In-Home Supportive Services (IHSS)

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By
Rachael Serrao
Date Published
March 28, 2025

The In-Home Supportive Services (IHSS) program helps low-income Californians remain safely in their own homes by providing personal care and domestic services. By helping individuals continue to live in their home, IHSS allows recipients to maintain independence, stay part of their community, and avoid more costly services, such as nursing homes and board and care facilities.

IHSS costs are shared between the federal government, the state, and counties as the IHSS program is provided as a Medi-Cal benefit. Counties pay their portion through a maintenance of effort (MOE), which has been significantly modified several times in recent years. There are also ongoing efforts related to IHSS collective bargaining mechanisms and responsibilities. CSAC advocates to protect county fiscal, programmatic, and administrative responsibilities on any potential changes to the IHSS program.

2025 IHSS Statewide Collective Bargaining Report

The California Department of Social Services (CDSS) has released In-Home Supportive Services (IHSS) Statewide Collective Bargaining: Report to the Legislature. The Budget Act of 2023 (Chapter 38, Statutes of 2023) required CDSS to prepare an analysis of the costs and benefits of transitioning IHSS collective bargaining from the counties to the state. The required workgroup met throughout 2024 and included representatives from the California State Association of Counties (CSAC), the County Welfare Directors Association (CWDA), the California Association of Public Authorities (CAPA), IHSS provider unions, and IHSS consumers. The report was due to the Legislature by January 1, 2025, but is being submitted in April 2025. Learn more here. 

2019 IHSS MOE 

In the 2017 legislation (SB 90, Chapter 25, Statutes of 2017) that established the increased County In-Home Supportive Services (IHSS) Maintenance of Effort (MOE), CSAC advocated for a provision that required the Department of Finance to reexamine the 2017 IHSS fiscal structure during the development of the 2019-20 budget. This reopener provision was absolutely vital as counties knew that it was likely possible to manage the first two years of the new MOE, but starting with 2019-20, the increased costs would become unsustainable.

In conjunction with the release of the Department of Finance report in January 2019, the Governor released a proposal to revise and lower the County IHSS MOE. CSAC strongly supported this proposal, which was enacted into law through a budget trailer bill, Senate Bill 80 (Chapter 27, Statutes of 2019), and made several significant changes to the County IHSS MOE. These changes are:

  • Lowering the County IHSS MOE base in 2019-20 to $1.56 billion,
  • Reducing the MOE inflation factor from seven percent to four percent,
  • Stopping the redirection of VLF growth funds from Health, Mental Health, and County Medical Services Program to Social Services,
  • Ending the State General Fund IHSS mitigation,
  • Returning to the original method for calculating IHSS caseload and no longer utilizing accelerated caseload growth, and
  • Funding IHSS administrative costs through a General Fund allocation.

All these changes are made possible by an increased State General Fund commitment for IHSS costs that is ongoing and that totals nearly $2 billion in the first four years of this new structure. CSAC and counties worked for two years towards a more sustainable fiscal structure to manage IHSS costs and continue to deliver vital health and mental health services on behalf of the state. CSAC is grateful to the Governor and the Legislature for this outcome.

2019 IHSS MOE Related Materials

Background on 2017 IHSS MOE

In 2017, the conclusion of the Coordinated Care Initiative also resulted in the cessation of the existing IHSS MOE and the shift of nearly $600 million in IHSS costs from the state to counties. In response, a new IHSS MOE was negotiated, which also included specific offsetting revenue, additional collective bargaining provisions, and refinement of the costs for county administration of the IHSS program. Specifically, the 2017-18 Budget Act included provisions that:

  • Established a new County IHSS MOE with an annual inflation factor (5% for one year, 7% thereafter),
  • Provided State General Fund contributions to partially offset increased county IHSS costs ($400 million in 2017-18, $330 million in 2018-19, $200 million in 2019-20, $150 million thereafter),
  • Redirected Health, Mental Health, and CMSP 1991 Realignment VLF growth funding to Social Services (100% of growth for three years, 50% of growth in the next two years),
  • Accelerated caseload growth payments from 1991 Realignment sales tax growth so that counties receive this funding earlier to partially offset increased county IHSS costs, and
  • Provided additional tools for local collective bargaining including a wage supplement and state participation in a limited amount above the state participation cap.

Counties dedicated significant time and effort to partnering with the Department of Finance and the Department of Social Services on implementing these changes. Counties and provider unions have also utilized the new tools during local collective bargaining.. 

IHSS Related Materials

Issue Brief: In-Home Supportive Services