/source of information
PCSP	283 hrs/mo	283 hrs/mo	All County Letter (ACL) No. 93-21 ACL 99-86
IPO	283 hrs/mo	195 hrs/mo	ACL 11-19
IHSS-R	283 hrs/mo	195 hrs/mo	Welf. & Inst. Code § 12303.4
CFCO	283 hrs/mo	Up to 283 hrs/mo	ACL 14-60

2. IHSS Subprogram Eligibility, Services & Limitations

i. Personal Care Services Program (PCSP)

To be eligible for PCSP:

• You must be eligible to receive full-scope federal financial participation Medi-Cal.
• You cannot have a spouse provider or parent provider.
• You cannot get advance pay2 or restaurant meal allowance.3

Under the PCSP subprogram, you can get 283 hours per month of IHSS if you are found eligible for Protective Supervision.4

ii. Community First Choice Option (CFCO)

To be eligible for CFCO:

• You must be eligible to receive full-scope federal financial participation Medi-Cal.
• You must meet nursing facility level of care.5
• There are no restrictions on getting advance pay, restaurant meal allowance, or having a spouse provider or parent provider.

Under the CFCO subprogram, if you get protective supervision and are severely impaired, you can get 283 hours per month of IHSS. If you get protective supervision and are non-severely impaired, you can get 195 hours of protective supervision plus other services you need up to 283 hours per month.

If you are married, do not have Medi-Cal, and need IHSS services, you may benefit from applying for IHSS under the CFCO program. Married individuals who need Medi-Cal and IHSS can use more favorable Medi-Cal eligibility rules called “Spousal Impoverishment Provisions” to get IHSS under the CFCO subprogram.6 These rules allow the spouse needing IHSS services to qualify for Medi-Cal while the other spouse retains significantly more income than allowed under other Medi-Cal eligibility rules.7 The Community Spouse Resource Allowance also known as the asset limit has been eliminated as of January 1, 2024.8 For more information about Medi-Cal spousal impoverishment provisions see DRC publications entitled, Determining Eligibility Under the Aged & Disabled Federal Poverty Level (A&D FPL) Program and In-Home Supportive Services (IHSS): A Guides for Advocates.

iii. IHSS Plus Option (IPO)

To be eligible for IPO:

• You must be eligible to receive full-scope federal financial participation Medi-Cal.
• You do not meet nursing facility level of care but need IHSS, and
• You have a spouse provider or receive advance pay or a restaurant meal allowance.9

Under the IPO subprogram, if you get protective supervision and are severely impaired, you can get 283 hours per month of IHSS. If you get protective supervision and are non-severely impaired, you can get 195 hours per month of IHSS.

In general, people who do not meet nursing facility level of care and have a spouse provider, or receive advance pay, or a restaurant meal allowance are placed in this program as an alternative to the PCSP and CFCO subprograms.

iv. IHSS Residual (IHSS-R)

To the eligible for IHSS-R:

• You are not eligible to receive full scope federal financial participation Medi-Cal.

Under the IHSS-R subprogram, if you get protective supervision and are severely impaired, you can get 283 hours per month of IHSS. If you get protective supervision and are non-severely impaired, you can get 195 hours per month of IHSS.

The IHSS-R subprogram is state and locally funded. It consists mostly of IHSS recipients who have lost Medi-Cal (SB87) and some people who are (lawful permanent residents or persons residing in the United States under the color of law and are unable to get full scope federal financial participation Medi-Cal. SB 87 is a Medi-Cal rule that requires people who lose Medi-Cal to receive one extra month of Medi-Cal while the county looks to see if there is a Medi-Cal program the individual can qualify for. Very few people are in the IHSS-R program. If you receive an IHSS Notice of Action placing you in the residual program and terminating your IHSS because you do not have Medi-Cal, you should appeal the IHSS Notice of Action and contact Medi-Cal immediately to see what you can do to reestablish Medi-Cal eligibility.

Note: Most people, regardless of immigration status can get Medi-Cal in California.10 The county cannot deny your IHSS application because you do not have a Social Security Number or Individual Taxpayer Identification Number.11 You can visit the California Department of Health Care Services website for information about applying for Medi-Cal.

v. How IHSS Hours Differ Based on Individual Need

The chart below shows how you can receive a different amount of hours depending on what IHSS subprogram you are in and whether you receive protective supervision as a severely or non-severely impaired individual.

	PCSP	CFCO	IPO	IHSS-R
Individual A Protective Supervision Eligible and Severely Impaired Individual A needs 20 hours of non-medical personal care per week.	283 hrs/mo	283 hrs/mo	283 hrs/mo	283 hrs/mo
	PCSP	CFCO	IPO	IHSS-R
Individual B Protective Supervision Eligible, Non-Severely Impaired, and 6 Hours of Domestic Services Individual B needs 19 hours and 56 minutes (or 19.9 hours) of non-medical personal care per week. Convert Minutes to Decimal 56 / 60 =.9333 →.9 (rounded down) Personal Care Services Monthly Hours Decimal Calculation: 19.9 hours x 4.33 = 86.167 = 86.17 (rounded up) Conversion to Minutes: .17 x 60 = 10.2 minutes = 10 minutes (rounded down) Monthly Personal Care Service Hours: 86 hours and 10 minutes or 86:10 Add Domestic Services 86:10 + 6:00 = 92:10	283 hours per month	283 hours per month [This includes 195 Protective Supervision + 86:10 of Personal Care Services per month + 6 hours of Domestic Services = 287:10 per month. Individual will get 283 hours due to IHSS monthly limit]	195 hours per month	195 hours per month
	PCSP	CFCO	IPO	IHSS-R
Individual C Ineligible for Protective Supervision, Non-Severely Impaired, and 6 Hours of Domestic Services Individual C needs 19 hours and 56 minutes (or 19.9 hours) of non-medical personal care per week. Convert Minutes to Decimal 56 / 60 =.9333 →.9 (rounded down) Personal Care Services Monthly Hours Decimal Calculation: 19.9 hours x 4.33 = 86.167 = 86.17 (rounded up) Conversion to Minutes: .17 x 60 = 10.2 minutes = 10 minutes (rounded down) Monthly Personal Care Service Hours: 86 hours and 10 minutes or 86:10 Add Domestic Services 86:10 + 6:00 = 92:10	92:10 (or 92 hours and 10 minutes per month)	92:10 (or 92 hours and 10 minutes per month)	92:10 (or 92 hours and 10 minutes per month)	92:10 (or 92 hours and 10 minutes per month)

Your IHSS NOA will contain the amount of time you can get per week and per month in hours and minutes. To calculate the amount of IHSS hours you can receive in a month, you must convert the hours and minutes you need of IHSS services per week to 10ths of an hour and then multiply by 4.33. We will review this process again in more detail later.

3. The IHSS In-Home Assessment

Your IHSS Worker will assess you in your home to determine what services you need and how much time you need for each service. The IHSS Worker, if applicable, will prorate certain services and identify alternative resources. The amount of time in your IHSS Notice of Action for proration and alternative resources will reduce the amount of time you can be authorized. The number of hours you can get each month is called “authorized hours.” Your authorized hours are the number of hours you can get after proration, alternative resource, the hourly task guidelines and all other IHSS rules for determining your need for IHSS have been applied. Proration and alternative resources will be discussed in more detail below.

For more information about the In-Home Assessment process see DRC’s publication, IHSS In-Home and Self-Assessment Guide.

i. IHSS Notice of Action

Your IHSS Notice of Action (NOA) is how the county provides information to you about your IHSS benefits. Your IHSS NOA is required to have information about:

• How much time you will receive for each IHSS task you need help with,
• The effective date of the county action,
• What IHSS rules the county relied on to make its decision, and
• Information about your right to dispute the county’s decision by asking for a hearing.12

IHSS will send you an IHSS NOA approving or denying your request for IHSS and each time there is a change to your IHSS services. If the IHSS NOA reduces or terminates an IHSS service, the NOA must be mailed 10 days in advance of the effective date of the intended termination or reduction.13 The IHSS Approval NOA and Change NOA has a list of all IHSS services and how much time you can get for each task per week and month. If your IHSS NOA does not have time listed next to a service, then you have not been authorized time to get help with that IHSS service. If you disagree, you can request a hearing. Your NOA should say how to request a hearing. You can also visit the California Department of Social Services State Hearings Division for more information about asking for a hearing: https://www.cdss.ca.gov/hearing-requests. For more information about hearing deadlines and other related information, you may also review DRC’s publication IHSS Fair Hearing Guide: How to Prepare for IHSS Terminations or Reductions in Hours.

4. Proration

When two or more IHSS recipients live in the same home and need IHSS services, their hours may be combined or “prorated.” For example, if multiple people benefit from an IHSS related or domestic service, then the time it takes to prepare that IHSS service is dividedequally among everyone who benefits, including non-IHSS recipients in the home. IHSS will only pay for your portion of an IHSS service met in common with housemates. This prevents IHSS from paying for IHSS tasks for people who do not receive IHSS.

Service categories which may be prorated:

• Domestic Services (6 hours maximum)14
• Meal Prep/Clean-Up
• Laundry (1 hour per week)
• Food Shopping (1 hour per week)
• Errands (30 minutes per week)
• Heavy Cleaning

If a caregiver does not provide a service to anyone other than the recipient, then it should not be prorated.15 If you have a live-in provider, domestic services may not be authorized for areas used only by your live-in provider. Related services may be prorated only if you and your live-in provider agree.16 You calculate proration by taking the “total need” met in common with housemates or family members / (divided by) the # (number) of people benefiting from the service = this equals the time you need to receive your portion of the IHSS service.

Example: If a parent does her son’s laundry separately from the four family members in the house because of bowel and bladder issues, then the laundry does not benefit the other household members. Here, the son’s laundry is not prorated among the other four family members.

Example: It takes a parent 100 minutes to do the weekly laundry for a family of 5. The parent washes the IHSS recipient’s clothing with the family’s clothes. You divide 100 minutes for laundry by 5 people in the household. This equals 20 minutes for laundry for the IHSS recipient. [100 minutes ÷ 5 people = 20 minutes].

5. Alternative Resources

Alternative resources are free IHSS services you receive through other people or programs such as adult or child day care centers, adult day programs, community resource centers, senior centers, respite centers, or school.17 Regional Center services such as respite are not an alternative resource.18 IHSS will determine what IHSS services you get from alternative resources (for example, meal preparation and clean-up, feeding, and diaper changes from a day care program) and the time it takes for you to get those services. The time for IHSS tasks from an alternative resource will be deducted from your total assessed need. The amount of time left over is the time you get to receive services.

When an alternative resource has been identified, the county is required to obtain a signed statement, Voluntary Services Certification Form (SOC 450), from the alternative resource provider indicating that the provider knows about the right to be compensated but chooses not to accept payment for the services.19 The county may not reduce hours because of an alternative resource until an SOC 450 has been completed and placed in the IHSS claimant file. If a provider indicates that they would like to receive payment for compensable services, the county must immediately discontinue showing the services as voluntary services and the provider should then be enrolled as an IHSS provider.20 IHSS also cannot make family, friends, or other people and agencies provide you with free IHSS services.21

Example: You live in a household with your IHSS provider. The provider cleans up after breakfast and dinner for both of you. You go to an adult day care center where you receive assistance with cleaning up after your lunch.

Step 1 – For meal clean-up, there is a column labeled “Total Amount of Service Needed.”Here, the County IHSS Worker will include the total amount of time spent cleaning up after breakfast, lunch, and dinner. This is your total need before proration and alternative resource rules are applied.

Step 2 – Then the County IHSS Worker will apply proration rules to breakfast and dinner clean-up services that benefit you and your provider. The amount of time for your total need will be reduced in the column “Adjustments for Others Who Share the Home (Proration).”

Step 3 – The County IHSS Worker will put the amount of time for meal clean-up assistance you get from your adult day care center in the “Services You Refused or You Get From Others” column. This column represents the amount of time the “Total Amount of Service Needed” will be reduced because you get free IHSS services from an alternative resource.

Step 4 – The County IHSS worker will put the amount of time you can get for clean-up in the “Authorized Amount of Service You Can Get – Now” column. This is the amount of time you can get for meal clean up after proration and alternative resource rules have been applied.

6. How to Qualify as Severely Impaired

Individuals in either the CFCO, IPO, or IHSS-R program who get protective supervision can receive at least 195 hours or 283 hours per month depending on whether they are “severely” or “non-severely” impaired.

• If you qualify as severely impaired and you get protective supervision, you will receive283 monthly hours of IHSS.
• If you are non-severely impaired and you get protective supervision, then you will receive at least 195 hours per month.
• If you are not eligible for protective supervision, you will only get 283 hours per month if you need at least 283 hours of IHSS services, such as personal care services, related, and other services.

i. Who is Severely Impaired?

To be “severely impaired” you must have a “total assessed need” of 20 or more hours per week in:

• Meal Preparation and Meal Clean-Up (if feeding is required)
• Respiration Assistance
• Bowel and Bladder Care
• Feeding
• Routine Bed Bath
• Dressing
• Menstrual Care
• Ambulation
• Transferring
• Bathing
• Oral Hygiene
• Grooming
• Rubbing Skin
• Repositioning
• Help with Prosthesis (artificial limb, Visual Hearing Aid), Setting up Medications
• Paramedical Services

ii. What is included in the “Total Assessed Need”?

Your “total assessed need” includes your need for meal preparation, meal clean-up (when feeding is required), personal care, and paramedical services after proration rules are applied and before alternative resource rules are applied.22

iii. How to Calculate Your “Total Assessed Need”.

To calculate your “Total Assessed Need” add up the time in your IHSS Notice of Action in the column marked “Total Amount of Service Needed” for each of the above listed services. If proration has been applied for meal preparation and meal clean up, include the prorated amount. Prorated time for meal preparation and meal clean-up includes only the time you need for those services. The result is your “total assessed need.”

• If your “Total Assessed Need” is 20 hours or more per week, then you are considered severely impaired.
• If your “Total Assessed Need” is less than 20 hours per week, then you are considered non-severely impaired.

Example: You get protective supervision and attend an adult day care center during the week. At the adult day care center, you receive assistance with meal preparation and meal clean-up for lunch. The help you get while at the adult day care center is an alternative resource. During other times of the day and on the weekends when you are home you receive help with meal preparation and clean-up. At home, food is prepared by a family member for the entire family. Meal preparation and meal clean up services are prorated because you eat food prepared by a family member for the entire family when you are home.

The time you need for meal preparation and meal clean up while you are at the adult day care center and the prorated time you need for meals at home counts in determining if you are “Severely Impaired” or “Non-Severely Impaired.”

7. Calculating Monthly Hours

i. Calculating Monthly Hours

To calculate the total IHSS hours you can get in a month, IHSS will add up all the time you need in a week except for domestic services. IHSS will then multiply your weekly hours by 4.33. Last, IHSS will then add the total time you can get for domestic services. To calculate monthly hours, you must be able to convert hours and minutes into decimals and back into hours and minutes. There is a time conversion chart at the end of this document.

Your IHSS Notice of Action lists weekly hours in an Hours and Minutes (HH:MM) format. Here are examples of how your weekly hours and minutes are listed in your IHSS Notice of Action:

ii. Converting Time from Hours to Minutes to Decimal Format

To convert your weekly IHSS hours and minutes to monthly hours you must multiply the amount of time you need by 4.33. This means you will need to convert your weekly hours to decimals by dividing the number of minutes by 60.

How to convert minutes to decimals:

How to convert time from decimals to minutes:

Here is an example based on an individual who needs 63:58 per week of IHSS:

Step 1: Add up Weekly Hours

IHSS Services	Time Authorized Hours and Minutes (HH:MM)
Domestic Services (per month)	6:00
Prepare Meals	7:00
Meal Clean Up	2:20
Routine Laundry	1:00
Shopping for Food	1:00
Other Shopping/Errands	0:30
Bowel, Bladder Care	4:13
Dressing	1:55
Ambulation	2:38
Transferring	1:43
Bathing Oral Hygiene, Grooming	4:05
Rubbing Skin, Repositioning	1:47
Accompaniment to Medical Appointments	0:03
Protective Supervision	34:35
Total Weekly Hours	63:58 (not including Domestic Services)

Step 2: Multiply IHSS Weekly Hours by 4.33

Since this individual needs 63 hours and 58 minutes per week of IHSS services, 58 minutes must be converted to decimal. To convert to decimal, you must take 58 minutes ÷ 60 =.9666 =.97 (rounded up). Then multiply 63.97 x 4.33 = 276.99 = 277 hours (rounded up).

Step 3: Add Monthly Domestic Service Hours

277 hours + 6 Domestic Services hours = 283. This individual will receive 283 hours per month in IHSS services.

The following page contains a time conversion chart that you may want to use to make converting numbers easier.

8. Contact DRC

If you have questions about your IHSS hours or a family member’s, please contact Disability Rights California’s intake line. You can call our intake line at 1-800-776-5746, or for TTY call 1-800-719-5798, Monday through Fridays from 9:00 a.m. to 3:00 p.m., except Wednesdays when the intake line is closed.

Time Conversion Chart (Minutes to Decimal Hours)
Minutes	Decimal Hours	Minutes	Decimal Hours	Minutes	Decimal Hours
1	.02	21	.35	41	.68
2	.03	22	.37	.42	.70
3	.05	23	.38	43	.72
4	.07	24	.40	44	.73
5	.08	25	.42	45	.75
6	.10	26	.43	46	.77
7	.12	27	.45	47	.78
8	.13	28	.47	48	.80
9	.15	29	.48	59	.82
10	.17	30	.50	50	.83
11	.18	31	.52	51	.85
12	.20	32	.53	52	.87
13	.22	33	.55	53	.88
14	.23	34	.57	54	.90
15	.25	35	.58	55	.92
16	.27	36	.60	56	.93
17	.28	37	.62	57	.95
18	.30	38	.63	58	.97
19	.32	39	.65	59	.98
20	.33	40	.67	60	1.00
120	2.00	180	3.00	240	4.00

• 1. To the best of our knowledge, this is the formula the State uses to calculate IHSS services.
• 2. Advance Pay is when IHSS recipients receives money in advance to be used to pay IHSS providers for IHSS services. Recipients who receive advance pay must be “severely impaired.” IHSS recipients must also show that they spent the money received on IHSS services. If an IHSS recipient is unable to show that the money was used to pay for IHSS services (such as providing copies of canceled IHSS provider pay checks and IHSS timesheets covering each pay period) the money may be required to be repaid. For more information, see the California Department of Social Services publication,"In-Home Supportive Services (IHSS) Program Advance Pay". Information about advance pay can also be found in DRC’s publication, “In-Home Supportive Services (IHSS): A Guide for Advocates".
• 3. A “Restaurant Meal Allowance” is given to IHSS recipients who have adequate cookingfacilities at home, but their disabilities prevent them from using the facilities. MPP 30-757.133(a). If you receive Supplemental Security Income (SSI) linked Medi-Cal and do nothave adequate cooking and storage facilities at home, you should be receiving a RestaurantMeal Allowance through the State Supplemental Payments which will be part of your total SSI payment. People who get a Restaurant Meal Allowance through SSI cannot get an IHSS Restaurant Meal Allowance. For more information, see ACL No. 16-12
• 4. See ACL 93-21, p. 4 “Any non-severely impaired PCSP recipient who is authorized protective supervision is entitled to an increase in the authorization to the maximum of 283 hours per month.” https://www.cdss.ca.gov/lettersnotices/entres/getinfo/acl93/93-21.PDF
• 5. All County Letter 14-60
• 6. All County Welfare Directors Letter No. 17-25
• 7. All County Welfare Directors Letter No. 23-24
• 8. All County Welfare Directors Letter No. 23-16
• 9. All County Letter No. 11-19
• 10. Covered California information for Immigrants, All County Welfare Directors Letter No. 21-13, DHCS Older Adult Expansion, DHCS Ages 26 through 49 Adult Full Scope Medi-Cal Expansion
• 11. All County Information Notice No. I-70-23
• 12. MPP 10-116.4
• 13. MPP 10-116.32
• 14. When prorating Domestic Services, the natural or adoptive children of the recipient who are under 14 are not considered (MPP section 30-763.46). Other children in the household (i.e., grandchildren, nieces, nephews, etc.) under 14 are considered.
• 15. MPP 30-763.3
• 16. MPP 30-763.47
• 17. MPP § 30-757.171(a)(2)
• 18. All County Welfare Directors Letter No. 98-53>
• 19. MPP 30-757.176
• 20. All County Letter No. 00-28
• 21. MPP 30-763.622
• 22. MPP 30-701(s)(1), MPP 30-763.5 and MPP 30-761.273