IHSS: In-Home Supportive Services, and its equivalent in every state

What is IHSS?

In-Home Supportive Services is a California program, funded mainly through Medi-Cal, that pays for help at home so people who are 65 or older, blind or disabled don't have to move into a nursing home. Services include bathing, dressing, meal preparation, housework, laundry, shopping, rides to medical appointments and some paramedical tasks.

IHSS is a model of consumer-directed care. The recipient is the employer: they hire, train, supervise and, if needed, fire their own "individual provider". That provider can be a relative, which is why IHSS is one of the largest paid family caregiver programs in the country.

The California Department of Social Services oversees IHSS, but each county's IHSS office runs it day to day. There's no waitlist — if your relative qualifies, they get the hours.

Who qualifies for IHSS in California

The person receiving care must:

• Live in California, in their own home (not a hospital, nursing home or licensed care facility).
• Be 65 or older, blind or disabled — including children with disabilities.
• Be eligible for Medi-Cal.
• Have a health care provider complete the Health Care Certification form.
• Need help to stay safely at home, as confirmed by a county social worker's in-home assessment.

To apply, contact your county IHSS office and submit form SOC 295, the Application for In-Home Supportive Services. A social worker then visits to decide which services and how many hours are authorized. See the California caregiver program page and county pages like Los Angeles County, San Diego County and Orange County.

Can family members be paid IHSS providers?

Yes. Adult children, grandchildren, siblings and friends can all be IHSS providers. The rules for the two closest relationships are specific:

Providers enroll with the county, complete a criminal background check and a provider orientation, and are paid through the state's payroll system, which withholds taxes. If you live with the person you care for, some or all of the pay may be tax-free under the IRS difficulty-of-care rule. More in paid parent caregivers and California spousal caregiver rules.

How much IHSS pays

California's statewide IHSS minimum is $16.90 an hour as of January 1, 2026. Counties negotiate their own wages above that, so providers earn roughly $16.90 to $22 an hour depending on the county.

Your total depends on the authorized hours. A recipient approved for 100 hours a month at $19 an hour means $1,900 a month in provider pay. Compare every state in family caregiver pay rates or see California caregiver pay.

IHSS Colorado: In-Home Support Services

Colorado is the one other state with a program actually named IHSS — here it stands for In-Home Support Services. The IHSS program Colorado runs lets a member direct their own care through a licensed IHSS agency, which employs the attendant. The attendant can be a family member, including a spouse.

Colorado IHSS sits alongside CDASS (Consumer-Directed Attendant Support Services), where the member hires attendants directly and a financial management vendor runs payroll, and the Family CNA pathway for parents of children with high needs. Since July 2025 these personal care services come through Community First Choice, a Medicaid state-plan benefit with no waitlist.

IHSS Colorado pay

Colorado IHSS pay runs roughly $17 to $20 an hour. The floor is the state minimum wage ($17.00 in 2026, $19.29 in Denver), and the wage is set within the member's allocation. People searching "ihss colorado pay" should also check the agency's own wage, since the agency is the employer.

To start with Colorado IHSS, the member must be enrolled in Health First Colorado (Medicaid) and contact their local Case Management Agency for an assessment. See the Colorado caregiver program, Denver and El Paso County. Anyone searching "in-home support services Colorado" is looking for the same program.

IHSS Arizona: ALTCS caregiver options

Arizona has no program called IHSS. Its equivalent runs through ALTCS, the Arizona Long Term Care System, part of the state's Medicaid agency (AHCCCS). ALTCS is an entitlement: if your relative qualifies financially and medically, there's no waitlist.

An ALTCS caregiver who is family can be paid three ways:

• Self-Directed Attendant Care — the member hires and manages their own attendant, and a fiscal agent runs payroll.
• Agency with Choice — the member shares employer duties with a provider agency. Spouses reportedly must use this route.
• Parents as Paid Caregivers — parents of minor children who meet direct care worker requirements, capped at 40 paid hours a week per child across both parents since July 2025.

Reported pay is about $13 to $16 an hour. See the Arizona caregiver program, Maricopa County and Pima County.

IHSS Texas: Consumer Directed Services

There's no IHSS in Texas. People who search "IHSS Texas" or "in-home support services Texas" are looking for Consumer Directed Services (CDS), an option inside STAR+PLUS and several waivers. Under CDS, the member becomes the employer, hires their own attendant — often a relative — sets schedules and approves timesheets, and a CDS agency handles payroll.

Texas does not pay spouses as CDS attendants, and reported pay is around $15 an hour. The bigger issue is waiting: STAR+PLUS HCBS, CLASS and MDCP have interest lists measured in years. See the Texas caregiver program, Harris County, Dallas County and Bexar County.

IHSS Oregon, Georgia, Massachusetts, Wisconsin and Virginia

Here's what to look for when you've searched for IHSS in a state that doesn't use the name:

Oregon pays homecare workers $20 to $24.10 an hour and runs a dedicated Spousal Pay Program. Georgia's main family option is a live-in daily stipend — see Structured Family Caregiving. Massachusetts PCA pays $19.50 to $23.25 an hour on a seniority scale, and Adult Foster Care pays a live-in caregiver a tax-free stipend. Wisconsin's IRIS has no waitlist and allows paid spouses. Virginia can pay a spouse or parent only for "extraordinary care" under its legally responsible individual rules.

The full list for every state is in Medicaid family caregiver programs by state. If your relative is in New York, the closest match to IHSS is CDPAP.

Which states have IHSS? The equivalent in all 50 states

Only California runs a program called In-Home Supportive Services. Colorado has a separate program with a near-identical name, In-Home Support Services. Every other state pays for the same kind of help at home through its own Medicaid programs, and most of them let the person receiving care hire a relative. Here is the name to look for in each state:

Medicare in-home support services

IHSS is a Medicaid (Medi-Cal) program. Original Medicare doesn't cover ongoing help with bathing, dressing or chores when that's the only care someone needs, and it doesn't pay family caregivers.

Since 2019, some Medicare Advantage plans have been allowed to offer "in-home support services" as a supplemental benefit. Where a plan offers Medicare in-home support services, it's usually a limited number of hours from a contracted agency, not wages for a relative. Check the plan's Evidence of Coverage. Full details in does Medicare pay family caregivers?.

How to apply for IHSS or your state's version

1. Confirm Medicaid (Medi-Cal in California). Apply first if your relative isn't enrolled.
2. Contact the local office — the county IHSS office in California, the Case Management Agency in Colorado, ALTCS in Arizona, or the state program listed on your state page.
3. Complete the in-home assessment, which sets the hours.
4. Name yourself as the provider and complete enrollment, background check and any orientation.
5. Submit timesheets and get paid each pay period.

Not sure which program your relative qualifies for? Check eligibility in two minutes, or read how to become a paid caregiver for a family member.

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