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California’s In-Home Supportive Services Program—An Equity Analysis

June 8, 2023

In-Home Supportive Services (IHSS), administered by the California Department of Social Services (CDSS), is the state’s largest Medi-Cal home and community-based services program (HCBS). It provides consumer-driven personal care services to over 585,000 low-income older adults and individuals with disabilities annually, making it the biggest personal care system in the country.

Medi-Cal-funded HCBS are essential for the ability of California’s older adults and adults with disabilities with low incomes to live and age in the community. But, as in health care generally, HCBS programs are impacted by systemic racism, discrimination, and bias that can ultimately lead to disparities in health outcomes and quality of life of program users.

Issue Brief

For California’s In-Home Supportive Services Program: An Equity Analysis, Justice in Aging used its equity framework to analyze the state’s IHSS system. The Framework evaluates five domains of the program:

  1. Program Design
  2. Provider Availability
  3. Program Awareness and Enrollment
  4. Assessments and Authorization of Services
  5. Provision of IHSS Services and provides examples of policies, rules, and decision points that can address inequities.


Justice in Aging developed the Equity Framework for Evaluating California’s Medi-Cal Home and Community Based Services for Older Adults and People with Disabilities (December 2022) and an accompanying webinar as part of a series funded by the California Health Care Foundation. Justice in Aging is also using this framework to evaluate programs in other states. Additional papers in the series include:

Related Resources

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