In-Home Supportive Services 101: Opportunities and Challenges Under CalAIM

Through its CalAIM (California Advancing and Innovating Medi-Cal) initiative, the California Department of Health Care Services seeks to offer a more equitable, coordinated, and person-centered approach that prioritizes whole-person care. One component of CalAIM includes building the infrastructure over time to provide some long-term services and supports (LTSS) through managed care plans statewide by 2027. This shift is intended to increase coordination, reduce silos, and improve access to LTSS.

While a limited number of LTSS have been integrated into Medi-Cal managed care plan contracts, In-Home Supportive Services (IHSS) — by far the largest Medi-Cal LTSS program and one expected to grow over time — remains outside of managed care. The IHSS program provides personal care services and other supports to Medi-Cal enrollees of all ages to enable them to remain in their own homes, rather than living in a nursing home or other facility.

With the implementation of CalAIM and shifts in the Medi-Cal LTSS delivery system, policymakers and other stakeholders will need to consider both opportunities and challenges for California’s IHSS program, given its outsized role in the LTSS landscape and its unique operating model. This fact sheet provides an overview of the IHSS program and considerations to strengthen coordination of IHSS with other services.