California Medi-Cal offers four main home care benefit pathways for San Diego seniors: 1) In-Home Supportive Services (IHSS), which pays an hourly wage to a hired caregiver to provide non-medical help at home; 2) The Assisted Living Waiver, which covers assisted living facility costs for Medi-Cal eligible seniors who would otherwise need nursing home care; 3) Community-Based Adult Services (CBAS), which provides day program services for seniors with cognitive or functional impairment; 4) CalAIM Community Supports, which expanded benefits to include personal care, respite, home modifications, and other services for Medi-Cal members in 2022 onward. Eligibility requires meeting California Medi-Cal income and asset limits and demonstrating functional or medical need. Apply through the San Diego County Health and Human Services Agency. United Home Care works alongside IHSS-funded care for many families. Call (619) 373-3533 to discuss your situation.
What Is Medi-Cal and Who Qualifies?
Medi-Cal is California's Medicaid program, providing health coverage to qualifying low-income residents including seniors, children, families, and people with disabilities. For seniors, Medi-Cal is the primary state-funded program for long-term care and home care benefits.
Eligibility for seniors generally requires meeting income limits (adjusted annually by the California Department of Health Care Services) and meeting asset limits. California eliminated the asset limit for most Medi-Cal programs in 2024, which significantly expanded eligibility for seniors with moderate savings.
Other eligibility factors include California residency, U.S. citizenship or qualifying immigration status, and Social Security number or eligibility for one. Applications can be filed at any time and benefits are not limited by enrollment periods the way some other programs are.
Apply through the County of San Diego Health and Human Services Agency. Applications are accepted online at the BenefitsCal portal, by phone, by mail, in person at HHSA service centers, or with help from community-based organizations.
If a senior already qualifies for Medi-Cal, the home care benefits described below are available through additional application processes. If the senior does not yet qualify, the Medi-Cal application is the first step before any home care benefit application.
How Does In-Home Supportive Services (IHSS) Work?
IHSS is California's largest home care benefit program. It pays an hourly wage to a caregiver, who can be a family member, friend, or hired provider, to provide non-medical care to a Medi-Cal eligible recipient at home.
IHSS authorizes hours based on a needs assessment performed by a county social worker. The assessment evaluates the recipient's ability to perform daily activities and assigns hours by category. Categories include domestic services (cooking, cleaning), personal care services (bathing, dressing, transferring), paramedical services (with nurse oversight), and protective supervision for cognitively impaired recipients.
Approved monthly hours typically range from 20 to 280 hours. The average authorization in California is approximately 90 to 120 hours per month, though severely impaired recipients with protective supervision needs can receive significantly more.
The IHSS hourly wage in San Diego County for 2026 is in the upper teens per hour. The wage is set by union contract and adjusted periodically. The recipient acts as the legal employer and selects the caregiver.
Many San Diego families combine IHSS with private home care from an agency like United Home Care. IHSS covers basic hours; private agency care covers specialized needs (dementia care, post-surgery recovery, complex behaviors) or hours that exceed IHSS authorization.
How Do I Apply for IHSS in San Diego?
Apply through the San Diego County Health and Human Services Agency. The process has four main steps.
Step 1: Establish Medi-Cal eligibility. The recipient must be enrolled in Medi-Cal or in the process of enrolling. If not yet enrolled, complete the Medi-Cal application first.
Step 2: Apply for IHSS. Submit the SOC 295 application form to the San Diego County IHSS office. Forms are available online and at HHSA service centers.
Step 3: County assessment visit. A social worker schedules an in-home visit, typically within 30 to 60 days of application. The visit lasts one to two hours. The social worker evaluates the recipient's daily living abilities and the home environment.
Step 4: Hours authorization and caregiver enrollment. After the assessment, the county sends a Notice of Action with authorized hours and approved tasks. The recipient then selects a caregiver, who must enroll with the IHSS program (background check, orientation, paperwork).
Total time from application to first paid caregiver hours typically runs 60 to 120 days. Plan accordingly if home care is needed urgently.
What Is the Assisted Living Waiver?
The Assisted Living Waiver is a Medi-Cal program that covers the cost of assisted living facility care for seniors who would otherwise require placement in a nursing facility. It is not strictly a home care benefit, but it is an important option for San Diego families considering facility care.
Eligibility requires Medi-Cal enrollment, age 21 or older, and a level of care equivalent to what a nursing facility would provide. The recipient must also choose to receive care in a Residential Care Facility for the Elderly (RCFE) rather than a nursing home.
The waiver covers most assisted living costs, with the recipient typically responsible for room and board costs. Several San Diego County RCFEs participate in the Assisted Living Waiver program.
The Assisted Living Waiver has waiting lists in many California counties. San Diego County's wait times vary. Families considering this option should apply early and continue exploring other care options in case the wait extends.
What Are Community-Based Adult Services (CBAS)?
CBAS provides day program services for seniors and adults with disabilities who meet medical and functional eligibility criteria. CBAS centers operate during the day, with participants coming for several hours per day, several days per week, while continuing to live at home.
Services at CBAS centers include nursing oversight, social activities, meals, therapy services, and supervision. The model is well-suited for seniors who live with family caregivers and need supervised activity during the day while the family caregiver works or rests.
Eligibility requires Medi-Cal enrollment and a medical or functional condition that requires CBAS-level care. The application includes a medical assessment.
Several CBAS centers operate in San Diego County, serving different neighborhoods and offering varying program structures. Families considering CBAS should visit multiple centers to find the right fit for the participant.
What Is CalAIM and How Does It Change Home Care Benefits?
CalAIM (California Advancing and Innovating Medi-Cal) is a major Medi-Cal reform that began in 2022 and continues to evolve. CalAIM expanded benefits for Medi-Cal members in significant ways, particularly through Community Supports.
Community Supports under CalAIM include services that traditional Medi-Cal did not previously cover: housing transition services, housing tenancy supports, short-term post-hospitalization housing, recuperative care, respite services, day habilitation programs, nursing facility transition assistance, asthma remediation, home modifications, sobering centers, and personal care and homemaker services.
Personal care and homemaker services under Community Supports can include some of the same services that private home care agencies provide: help with bathing, dressing, meals, and light housekeeping. The benefit operates through Medi-Cal managed care plans rather than traditional fee-for-service Medi-Cal.
In San Diego, the Medi-Cal managed care plans include Community Health Group, Blue Shield of California Promise Health Plan, Molina Healthcare, and others. Members request Community Supports through their managed care plan.
CalAIM benefits continue to evolve. The specific services available and the application processes change periodically. Members should check with their managed care plan for current information.
How Do I Coordinate Medi-Cal Benefits With Private Home Care?
Many San Diego families use a combination of Medi-Cal benefits and private home care. The combination often works better than either source alone.
Common structures include: IHSS for basic hourly care plus private agency care for specialized needs or additional hours; IHSS during weekdays plus private weekend care; CBAS for daytime activity plus private overnight or weekend care; CalAIM Community Supports for some services plus private care for the rest.
United Home Care has worked with many Medi-Cal eligible families. We can provide private care that complements IHSS or CBAS, coordinate around the IHSS caregiver's schedule, and help families think through how to combine resources.
Call (619) 373-3533 to discuss your situation. We can help families understand the landscape, even when our services may not be the right fit for every hour of needed care.
Frequently Asked Questions
Q1. Does Medi-Cal pay for in-home care in California?
Yes, through several programs. The largest is In-Home Supportive Services (IHSS), which pays an hourly wage to a hired caregiver for non-medical home care. CalAIM Community Supports added additional home-based services through Medi-Cal managed care plans starting in 2022. The Assisted Living Waiver and Community-Based Adult Services (CBAS) provide additional home and community-based options for qualifying members.
Q2. What is the income limit for IHSS in California?
IHSS requires Medi-Cal eligibility. Medi-Cal income limits are set annually by the California Department of Health Care Services and vary based on the program category (Modified Adjusted Gross Income or non-MAGI). California eliminated the asset limit for most Medi-Cal programs in 2024. The San Diego County Health and Human Services Agency or California Health Care Foundation can provide current income figures.
Q3. Can a family member be paid as an IHSS caregiver?
Yes. Adult children, spouses (with some restrictions), siblings, and other family members can be paid IHSS caregivers in most cases. The caregiver must enroll with the IHSS program, complete background check and orientation, and meet other requirements. Many San Diego families use a family caregiver for IHSS hours, which provides income to the family member providing care.
Q4. How many hours of IHSS can someone get?
Authorized hours range from 20 to 280 per month based on a county social worker's needs assessment. The average authorization is approximately 90 to 120 hours per month. Recipients with severe cognitive impairment or significant protective supervision needs can receive higher authorizations. Hours are reassessed periodically.
Q5. How long does it take to get IHSS approved?
From application to first paid caregiver hours typically takes 60 to 120 days in San Diego County. The process includes Medi-Cal eligibility verification, county social worker assessment visit, hours authorization notice, and caregiver enrollment with background check and orientation. Families needing care immediately should plan for private-pay care during the IHSS application period.
Q6. Can I use private home care while waiting for IHSS to start?
Yes, and many San Diego families do. Private home care can begin within 24 to 72 hours of an initial call, while IHSS takes 60 to 120 days. United Home Care frequently serves families during this gap. Some families continue using private care for specialized needs or additional hours after IHSS starts, while others transition entirely to IHSS-funded care.