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 Social Worker, and received a Notice of Action (NOA) approving hours.  For more information on the IHSS application process, please see the IHSS Nuts and Bolts Manual, # 5470.01.²

A)  Background Information

(1)  IHSS Funding

First, it is important to understand the different funding sources for IHSS because which funding source (also known as “program”) you are placed in will determine the maximum amount of monthly IHSS hours that are available to you.  Note, that “hours available to you” does not mean that you will get all those hours.  Factors determining the hours you receive will be discussed in this publication.

There are four IHSS programs.  Each program has different eligibility criteria and maximum monthly hours available, depending on whether you are considered Severely Impaired or Non Severely Impaired (more on this below).  These programs are:

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

You can find information about what program you are on by looking at your Notice of Action³ approving your application for IHSS, or by asking your IHSS Social Worker.

The following chart lists the programs and the maximum available monthly IHSS hours:

Program	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/mth	283  hrs/mth	All County Information Notice (ACIN) Number I-28-06
IPO	283 hrs/mth	195  hrs/mth	All County Letter (ACL) Number 11-19
IHSS-R	283 hrs/mth	195  hrs/mth	ACIN I-28-06
CFCO	283 hrs/mth	Up to 283  hrs/mth	ACL 14-60

i. PCSP:

To be eligible for PCSP, you must be receiving full-scope Medi-Cal⁴ and your IHSS provider cannot be your spouse or parent.  

ii. IPO:

To be eligible for IPO, you do not qualify for the PCSP program because of one of the following:

• your IHSS provider(s) is your spouse or parent,
• you receive Advance Pay,⁵
• or you receive a Restaurant Meal Allowance.⁶

iii. IHSS-R:

To be eligible for IHSS-R, you do not receive full-scope Medi-Cal, or do not receive full-scope Medi-Cal with federal financial participation.⁷ This generally means IHSS-R is for lawful permanent residents, or persons residing in the United States under color of law.⁸

iv. CFCO: Community First Choice Option

To be eligible CFCO, you must be eligible for full-scope, federal financial participation Medi-Cal, and meet a nursing facility level of care based.⁹

If you are on IPO but can also be on CFCO, consider switching to CFCO. CFCO allows for a greater maximum of hours (which you would still need to prove eligibility for), and you may benefit from the  spousal impoverishment rules (see DRC publication # 5392.01;¹⁰ and the “All County Welfare Directors Letter, No. 17-25.¹¹)

(2) Severity:

IHSS establishes maximum monthly hours depending on whether you are considered Severely Impaired (SI) or Non Severely Impaired (NSI).  According to IHSS regulations, whether you are  NSI or SI is determined by adding the hours in these categories: Meal Preparation, Meal Clean Up, Respiration Assistance; Bowel, Bladder Care; Feeding; Routine Bed Bath; Dressing; Menstrual Care; Ambulation; Transferring; Bathing, Oral Hygiene, Grooming; Rubbing Skins, Repositioning; Help with Prosthesis; Paramedical Services.¹²

If you receive alternative resources¹³ providing any of the above services, then those hours are included in determining whether a recipient is NSI or SI, even though those same hours are not counted towards that consumer’s IHSS need.¹⁴

Example: if you go to an adult day care center and receive assistance with meal clean-up for lunch, then your IHSS monthly hours will not include the assistance you need in cleaning up after lunch. The lunch clean up assistance you receive at the adult day care center will count towards whether you are “Severely Impaired” or “Non Severely Impaired,” however. This means that your maximum monthly hours may be 283, or 195, depending on whether you are found to be “Severely Impaired” or “Non Severely Impaired.”

You are considered SI if you receive 20 hours or more in the above categories each week.¹⁵ You are considered NSI if you receive 19 or less hours in the above categories each week.

(3) Home Assessment

The Social Worker will assess you in your home to determine what services you need and how much time you need for each service.  Thereafter, if applicable, the Social Worker will prorate certain services, and will deduct time if there are alternative resources.  Proration and Alternative Resources are discussed more below.  Note that protective supervision may be prorated depending on your circumstances.  Please see the DRC publication # 5612.01, for more information.

(4)  Proration

When IHSS services can be met in common among anyone in the home, the hourly need for that service should be prorated.¹⁶ For example, if multiple people benefit from the provision of a related or domestic service, then the time it takes to prepare that service is divided equally among everyone who benefits, including non-IHSS recipients in the household.

Example: if it takes a parent 100 minutes to do weekly laundry for all five members of the family (including the parent and the single IHSS beneficiary), then the amount of time allotted to the IHSS beneficiary is 20 minutes (100 ÷ 5 = 20 minutes).

These service categories are prorated:

• Domestic Services and Heavy Cleaning;¹⁷
• Related Services,¹⁸ and
• If a service is not provided to more than one person at a time, then it should not be prorated.

Example: if a parent in the above example does her son’s (and he is the IHSS recipient) laundry separately 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.

(5)  Alternative Resources:

Alternative Resources are IHSS-like services you receive through other programs such as an adult day care program, or school.²⁰ After determining the amount of alternative resources you receive, the Social Worker will deduct this time from your total assessed need.

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 cleaning up after your lunch. In the meal clean-up category, there is a column labeled “Services You Refused or You Get From Others.”  Here, the County Social Worker would first add up the total amount of time spent cleaning up after breakfast, lunch, and dinner.  Then the County Social Worker would make an adjustment, or proration, because the clean-up services your providers provides benefits both you and the provider.  This means the Social Worker assigns your prorated time to you in the column “Amount of Service You Need.” Then, the County Social Worker indicates the clean-up assistance you receive from the alternative resource; this information is listed in the “Services you Refused or You Get From Others” column. 

 

¹ To the best of our knowledge, this is the formula the State uses to calculate IHSS services. – (Return to main document)

² The DRC Publication “In-Home Supportive Services Nuts and Bolts Manual” is available at: DRC In-Home Supportive Services Nuts & Bolts Manual. – (Return to main document)

³ See Notice of Action In-Home Supportive Services (IHSS) Change for a sample NOA. – (Return to main document)

⁴ Full-scope Medi-Cal means that  you can access all the services available under Medi-Cal. – (Return to main document)

⁵ Advance Pay is an option for IHSS recipients to receive an advanced payment for their monthly services to pay their providers directly.  For more information, see the California Department of Social Services publication, “In-Home Supportive Services (IHSS) Program Advance Pay” for more information.  Available here: In-Home Supportive Services (IHSS) Program Advance Pay. – (Return to main document)

⁶ Restaurant Meal Allowance is given to IHSS recipients who have adequate cooking facilities at home, but their disabilities prevent them from using the facilities. MPP 30-757.133(a).  Note that if you receive Medi-Cal through Supplemental Security Income, and you do not have adequate cooking and storage facilities at home, you should be receiving Restaurant Meal Allowance through the State Supplemental Payments.  For more information, see ACL No. 16-12, available at: Publication of the Regional Program Operations Manual System (POMS). – (Return to main document)

⁷ California provides full-scope Medi-Cal using state dollars and not federal dollars for certain groups of immigrants. For more information, see Western Center for Law and Poverty, “Getting and Keeping Health Coverage for Low-Income Californians: A Guide for Advocates,” Chapter 1, available at: Chapter 1: Overarching Eligibility for Medi-Cal. – (Return to main document)

⁸ For more information, see IHSS Personal Care Services Program, Independence Plus Waiver, and Residual Program. – (Return to main document)

⁹ For more information, see ACL No. 14-60, available at: Implementation of the Community First Choice Option (CFCO) Program. – (Return to main document)

¹⁰ Available at: DRC Medi-Cal Programs to Help You Stay in Your Own Home or Leave a Nursing Home. – (Return to main document)

¹¹ Available at: Home and Community-Based Services and Spousal Impoverishment Provisions. – (Return to main document)

¹² MPP 30-7-1(s)(1)(A)-(D); The Manual of Policies and Procedures are available here: Social Services Standards - Chapter 30-700 Service Program No. 7: IHSS; and Social Services Standards - Service Program No. 7: IHSS Cost Limitations. – (Return to main document)

¹³ Alternative Resources are IHSS-like services you receive through other programs. MPP 30-757.171(a)(2), and MPP 30-763.611. – (Return to main document)

¹⁴ MPP 30-701(s)(1), 30-763.5, 30-761.273. – (Return to main document)

¹⁵ MPP 30-701(s)(1). – (Return to main document)

¹⁶ MPP 30-763.32. – (Return to main document)

¹⁷ MPP 30-763.31 – (Return to main document)

¹⁸ MPP 30-763.32. Related services includes meal preparation, meal clean-up, routine laundry, shopping, for food, and other shopping/errands. – (Return to main document)

²⁰ MPP 30-757.171(a)(2), MPP 30-763.611. – (Return to main document)