For over a half million Medi-Cal enrollees who need help with activities of daily living, personal care services are essential for health, well-being, and independence. In California, most personal care services are delivered through the In-Home Supportive Services (IHSS) Program. While most IHSS care recipients successfully hire an independent provider (often a family member or friend), some people have difficulty finding, hiring, and managing their own aides. One strategy to address that need is to use an agency that employs IHSS providers and connects them to care recipients — a delivery model known as contract mode IHSS. Currently, access to contract mode IHSS is very limited, with only one county in California offering this option.

This report describes findings from an analysis of the experiences of a small group of Medi-Cal enrollees with high needs in San Mateo County who were receiving contract mode IHSS but then lost access due to policy changes. In this group, the discontinuation of contract mode IHSS was associated with higher per-member use of institutional long-term care and more inpatient admissions. This study suggests that although contract mode may be a more expensive model for delivering IHSS, in this selected population it may be associated with lower overall costs due to lower use of institutional long-term care and lower rates of hospitalization.

These preliminary findings support the need for deeper examination of when and how to deliver personal care services to a high-needs population. This study can also help inform the expansion of optional Community Supports — including personal care / homemaker services and caregiver respite services — available through Medi-Cal managed care plans under CalAIM (California Advancing and Innovating Medi-Cal).

About the Author

At the time this publication was written, Ann Hwang, MD, was a senior consultant with Bailit Health.