If your loved one needs help at home, one of the first questions you may have is:
"Will Medi-Cal pay for in-home care?"
The answer is yes:
Medi-Cal can cover certain types of in-home care for eligible Californians, but it depends on the program, your loved one's needs, and their eligibility.
Medi-Cal supports several programs that can help eligible individuals receive care and services in their homes and communities instead of moving into a nursing facility or other institutional setting.
For San Diego families, two programs you may hear about most often are In-Home Supportive Services (IHSS) and CalAIM Community Supports.
These programs can both help people remain at home, but they work very differently.
This guide explains what Medi-Cal may cover, who may qualify, how IHSS and CalAIM differ, and how San Diego families can begin exploring their options.
What Types of In-Home Care Does
Medi-Cal Cover?
Medi-Cal is California's Medicaid program, and it provides coverage for a wide range of health and support services.
For eligible people, Medi-Cal's Home and Community-Based Services can include personal care, homemaker services, home health aide services, nursing, respite care, habilitation, and other supports.
The specific services available depend on the program and the individual's eligibility.
Non-Medical In-Home Care
Some Medi-Cal programs can help cover non-medical support with everyday activities.
Depending on the program, this may include:
- Bathing
- Dressing
- Grooming
- Personal hygiene
- Mobility assistance
- Transfers
- Meal preparation
- Laundry
- Shopping
- Light housekeeping
- Accompaniment to appointments
- Supervision
- Respite for family caregivers
For example, DHCS describes Personal Care and Homemaker Services under CalAIM Community Supports as assistance with activities of daily living and instrumental activities of daily living, including bathing, feeding, meal preparation, grocery shopping, and accompaniment to medical appointments.
Medical Home Health Care Is Different
It's important to distinguish home care from home health care.
Non-medical home care focuses on everyday assistance and support.
Home health care involves medical services provided by healthcare professionals, such as skilled nursing or therapy, when medically appropriate.
If your loved one needs wound care, medical treatment, skilled nursing, or other clinical services, they may need home health rather than a non-medical home care provider.
If what they need is help bathing, dressing, preparing meals, getting around safely, or having someone there for support, a non-medical home care program may be more appropriate.
What Is IHSS?
In-Home Supportive Services (IHSS) is one of California's primary programs for helping eligible people remain safely in their own homes.
IHSS can help pay for authorized services for people who are older, blind, or disabled, including disabled children. DHCS states that IHSS may cover services such as personal care, meal preparation, laundry, shopping, accompaniment to medical appointments, protective supervision, and certain paramedical services.
A county social worker assesses the individual's needs and determines which services and hours may be authorized.
Can a Family Member Get Paid Through IHSS?
Potentially, yes.
One of the features that makes IHSS different from many other home care programs is that an eligible recipient can have a qualified individual—including certain family members—provide authorized care.
California's IHSS Plus State Plan Option, for example, allows enrolled care providers, including parents or spouses in applicable circumstances, to provide services to qualified recipients.
However, being a family caregiver does not automatically mean you will be paid.
The person receiving care must qualify for IHSS, services must be authorized, and the caregiver must meet the applicable provider requirements.
If your primary goal is to get paid for caring for a family member, IHSS is an important program to investigate.
What Is CalAIM Community Supports?
CalAIM, or California Advancing and Innovating Medi-Cal, is California's initiative to make Medi-Cal more coordinated and focused on the whole person.
One part of CalAIM is Community Supports.
Community Supports are optional services offered through participating Medi-Cal managed care plans to eligible members who have identified health, functional, or support needs.
One of the Community Supports is Personal Care and Homemaker Services.
These services can provide in-home assistance with activities such as:
- Bathing
- Dressing
- Feeding
- Meal preparation
- Grocery shopping
- Mobility
- Accompaniment to appointments
CalAIM also includes Respite Services, which can provide temporary relief for caregivers of eligible members.
How Is CalAIM Different From IHSS?
The biggest difference is how the services are arranged.
With IHSS, the eligible recipient can have an individual provider deliver authorized services, and qualified family members may be able to serve as providers.
With CalAIM Community Supports, services are authorized through the member's Medi-Cal managed care plan and delivered by an authorized provider.
Coast Care is an authorized Community Supports provider in San Diego County. Coast Care works with participating Medi-Cal managed care plans to provide authorized in-home services.
CalAIM is not simply another way for a family member to receive an IHSS-style paycheck.
The programs have different eligibility requirements, provider structures, and purposes.
Who Qualifies for Medi-Cal In-Home Care?
Having Medi-Cal is an important starting point, but Medi-Cal enrollment alone does not automatically qualify someone for every in-home care program.
Eligibility depends on the specific program and the individual's circumstances.
IHSS Eligibility
To qualify for IHSS, an individual generally must meet the program's Medi-Cal and disability, age, or blindness requirements and have a demonstrated need for authorized services.
DHCS lists people who are:
- Age 65 or older
- Blind
- Disabled, including disabled children
- Living with certain chronic disabling conditions
among those who may qualify, provided the other program requirements are met.
The county conducts an assessment to determine the individual's functional needs and authorized services.
CalAIM Eligibility
CalAIM Community Supports are available to eligible Medi-Cal members through participating managed care plans.
A member may be considered for Community Supports when they have needs such as:
- Difficulty with daily activities
- Chronic or complex health conditions
- Risk of hospitalization
- Risk of nursing facility placement
- A need for additional support to remain safely at home
- A family caregiver who needs additional support
These circumstances do not guarantee approval.
The member's Medi-Cal managed care plan ultimately determines whether a particular Community Support is available and authorized.
Does Every Medi-Cal Plan Cover the Same In-Home Care?
No.
This is an important point for families.
Medi-Cal is statewide, but specific programs, services, and Community Supports can vary based on the member's managed care plan and circumstances.
DHCS maintains a Community Supports search tool so members and providers can see which Community Supports are offered by Medi-Cal managed care plans in different counties.
For CalAIM specifically, a health plan must authorize the service before an authorized provider can deliver it.
How to Get Medi-Cal In-Home Care in San Diego
If your loved one lives in San Diego County, there are several ways to begin.
Step 1: Confirm Medi-Cal Coverage
Start by confirming that your loved one has active Medi-Cal coverage.
If they have Medi-Cal through a managed care plan, identify the specific plan they are enrolled in.
This information can help determine which programs and Community Supports may be available.
Step 2: Determine What Type of Help Is Needed
Think about what your loved one actually needs help with.
For example:
- Bathing
- Dressing
- Toileting
- Mobility
- Meal preparation
- Transportation
- Companionship
- Supervision
- Household tasks
- Respite for a family caregiver
- Support following hospitalization
Having a clear picture of the person's needs can make it easier to determine which program may be appropriate.
Step 3: Explore IHSS
If your loved one may qualify for IHSS, contact the appropriate county IHSS program to begin the application process.
A social worker will evaluate your loved one's needs and determine which services may be authorized.
If you're hoping to become a paid family caregiver, ask about the IHSS provider requirements that apply to your relationship with the person receiving care.
Step 4: Ask About CalAIM Community Supports
If your loved one has Medi-Cal through a participating managed care plan, ask their:
- Health plan
- Care manager
- Physician
- Social worker
- Hospital discharge planner
- Enhanced Care Management provider
whether Community Supports may be appropriate.
You can also contact an authorized provider such as Coast Care for information about the services it provides.
Step 5: Complete the Eligibility and Authorization Process
For CalAIM Community Supports, the member's health plan evaluates the individual's circumstances and determines whether services can be authorized.
Coast Care can help families understand the process and provide a free phone screening, but Coast Care does not determine eligibility or approve Medi-Cal benefits. The health plan makes the authorization decision.
Does Medi-Cal Pay for Private Home Care?
This is where things can become confusing.
Medi-Cal does not simply reimburse any home care agency because someone has Medi-Cal.
Covered services must be provided through an applicable Medi-Cal program and meet that program's requirements.
For example:
- IHSS provides authorized services through the IHSS program.
- CalAIM Community Supports are authorized through participating Medi-Cal managed care plans and delivered through approved providers.
- Other Medi-Cal Home and Community-Based Services programs have their own eligibility and service requirements.
So if you're calling private home care agencies and asking whether they "take Medi-Cal," the better question is:
"Are you an authorized provider for a Medi-Cal program that may cover my loved one's in-home care?"
For San Diego families, Coast Care is an authorized CalAIM Community Supports provider for participating health plans.
Is Medi-Cal In-Home Care Free?
For some eligible individuals, yes, authorized in-home services may be provided with no out-of-pocket cost to the member.
Coast Care states that eligible Medi-Cal members receiving authorized CalAIM Community Supports may receive services at no cost.
However, it is important to understand that:
Having Medi-Cal does not automatically mean all home care is free.
Coverage depends on:
- The specific Medi-Cal program
- The member's eligibility
- The health plan
- The type of service
- The member's assessed needs
- Authorization requirements
- Program limitations
For IHSS, DHCS notes that individuals with Medi-Cal and no share of cost can have their authorized IHSS services paid for; members with a share of cost must meet that obligation before IHSS services are paid.
Medi-Cal In-Home Care vs. Paying Out of Pocket
If a family qualifies for a Medi-Cal program that covers the services they need, it can significantly reduce or eliminate the cost of care.
But not every family qualifies for every program.
If Medi-Cal does not cover the care your loved one needs, families may consider other ways to pay for non-medical home care, including:
- Private funds
- Long-term care insurance
- Veterans benefits
- Home equity
- Other applicable benefits or programs
Coast Care also offers private-pay non-medical home care for families who do not receive covered CalAIM services. Current private-pay pricing is listed at $39 per hour, with a four-hour minimum per visit.
How Coast Care Helps San Diego Families Navigate Medi-Cal Home Care
Understanding Medi-Cal programs can be overwhelming.
Families may hear terms like IHSS, CalAIM, Community Supports, Enhanced Care Management, Home and Community-Based Services, and Medi-Cal managed care—and it can be difficult to understand which one actually applies to their situation.
Coast Care can help make the process easier to understand.
As an authorized CalAIM Community Supports provider in San Diego County, Coast Care works with participating Medi-Cal managed care plans to provide authorized in-home services.
Depending on the member's needs and authorization, services may include:
- Personal care
- Bathing and dressing assistance
- Mobility support
- Meal preparation
- Light housekeeping
- Shopping and errands
- Family caregiver support
- Respite
- Transition support following hospitalization or rehabilitation
The services available depend on the individual's health plan, needs, and authorization.
Frequently Asked Questions About Medi-Cal
In-Home Care
Does Medi-Cal pay for someone to come to my home?
It can.
Eligible Medi-Cal members may receive in-home services through programs such as IHSS, CalAIM Community Supports, and other Home and Community-Based Services programs.
The specific services available depend on the individual's eligibility and the program involved.
Does Medi-Cal pay for a family member to be a caregiver?
Potentially, through IHSS.
IHSS allows qualified providers—including certain family members in applicable circumstances—to provide authorized services.
If getting paid to care for a parent, spouse, child, or another family member is your primary goal, IHSS is an important program to explore.
CalAIM Community Supports operate differently and generally use an authorized provider model rather than the IHSS individual-provider model.
Does Medi-Cal cover 24-hour home care?
Not automatically.
The amount and type of care that can be authorized depend on the program, the individual's assessed needs, and applicable program rules.
Families should not assume that having Medi-Cal automatically provides 24-hour in-home care.
Does Medi-Cal cover caregivers for seniors?
It can.
Seniors who meet the eligibility requirements may qualify for programs such as IHSS, which can authorize assistance with personal care, meals, household tasks, and other services.
Other Medi-Cal programs may also be available depending on the person's needs and circumstances.
Does Medi-Cal cover dementia home care?
Potentially.
An individual with dementia may qualify for certain Medi-Cal programs if they meet the applicable eligibility requirements and have an assessed need for covered services.
IHSS can provide authorized services to eligible individuals, while certain CalAIM Community Supports may also provide in-home assistance for eligible members.
Does Medi-Cal cover home care after a hospital stay?
Potentially.
Medi-Cal covers different types of services depending on the individual's needs and program eligibility.
CalAIM Community Supports can include transition-related services for eligible members, while other Medi-Cal programs may provide home health or other post-discharge services.
The appropriate service depends on whether the individual needs medical care, non-medical support, or both.
Can I use IHSS and CalAIM together?
The answer depends on the individual's circumstances and the services involved.
DHCS guidance states that CalAIM Personal Care and Homemaker Services are intended to supplement rather than replace services available through other public programs, and members receiving these services should be referred to IHSS when a reassessment may be appropriate.
Families should discuss their specific situation with IHSS and the member's health plan before assuming that services can be combined.
What if my loved one has Medi-Cal but doesn't qualify for IHSS?
IHSS is not the only Medi-Cal pathway to in-home support.
Depending on the person's needs and health plan, they may be eligible for another Medi-Cal program, including certain CalAIM Community Supports or Home and Community-Based Services.
If IHSS isn't the right fit, it can be worth asking what other programs are available.
Does Your Loved One Qualify for Medi-Cal In-Home Care?
If your loved one has Medi-Cal and is struggling to safely manage everyday activities at home, don't assume that paying privately is your only option.
Medi-Cal offers several programs that may provide in-home support for eligible individuals.
The key is identifying which program fits your loved one's needs.
For San Diego families, that may mean exploring IHSS, CalAIM Community Supports, or another Medi-Cal Home and Community-Based Services program.
See If Your Loved One May Qualify
Coast Care offers a free phone screening for San Diego families interested in learning whether their loved one may be appropriate for CalAIM Community Supports.
We'll help you understand the process, what information may be needed, and what the next steps could look like.