This is why family dynamics matter: the recipient controls the job—chooses the provider, sets tasks within the authorized plan, and can make changes.

Medi-Cal Eligibility & IHSS

IHSS requires full-scope Medi-Cal eligibility. If your Medi-Cal is “restricted” or “emergency-only,” IHSS may not be available until your coverage is expanded. Always check your status with your county social services office or through your Medi-Cal benefits portal. Learn more: DHCS Medi-Cal Eligibility.

• Regional Centers: For children and adults with developmental disabilities, Regional Centers can help families access the Home & Community-Based Services Developmental Disabilities (HCBS-DD) Waiver. This waiver allows a person to qualify for Medi-Cal without counting parental income, so IHSS can be approved when medically necessary.
• Automatic eligibility: Anyone receiving Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI) is automatically eligible for Medi-Cal in California, because they are already recognized as having a qualifying disability under federal law.

The In-Home Evaluation: What to Expect

Every IHSS case begins with an in-home evaluation. A county social worker will visit, observe daily activities, review medical records, and talk through what kind of support is needed. Their job is to understand how your loved one functions day to day, and what tasks require hands-on help to keep them safe at home. Based on this visit, the worker will recommend which IHSS services are authorized and how many hours per month are assigned.

Common forms include the SOC 873 Health Care Certification (completed by your doctor), and if specialized tasks are required, the SOC 321 Paramedical Services form.

What the social worker is really looking for: that your loved one is well-cared for, fed, safe, and supported in their own home. A clean and orderly space helps the visit go smoothly, but don’t stress about making your home look like a magazine cover. They’re not there to judge your decorating or lifestyle—they’re there to confirm that your family member needs help to remain safely at home.

• Bring daily logs showing when help was needed, incidents, fatigue, or safety concerns.
• Have clinician notes, discharge summaries, or therapy records ready to share.
• Be honest about hard days, not just good ones. This helps the worker see the full picture.
• Don’t over-clean or stage your home. A lived-in, safe environment is what matters most.
• Expect follow-ups: after your first evaluation, IHSS will return for annual reassessments to confirm needs and adjust hours as circumstances change.

After the visit: You will not know your exact hours right away. The county reviews everything and issues a Notice of Action (NOA) by mail, which can take several weeks. This wait can feel stressful—especially because hours aren’t based on how hard you already work, but on how the county measures your family member’s documented need. Some families get all the hours they expect, while others find they must fight through appeals to secure enough support. Don’t panic if the letter takes time to arrive, and remember: if you disagree with the decision, you have the right to appeal.

When you apply for IHSS, a county social worker will visit your home. Their job is to see what help your loved one needs to stay safe at home and to decide how many hours of care IHSS will pay for. They look at two tools: the Functional Index (FI), which measures how much help a person needs with daily activities, and the Hourly Task Guidelines (HTG), which give standard time estimates for tasks like bathing, dressing, or meal prep. They combine those tools with your records and your own descriptions of daily life.

What the social worker is really looking for: that your loved one is well-cared for, safe, fed, and supported. A clean house helps, but don’t stress about a “perfect” home—this isn’t a magazine photo shoot. The goal is to understand your family member’s needs, not to judge your lifestyle.

• Bring daily logs showing when help was needed, incidents, or safety concerns.
• Have clinician notes, discharge summaries, or therapy records ready.
• Be honest about tough days, not just good ones. This helps the worker see the real picture.
• Don’t over-clean or stage your home. A lived-in, safe space is exactly what they expect to see.
• Expect follow-ups: after your first evaluation, IHSS will return for annual reassessments to confirm needs and adjust hours as things change.

Protective Supervision (PS) is an IHSS service for people who, because of a cognitive impairment, engage in unsafe behaviors that put them at constant risk of injury. The focus is not on the diagnosis itself, but on the unpredictable actions that require someone to watch over them at all times. Examples include wandering outside, leaving the stove on, eating or drinking dangerous items, unsafe exits, or sudden aggression that could cause harm.

PS is one of the most difficult IHSS services to qualify for because it requires showing that the unsafe behaviors are ongoing, unpredictable, and related to a mental or cognitive condition. Families should prepare detailed logs and gather clinician notes to show what happens in real life—not just on good days. Importantly, PS is not considered “babysitting” or companionship; it is about preventing serious injury.

• Keep an incident log (wandering, stove left on, falls, ingestion, unsafe exits).
• Ask your doctor or therapist to describe unsafe behaviors in writing—these carry weight in the assessment.
• For minors, show why supervision goes beyond what is typical for their age.
• Forms often used: SOC 821 (Clinician Statement of Need) and, if approved, SOC 825 (24-Hour Coverage Plan).

Family reality: PS can unlock up to 24 hours of authorized care, but approval is strict. The county will expect detailed proof that without constant supervision, your loved one would be at immediate risk of harm. Be prepared, keep logs, and don’t understate the challenges.

Shows approved services/hours (or denials), your appeal rights and deadlines. Keep every NOA. Appeals info: CDSS hearings.

Where recipients/providers submit hours and signatures: ESP login. More tools: IHSS Provider Resources.