Medicaid Home Care Programs in California: What Caregivers Should Know

Main programs and routes to check

What Medicaid home care may cover in California

Medi-Cal home care is not one single program. It is a set of routes. The right route depends on the person’s Medi-Cal status, daily care needs, medical needs, county, and health plan.

For many families, IHSS is the most direct path for help inside the home. IHSS may cover personal care, such as bathing, dressing, feeding, toileting, and related help. It may also cover some homemaker tasks, such as house cleaning, cooking, shopping, laundry, and help getting to and from medical appointments.

Some care is through regular Medi-Cal benefits or state plan personal care. Some care is through home and community-based services waivers. A waiver lets Medi-Cal cover certain home or community services for people who would otherwise need a nursing facility, hospital, or other institutional level of care. Some services also go through the person’s Medi-Cal managed care plan.

Programs to check first

IHSS: the first call for in-home daily help

IHSS provides in-home help for eligible aged, blind, and disabled people as an alternative to out-of-home care. It is tied to Medi-Cal and is handled by county IHSS offices.

After the county approves IHSS, the recipient hires a provider. A friend or relative may serve as the provider after the required enrollment steps. If you are trying to learn whether a family caregiver can be paid, also read Can I get paid to be a caregiver? and use the paid caregiver quiz.

Do not assume the hourly rate or provider rules are the same in every county. The county or social worker should confirm the current rate and provider steps.

HCBA waiver: when care needs are higher

The Home and Community-Based Alternatives waiver, often called HCBA, is for people at risk of nursing home or institutional care. It provides care management through a team that includes a nurse and social worker.

HCBA can be important when a person has complex medical needs, needs waiver personal care, or needs help keeping a home care plan in place. DHCS has warned that some WPCS requests and calls may take longer than normal because of high volume, so families should keep working with the assigned waiver agency.

For a plain-English primer on waivers, read Medicaid HCBS waivers explained.

MSSP: care management for older adults

The Multipurpose Senior Services Program, or MSSP, provides health and social care management to help people remain at home and in the community. The program can link the person to services and may buy some needed services that are not otherwise available.

MSSP services can include care management, adult day care, minor home repair, added chore or personal care services, protective supervision, respite, transportation, counseling, meal services, and communication services.

CBAS: adult day health care

Community-Based Adult Services, or CBAS, is adult day health care for eligible Medi-Cal members. It may include assessment, nursing, therapies, mental health services, therapeutic activities, social services, personal care, a meal, nutrition counseling, and transportation to and from the center.

For many members, the Medi-Cal managed care plan decides CBAS eligibility. Call the plan and ask for a CBAS referral if the person needs a structured day program with health services.

Medi-Cal managed care: do not skip the health plan

Many Californians with Medi-Cal get care through a managed care plan. The plan may be the right place to ask about transportation, care management, home health, medical supplies, equipment, CBAS, and plan appeals.

IHSS still goes through the county IHSS office. Waivers may have their own agency. But the plan can still matter if the person needs covered health care, rides, equipment, or help tying services together.

California Paid Family Leave: help for a working caregiver

California Paid Family Leave is not Medicaid home care. It does not pay for the older adult’s care services. It may replace part of a worker’s wages for a limited time when the worker needs time off to care for a seriously ill family member.

If you are missing work because of caregiving, check this while you apply for care services. Also read caregiver tax deductions and keep records of out-of-pocket care costs. For planning, use the care cost calculator.

Who may qualify

Each program has its own rules. Do not rely on a single phone answer if the person has serious care needs. Ask for the exact program name, the rule used, and whether there is another route.

How the assessment works

For IHSS, a county social worker interviews the person at home. The worker decides what services are needed and how many hours can be authorized. The worker may consider the person’s medical condition, living arrangement, help already available, safety risks, and information from the person, family, friends, doctor, or other licensed health care professional.

The doctor or other approved health care professional must complete the SOC 873 health care certification. This form supports the need for IHSS. The county must receive it before IHSS services can be authorized.

After the decision, the county sends a Notice of Action. The notice should say whether IHSS was approved or denied. If approved, it should list the services, time for each service, and total monthly hours.

How to apply

For more scripts, use caregiver phone scripts. For a task list you can print, use caregiver checklists.

What to do while waiting

Waiting is common. It does not mean you should stop asking. Keep notes of each call. Write down the date, time, agency, worker name, and what they said.

If a hospital or nursing facility is trying to discharge the person, ask for a safe discharge plan. Ask whether the person needs IHSS, home health, durable medical equipment, transportation, HCBA, MSSP, CBAS, or a managed care plan care manager before going home.

If services are denied or cut

Ask for the decision in writing. In California, many benefit decisions come as a Notice of Action. Keep the envelope and all pages.

Look for the reason. It may say the person does not qualify, the county did not get a form, the hours were reduced, the task was not allowed, or the person should use another route.