In-Home Supportive Services (IHSS) caregivers in California play a crucial role in providing essential care to the elderly and disabled. However, securing insurance for these caregivers can often be a complex process. This article aims to demystify insurance options available to IHSS caregivers in California, detailing eligibility requirements, costs, and additional resources.
Looking for 2027 enrollment details?
This article was first published in January 2024. For open enrollment deadlines, 2027 price changes, and new Medi-Cal rules, read our updated guide: Health Insurance for IHSS Caregivers: Every Way to Get Covered in California for 2027.
Insurance options at a glance
| Option | Eligibility | Cost | How to apply |
|---|---|---|---|
| Medi-Cal | Based on income and household size; assets count for people 65+ or with a disability | Generally free or low cost | Covered California website or county social services office |
| CalPERS Health Program | Employees of the state or a CalPERS-contracting public agency — not IHSS work alone | Varies by plan | CalPERS website or your HR department |
| Covered California plans | California residents who are U.S. citizens, U.S. nationals, or lawfully present | Varies; subsidies based on income | Covered California website |
| Employer-sponsored insurance | Depends on the employer’s policy (for example, if you work for an agency) | Varies; employer often pays part | The employer’s HR department |
| Union-negotiated county plan | Only in counties with a negotiated plan; usually a minimum number of hours | Varies by county | Your county IHSS Public Authority or your union |
State-Provided Insurance Programs
Medi-Cal Sponsored Insurance
IHSS caregivers may be eligible for Medi-Cal, California’s Medicaid program. This is contingent on income and family size. Medi-Cal offers comprehensive coverage, including medical, dental, and vision.
- Eligibility: Varies based on income and household size. For caregivers 65 and older or with a disability, assets are also counted.
- Cost: Generally free or low-cost depending on the caregiver’s income.
- How to Apply: Through the Covered California website or local county social services office.
California Public Employees’ Retirement System (CalPERS) Health Program
Caregivers who also hold a separate job with the State of California, or with a public agency that contracts with CalPERS, may qualify for CalPERS health insurance. IHSS work alone does not qualify you: an IHSS provider works for the person receiving care, even though the state issues the paycheck.
- Eligibility: Employment with the state or with a public agency that contracts with CalPERS for health benefits.
- Cost: Varies based on plan chosen.
- How to Apply: Through the CalPERS website or HR department.
Private Insurance Options
Individual Health Insurance Plans
Caregivers can purchase private health insurance through the Covered California exchange.
- Eligibility: Open to California residents who are U.S. citizens, U.S. nationals, or lawfully present immigrants. People who are not lawfully present cannot buy a Covered California plan but may qualify for Medi-Cal. Under a federal rule change, DACA recipients lost Covered California eligibility on Aug. 31, 2025.
- Cost: Varies based on plan coverage, with potential subsidies based on income.
- How to Apply: Directly through the Covered California website.
Employer-Sponsored Health Insurance
Some IHSS caregivers may be eligible for health insurance through their employer, if they work for an agency.
- Eligibility: Dependent on employer’s policy.
- Cost: Varies, often with employer contributing a portion.
- How to Apply: Through the employer’s HR department.
Union-Negotiated Insurance Options
In-Home Supportive Services (IHSS) caregivers in California are represented by unions like the United Domestic Workers of America (UDW) and the Service Employees International Union (SEIU), which negotiate wages and benefits with each county. In counties where a health plan has been negotiated, caregivers who meet the county’s eligibility rules have access to specialized insurance options. Here’s an expanded look at how these caregivers can obtain insurance through these unions:
Worth knowing
Health plans for IHSS providers exist only where one has been negotiated with the county. A 2024 UC Berkeley Labor Center report for the California Department of Social Services found health benefits offered to at least some providers in 28 of California’s 58 counties.
Eligibility is set by the county contract and decided by the county’s IHSS Public Authority. In Los Angeles County, for example, it is based on authorized hours, payroll status, and where you live.
United Domestic Workers of America (UDW)
- Negotiated Benefits
- Where UDW has negotiated a health plan with a county, providers who meet that county’s eligibility rules can enroll. This is especially beneficial for caregivers who may not have access to traditional employer-provided insurance.
- The union negotiates health insurance plans on behalf of the providers it represents, often achieving more favorable terms and rates than an individual might get on their own.
- Eligibility
- Eligibility for these benefits typically depends on meeting certain work hour requirements. For example, caregivers may need to work a minimum number of hours to qualify.
- The specific eligibility criteria can vary, so it’s important for caregivers to check the latest requirements with UDW.
- Enrollment Process
- UDW typically has an enrollment period during which caregivers can sign up for or change their insurance plans.
- Caregivers can receive assistance from UDW representatives to understand their options and complete the enrollment process.
- Types of Insurance
- Health insurance plans offered may include medical, dental, and vision coverage.
- Some plans might also offer additional benefits like mental health services and wellness programs.
Service Employees International Union (SEIU)
- Collective Bargaining for Health Benefits
- SEIU uses its collective bargaining power to negotiate health benefits for the providers it represents, including IHSS caregivers.
- This often results in better coverage options and lower costs than what individuals might find on their own.
- Eligibility and Requirements
- As with UDW, eligibility for health benefits through SEIU typically depends on working a minimum number of hours.
- The criteria can vary, so caregivers should consult with SEIU for the most current information.
- Wide Range of Plans
- SEIU often offers a variety of plan options, allowing caregivers to choose the coverage that best fits their needs and budget.
- This might include comprehensive health plans as well as more specific coverage like dental or vision insurance.
- Enrollment and Support
- SEIU provides enrollment periods and guidance for caregivers to select and enroll in health insurance plans.
- The union also offers support services to help caregivers navigate the healthcare system and understand their benefits.
General Advice for IHSS Caregivers
- Stay Informed: Union benefits can change, so it’s important for caregivers to stay informed about their insurance options and any changes that may occur.
- Utilize Union Resources: Both UDW and SEIU offer resources and support to help caregivers understand and access their benefits. Taking advantage of these resources can be crucial in making informed decisions about healthcare coverage.
Through the contracts unions like UDW and SEIU negotiate with counties, IHSS caregivers in some counties have access to group health insurance options that might otherwise be unavailable or unaffordable, providing a critical safety net for those who dedicate their lives to caring for others.
Additional Resources and Assistance
- Local Health Insurance Counseling and Advocacy Programs (HICAP): Provide free counseling to people with Medicare, or soon eligible for it, about Medicare and other health insurance issues. Call (800) 434-0222.
- IHSS Social Workers: Can provide information and assistance in navigating insurance options.
Understanding and choosing the right insurance option is vital for IHSS caregivers in California. With a range of options from state-sponsored programs to private and union-negotiated plans, caregivers can find a plan that best suits their needs and ensures they are protected while they care for others.
Originally published January 2024. Format refreshed and facts checked September 2026.
About this article
IHSS Connect publishes this article for general information and education. It is not legal advice, and reading it does not create an attorney–client relationship. IHSS Connect is not a law firm, does not sell insurance, and is not affiliated with Covered California, the Department of Health Care Services, the California Department of Social Services, Medicare, any IHSS Public Authority, or any county agency.
Coverage rules, prices, and deadlines change — sometimes mid-year. Only your county Medi-Cal office can decide your Medi-Cal eligibility, only Covered California can decide what financial help you get, and only your county IHSS Public Authority can tell you whether you qualify for a county provider health plan.
If a decision on your case looks wrong, or you want advice about your own situation, talk to someone who can look at your file:
- Free and low-cost legal help: LawHelpCA.org
- Health Consumer Alliance (free help with Medi-Cal and Covered California): 1-888-804-3536
- Covered California: (800) 300-1506
Originally published January 2024. Format refreshed and facts checked September 2026.
Read more
More guides from IHSS Connect
- Health Insurance for IHSS Caregivers: Every Way to Get Covered in California for 2027
- IHSS Union in California: What to Know About SEIU & UDW
- Understanding Medi-Cal Redetermination for California Families
- How to Apply for Medi-Cal in California: A 2026 Guide
- IHSS and Regional Center in 2026: New DDS Data Sharing Explained
- What Is Medi-Cal? How It's Different From Medicare — and From “Medicaid”
Sources
- Covered California — Who can get a health plan through Covered California?Immigrants who are not lawfully present do not qualify for a Covered California plan but may qualify for Medi-Cal; lawfully present groups that qualify.
- Covered California — Proof of Immigration Status or Lawful PresenceDACA recipients no longer eligible for Covered California under federal rules; coverage ended Aug. 31, 2025.
- DHCS — Medi-Cal Changes (updated Sept. 2, 2026)Medi-Cal asset limits apply to people 65 and older, people with disabilities, and certain other non-income-based groups — not to the income-based program most working-age adults use.
- CalPERS — Health Benefits for EmployersThe CalPERS Health Program covers state employees by law; local public agencies and school employers can contract to cover their employees.
- Senate Judiciary Committee — Analysis of AB 283 (Haney), July 1, 2025The IHSS recipient is considered the provider’s employer; the provider is paid by the state; bargaining happens county by county.
- UC Berkeley Labor Center — Analysis of the Potential Impacts of Statewide or Regional Collective Bargaining for IHSS Providers (Dec. 2024)Health benefits offered to at least some IHSS providers in 28 of 58 counties (2024 data); unions bargain with county Public Authorities.
- PASC — Health Care Plan Frequently Asked QuestionsLos Angeles County example: eligibility based on authorized hours, active payroll, and residence.
- L.A. Care — PASC-SEIU Homecare Workers Health Care PlanPASC, as employer of record, determines eligibility for the plan.
- California Department of Aging — Answers About Medicare (HICAP)HICAP serves people 65 and older with Medicare, people under 65 with Medicare through a disability, and people soon eligible; (800) 434-0222.
- IHSS Connect — Health Insurance for IHSS Caregivers: Every Way to Get Covered in California for 2027Current guide with 2027 open enrollment dates, prices, and rule changes.
Covered California, DHCS, and CalPERS are the primary authorities for their programs. County IHSS Public Authorities decide eligibility for county provider health plans.
Editor’s note: what we corrected in September 2026
We refreshed this article’s format and corrected five statements:
Medi-Cal: assets count only for people 65 and older or with a disability, not for most working-age caregivers.
CalPERS: IHSS work alone does not qualify you; CalPERS covers employees of the state and of public agencies that contract with CalPERS.
Covered California: plans are open to citizens, nationals, and lawfully present immigrants — not all residents.
Union plans: health plans are negotiated county by county and exist in only some counties; eligibility is set by the county contract.
HICAP: serves people with Medicare or soon eligible for it.
