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Home care programs · California

California home care programs

California pays for care at home through 9 programs. Consumer-directed care is available through In-Home Supportive Services (IHSS), Self-Determination Program (SDP), and Waiver Personal Care Services (WPCS). Family members can be paid caregivers in 4 of them.

Verified Oct 9, 2026Sources: official state and federal agencies

Every state
Programs
9
Consumer-directed
Yes
Family can be paid
Yes
Structured family caregiving
No
On this page
Programs

Every way California pays for care at home

California pays for care at home through 9 programs. Consumer-directed care is available through In-Home Supportive Services (IHSS), Self-Determination Program (SDP), and Waiver Personal Care Services (WPCS). Family members can be paid caregivers in 4 of them.

ProgramTypeCan family be paidHow it differs
Home Health Agency services (Medi-Cal) (HHA)State Plan home health (1905(a)(7)); 42 CFR 440.70Home healthNot statedSkilled home health: nursing, therapy and aide visits under a plan of care from a licensed home health agency; run as a Medicaid State Plan benefit, available through fee-for-service and managed care.
Community Supports: Personal Care and Homemaker Services; Respite Services for Caregivers (PCHS)1915(b)/1115 CalAIM (in lieu of services)Agency personal careNot statedAgency personal care: non-medical daily help from aides a licensed agency employs; run as an 1115 demonstration, delivered through managed-care plans.
In-Home Supportive Services (IHSS)State Plan personal care (PCSP, 1905(a)(24)); 1915(k) Community First Choice Option; 1915(j) self-directed PAS (IHSS Plus Option); state/county-funded IHSS-ResidualConsumer-directedYesConsumer-directed care: the participant hires and directs their own aide, with payroll handled for them; run as a Community First Choice (1915(k)) state plan option, paid fee-for-service.
Self-Determination Program (SDP)1915(c) waiver CA.1166Consumer-directedYesConsumer-directed care: the participant hires and directs their own aide, with payroll handled for them; run as a 1915(c) home and community-based services waiver, paid fee-for-service.
Waiver Personal Care Services (WPCS)1915(c) waiver CA.0139 (Home and Community-Based Alternatives Waiver)Consumer-directedYesConsumer-directed care: the participant hires and directs their own aide, with payroll handled for them; run as a 1915(c) home and community-based services waiver, paid fee-for-service.
HCBS Waiver for Californians with Developmental Disabilities1915(c) waiver CA.0336; also 1915(i) state plan HCBS for DDWaiver in-homeYesWaiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(i) state plan HCBS benefit, paid fee-for-service.
Home and Community-Based Alternatives Waiver (HCBA)1915(c) waiver CA.0139Waiver in-homeNot statedWaiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.
Multipurpose Senior Services Program (MSSP)1915(c) waiver CA.0141Waiver in-homeNot statedWaiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.
Program of All-Inclusive Care for the Elderly (PACE)1934 PACE (State Plan)PACENot statedPACE: one organization covers medical care, a day center and home care for people 55 and over; run as the PACE benefit, delivered through managed-care plans.
Guide

Home health vs home care vs consumer-directed care in California

What each kind of program is, who employs the caregiver and when a family member can be paid.

Home health: the medical benefit

In California, skilled home health is Home Health Agency services (Medi-Cal) (HHA). It is a medical benefit: a doctor or other practitioner orders nursing, therapy or home health aide visits under a written plan of care, and the visits stop when the skilled need ends.

Only a licensed home health agency enrolled with California Medicaid can bill it, and the agency's own nurses, therapists and aides make the visits.

Home care: non-medical personal care through an agency

Help with bathing, dressing, eating, toileting and household tasks is "home care" or personal care. In California the agency route is Community Supports: Personal Care and Homemaker Services; Respite Services for Caregivers (PCHS). No skilled need is required; the person qualifies on functional need, usually measured by an assessment of daily activities.

The agency recruits, trains, schedules and pays the aides, and it is the employer. The aide is agency staff rather than a relative.

Consumer-directed care: the person hires their own aide

California's consumer-directed option is In-Home Supportive Services (IHSS), Self-Determination Program (SDP), and Waiver Personal Care Services (WPCS). The person receiving care, or a representative, recruits, hires, trains, schedules and supervises the aide, and can let go of one. A fiscal intermediary runs payroll, taxes and background checks, so the person never handles wages directly.

This is the route most families use to be paid: In-Home Supportive Services (IHSS), Self-Determination Program (SDP), and Waiver Personal Care Services (WPCS) allow a relative to be hired as the paid aide. Which relatives qualify (adult children, parents of adults, spouses, legal guardians) and how a live-in caregiver is treated are set program by program.

Structured family caregiving: a paid live-in family caregiver

California has no structured family caregiving program. A family caregiver is paid instead through consumer-directed care (In-Home Supportive Services (IHSS), Self-Determination Program (SDP), and Waiver Personal Care Services (WPCS)), by the hour, as the participant's chosen aide.

Other ways California pays for care at home

Waiver in-home services: HCBS Waiver for Californians with Developmental Disabilities, Home and Community-Based Alternatives Waiver (HCBA), and Multipurpose Senior Services Program (MSSP). These pay for in-home supports for people who meet a nursing-home or similar level of care, often with more services than state plan personal care and, in some programs, a waiting list or enrollment cap.

PACE: Program of All-Inclusive Care for the Elderly (PACE). One PACE organization covers medical care, a day center and home care for people 55 and over who need nursing-home level care.

Which one fits

  • Needs nursing, wound care, injections or therapy at home: home health (Home Health Agency services (Medi-Cal) (HHA)).
  • Needs daily help and wants an agency to supply and manage the aide: Community Supports: Personal Care and Homemaker Services; Respite Services for Caregivers (PCHS).
  • Wants to choose the aide, including a relative where allowed: In-Home Supportive Services (IHSS), Self-Determination Program (SDP), and Waiver Personal Care Services (WPCS).
  • Meets nursing-home level of care and needs more than personal care: HCBS Waiver for Californians with Developmental Disabilities, Home and Community-Based Alternatives Waiver (HCBA), and Multipurpose Senior Services Program (MSSP).
In the workspace

California program rules, side by side

Eligibility, the family caregiver rules (spouses, parents, live-in caregivers), employer of record, fiscal intermediary, caregiver training, provider requirements, how to enroll, published pay, EVV and waiting lists: 106 details across 9 programs.

ProgramFamily rulesEmployerEligibilityPay
See California's program rules — start free

Who can be paid, who employs the caregiver, what each program requires of agencies and caregivers, how to become a provider and what it pays, for all 9 programs.

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  • Provider requirements
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Program by program

California's programs

What each program is and how it differs from the others. Locked details open in the workspace.

Home Health Agency services (Medi-Cal) (HHA)

Home health

State Plan home health (1905(a)(7)); 42 CFR 440.70 · DHCS

Skilled home health: nursing, therapy and aide visits under a plan of care from a licensed home health agency; run as a Medicaid State Plan benefit, available through fee-for-service and managed care.

Can family be paid?Not stated
How to get set up
Provider track · 8 steps
  1. Form the business
  2. 7 more steps: forms, fees, timelines and links
Family / participant track · 5 steps
  1. Get Medi-Cal
  2. 4 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetEmployer of recordCaregiver requirementsProvider requirementsHow to become a providerEVVRecent changesHow it differs, in detailSetup checklistUnlock the details →

Community Supports: Personal Care and Homemaker Services; Respite Services for Caregivers (PCHS)

Agency personal care

1915(b)/1115 CalAIM (in lieu of services) · DHCS through Medi-Cal managed care plans

Agency personal care: non-medical daily help from aides a licensed agency employs; run as an 1115 demonstration, delivered through managed-care plans.

Can family be paid?Not stated
How to get set up
Provider track · 6 steps
  1. Form the business and get any license
  2. 5 more steps: forms, fees, timelines and links
Family / participant track · 4 steps
  1. Be a Medi-Cal managed care member
  2. 3 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetEmployer of recordProvider requirementsHow to become a providerManaged-care plansHow it differs, in detailSetup checklistUnlock the details →

In-Home Supportive Services (IHSS)

Consumer-directed

State Plan personal care (PCSP, 1905(a)(24)); 1915(k) Community First Choice Option; 1915(j) self-directed PAS (IHSS Plus Option); state/county-funded IHSS-Residual · California Department of Social Services (CDSS), run locally by county IHSS offices; county public authorities keep provider registries

Consumer-directed care: the participant hires and directs their own aide, with payroll handled for them; run as a Community First Choice (1915(k)) state plan option, paid fee-for-service.

Can family be paid?Yes
How to get set up
Provider track · 9 steps
  1. No agency license or Medi-Cal enrollment for individual providers
  2. 8 more steps: forms, fees, timelines and links
Family / participant track · 9 steps
  1. Get Medi-Cal
  2. 8 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetFamily caregiver rulesEmployer of recordFiscal intermediaryCaregiver requirementsProvider requirementsHow to become a providerPay rateEVVWaiting list or capManaged-care plansRecent changesHow it differs, in detailSetup checklistUnlock the details →

Self-Determination Program (SDP)

Consumer-directed

1915(c) waiver CA.1166 · DDS through regional centers

Consumer-directed care: the participant hires and directs their own aide, with payroll handled for them; run as a 1915(c) home and community-based services waiver, paid fee-for-service.

Can family be paid?Yes
How to get set up
Provider track · 5 steps
  1. FMS: become regional-center vendored
  2. 4 more steps: forms, fees, timelines and links
Family / participant track · 9 steps
  1. Be a regional center consumer
  2. 8 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetFamily caregiver rulesEmployer of recordFiscal intermediaryProvider requirementsHow to become a providerWaiting list or capRecent changesHow it differs, in detailSetup checklistUnlock the details →

Waiver Personal Care Services (WPCS)

Consumer-directed

1915(c) waiver CA.0139 (Home and Community-Based Alternatives Waiver) · Department of Health Care Services (DHCS), Integrated Systems of Care Division, with local HCBA Waiver Agencies

Consumer-directed care: the participant hires and directs their own aide, with payroll handled for them; run as a 1915(c) home and community-based services waiver, paid fee-for-service.

Can family be paid?Yes
How to get set up
Provider track · 6 steps
  1. Complete IHSS provider enrollment
  2. 5 more steps: forms, fees, timelines and links
Family / participant track · 6 steps
  1. Enroll in the HCBA Waiver
  2. 5 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetFamily caregiver rulesEmployer of recordFiscal intermediaryCaregiver requirementsProvider requirementsHow to become a providerEVVWaiting list or capHow it differs, in detailSetup checklistUnlock the details →

HCBS Waiver for Californians with Developmental Disabilities

Waiver in-home

1915(c) waiver CA.0336; also 1915(i) state plan HCBS for DD · Department of Developmental Services (DDS) through 21 regional centers

Waiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(i) state plan HCBS benefit, paid fee-for-service.

Can family be paid?Yes
How to get set up
Provider track · 6 steps
  1. Form the business and get licenses
  2. 5 more steps: forms, fees, timelines and links
Family / participant track · 6 steps
  1. Request intake at the regional center
  2. 5 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetFamily caregiver rulesEmployer of recordFiscal intermediaryProvider requirementsHow to become a providerEVVWaiting list or capHow it differs, in detailSetup checklistUnlock the details →

Home and Community-Based Alternatives Waiver (HCBA)

Waiver in-home

1915(c) waiver CA.0139 · DHCS Integrated Systems of Care Division; local HCBA Waiver Agencies do enrollment and care management

Waiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.

Can family be paid?Not stated
How to get set up
Provider track · 7 steps
  1. Form the business
  2. 6 more steps: forms, fees, timelines and links
Family / participant track · 7 steps
  1. Get Medi-Cal
  2. 6 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetEmployer of recordCaregiver requirementsProvider requirementsHow to become a providerEVVWaiting list or capRecent changesHow it differs, in detailSetup checklistUnlock the details →

Multipurpose Senior Services Program (MSSP)

Waiver in-home

1915(c) waiver CA.0141 · California Department of Aging (CDA) under DHCS; delivered by contracted local MSSP sites

Waiver in-home services: supports at home for people who meet a nursing-home or similar level of care; run as a 1915(c) home and community-based services waiver, paid fee-for-service.

Can family be paid?Not stated
How to get set up
Provider track · 4 steps
  1. Find the local MSSP site
  2. 3 more steps: forms, fees, timelines and links
Family / participant track · 6 steps
  1. Get Medi-Cal
  2. 5 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetEmployer of recordProvider requirementsHow to become a providerWaiting list or capRecent changesHow it differs, in detailSetup checklistUnlock the details →

Program of All-Inclusive Care for the Elderly (PACE)

PACE

1934 PACE (State Plan) · DHCS with CMS

PACE: one organization covers medical care, a day center and home care for people 55 and over; run as the PACE benefit, delivered through managed-care plans.

Can family be paid?Not stated
How to get set up
Provider track · 4 steps
  1. Home care vendors: contract with a PACE organization
  2. 3 more steps: forms, fees, timelines and links
Family / participant track · 5 steps
  1. Find a PACE organization
  2. 4 more steps: forms, fees, timelines and links
Open the full checklist →
EligibilityServices coveredHours or budgetEmployer of recordProvider requirementsHow to become a providerWaiting list or capManaged-care plansRecent changesHow it differs, in detailSetup checklistUnlock the details →
FAQ

Frequently asked questions

Can family members get paid to be caregivers in California?

Yes. In-Home Supportive Services (IHSS), Self-Determination Program (SDP), Waiver Personal Care Services (WPCS), and HCBS Waiver for Californians with Developmental Disabilities let a family member be the paid caregiver. Which relatives qualify, including spouses and parents of minor children, is set program by program.

Does California have consumer-directed care?

Yes: In-Home Supportive Services (IHSS), Self-Determination Program (SDP), and Waiver Personal Care Services (WPCS). The person receiving care hires and directs their own aide, and a fiscal intermediary handles payroll.

Does California have structured family caregiving?

No. California does not run a structured family caregiving program. Family caregivers are paid through consumer-directed care instead.

What is the difference between home health and home care in California?

Home health (Home Health Agency services (Medi-Cal) (HHA)) is medical: nursing, therapy and aide visits ordered by a practitioner and delivered by a licensed home health agency. Home care (Community Supports: Personal Care and Homemaker Services; Respite Services for Caregivers (PCHS)) is non-medical help with daily activities, based on functional need.

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