Key Takeaways
- Personal care services support older adults and people with disabilities who need assistance with daily activities like dressing, eating, and house cleaning.
- In California, Medi-Cal pays for these services through several programs; the largest, In-Home Supportive Services (IHSS), provides care to more than 700,000 people.
- The challenge is that these services are largely inaccessible to people unable to manage their own care and navigate complex program rules, leaving them at risk for poor health outcomes and unnecessary institutionalization.
Personal care services are essential for older adults and people with disabilities who need assistance with daily activities like dressing, eating, and house cleaning to live with dignity and to age in their communities rather than in institutional settings such as nursing facilities.
Policy at a Glance
Read CHCF’s fact sheet about personal care services and the findings of the Justice in Aging report.
In California, Medi-Cal pays for personal care services through several programs — the largest of which, In-Home Supportive Services (IHSS), provides care to over 700,000 people of all ages with disabilities. IHSS relies on an enrollee-directed model, where participants must manage their own care, including hiring and supervising care providers.
While a lifeline for many, IHSS and other personal care services provided through Medi-Cal waivers are not equally accessible to all who qualify for them. Breaking Down Barriers to Personal Care: Unlocking Vital Services for Those Who Need Them Most, a report from Justice in Aging produced with CHCF support, finds personal care services are largely inaccessible to people unable to manage their own care due to cognitive impairment or social complexities, especially those without family or community support. This leaves many at risk of injury, hospitalization, prolonged homelessness, and unnecessary institutionalization.
People’s primary challenges in accessing services include difficulty navigating complex program applications, hiring and managing care providers, and ensuring the quality of services.
The report highlights several opportunities for personal care services programs to more effectively serve people who can — and cannot — personally direct their care.
- Promote additional modes of care. Help counties contract with home care agencies that can act as the employer of IHSS providers for certain enrollees, relieving them of having to hire their own providers.
- Expand service availability. Increase access to waiver programs for people with the highest care needs by removing enrollment caps and geographic limits, making these services more widely available.
- Reduce administration barriers. Review and improve IHSS and other program rules to reduce barriers to enrolling in these programs and accessing personal care services.
- Fill care gaps through CalAIM (California Advancing and Innovating Medi-Cal). Improve the availability of personal care services through Medi-Cal managed care programs, including Community Supports.
- Replicate promising county practices. Adopt innovative practices such as training, case management, and peer support to facilitate access to enrollee-driven services.
Justice in Aging also held a one-hour webinar in October 2024 about the report. The webinar recording and slides are available on their website.
Authors & Contributors
Hagar Dickman
Justice in Aging
