If you are an IHSS provider, there is no single statewide health plan waiting for you. Whether you can get coverage through your IHSS work depends on your county — and in about half of California’s counties, IHSS providers are not offered a health plan at all. That does not mean you are stuck. Most IHSS caregivers can get covered through one of five routes, and several of them have deadlines coming up fast.
This guide covers county IHSS health benefits, Medi-Cal, Covered California, Medicare, and coverage through family or another job. It also explains the 2027 rule changes that could affect caregivers who already have coverage. Covered California’s open enrollment runs November 1, 2026 through January 31, 2027.
At a glance
Five ways IHSS caregivers get health coverage
- County IHSS health benefitsOnly in some counties, and only if you work enough authorized hours.
- Medi-CalFree or low cost. Apply any day of the year.
- Covered CaliforniaPrivate plans with financial help. Open enrollment runs Nov. 1, 2026 – Jan. 31, 2027.
- MedicareIf you are 65 or older or qualify through a disability. Changes due by Dec. 7.
- A family member’s plan or another jobAsk the employer’s benefits office when you can be added.
Many caregivers qualify for more than one. The right choice depends on your income, your hours, your age, and your county.
The five routes at a glance
- County IHSS health benefits — only in some counties, and only if you work enough authorized hours.
- Medi-Cal — free or low cost. Apply any day of the year.
- Covered California — private plans with financial help. Open enrollment runs Nov. 1, 2026 – Jan. 31, 2027.
- Medicare — if you are 65 or older or qualify through a disability.
- A family member’s plan or another job — ask that employer’s benefits office when you can be added.
Many caregivers qualify for more than one. The right choice depends on your income, your hours, your age, and your county.
Key dates for this enrollment season
Dates to know
- Dec. 7, 2026Last day of Medicare Open Enrollment. Changes start Jan. 1. Medicare
- Dec. 31, 2026Enroll in Covered California by this date for coverage that starts Jan. 1, 2027. Covered CA
- Jan. 31, 2027Covered California open enrollment ends. January sign-ups start Feb. 1. Covered CA
- Any dayApply for Medi-Cal. There is no enrollment period. Medi-Cal
- Jan. 1, 2027Medi-Cal work rules begin for some adults ages 19–64. Medi-Cal
- Mar. 1, 2027Six-month Medi-Cal eligibility checks begin for some adults ages 19–64. Medi-Cal
Route 1: Health benefits through your county IHSS program
IHSS wages and benefits are bargained county by county. In each county, the IHSS Public Authority acts as the employer of record for bargaining, and a union — SEIU Local 2015 or UDW/AFSCME Local 3930 — represents providers. A health plan exists only where one has been negotiated.
That makes county coverage the exception, not the rule. A report the UC Berkeley Labor Center prepared for the California Department of Social Services found that, as of 2024, health benefits were offered to at least some providers in 28 of California’s 58 counties, and about 110,000 providers — 16 percent — received them. Two-thirds of those enrolled worked in Los Angeles, San Francisco, or Santa Clara County. These are the most recent statewide figures we found. Individual county contracts may have changed since.
Example: Los Angeles County
In Los Angeles County, the Personal Assistance Services Council (PASC) and SEIU Local 2015 negotiated the PASC-SEIU Homecare Workers Health Care Plan, provided by L.A. Care. To qualify, county records must show you were authorized to work 74 or more hours a month for two months in a row, you must still be on active payroll in a 74-hour assignment when you enroll, and you must live in Los Angeles County or within 15 miles of its border. PASC mails an enrollment packet to eligible providers. The PASC Health Plan Call Center is 1-855-727-2756.
How to find out what your county offers
Call your county’s IHSS Public Authority or your union. If you don’t know who to call, the County Welfare Directors Association keeps a list of IHSS phone numbers for every county.
Questions to ask about county health benefits
- Does our county offer health coverage to IHSS providers? Medical only, or dental and vision too?
- How many authorized hours a month do I need, and for how many months in a row?
- What will it cost me each month?
- Can I add my spouse or children?
- What happens if my recipient’s hours are cut, or I miss a month of work?
- If I lose the plan, will I get a notice I can use to enroll somewhere else?
If you lose county coverage because your hours drop, you do not have to wait for open enrollment. Losing health insurance is a major life change that usually opens a 60-day special enrollment period with Covered California, and you can apply for Medi-Cal any time.
Worth knowing
A 2025 bill, AB 283, would have moved IHSS wage and benefit bargaining from the counties to the state. The Senate moved it to its inactive file in September 2025, and it did not become law in the 2025–26 session.
For now, whether IHSS providers get health benefits — and on what terms — is still decided county by county.
Route 2: Medi-Cal
Medi-Cal is California’s Medicaid program. For most adults under 65 it costs nothing, and there is no enrollment period. You can apply any day at BenefitsCal.com, through CoveredCA.com (one application checks both), or at your county social services office.
Working-age adults qualify with income up to 138 percent of the federal poverty level. For one person in 2026, that is about $1,836 a month. The figure changes every year, so check the current number when you apply. Many part-time IHSS providers fall under it. For example, 80 hours at $19.00 an hour is $1,520 a month before taxes. IHSS pay rates vary by county — see our county pay-rate guide.
Medi-Cal’s asset limit applies to programs for people 65 and older and people with disabilities. It does not apply to the income-based Medi-Cal most working-age caregivers get.
If you live with the person you care for
For income-based Medi-Cal, IHSS wages are not counted when you live in the same home as the recipient you are paid to care for — whether or not you are related. The Department of Health Care Services (DHCS) told counties this in MEDIL I 16-17 in 2016. A CDSS State Hearings research note says the same exclusion applies to Covered California programs. That can mean a live-in provider qualifies for Medi-Cal even with a full-time IHSS paycheck.
Worth knowing
An amount on your W-2 in Box 12, code II shows IHSS wages excluded from income tax because you live with your recipient. If you filed a SOC 2298 live-in self-certification, you have already told the state you live in the same home.
If you chose to count those wages on your tax return to claim the earned income credit, ask the county or a certified enroller how that choice affects your Medi-Cal or Covered California application before you submit it.
Medi-Cal changes coming in 2027 for adults 19 to 64
Two federal changes will affect adults who get Medi-Cal through the Affordable Care Act expansion — the income-based program for adults 19 to 64:
- Work rules starting Jan. 1, 2027. You must work, volunteer, go to school, or be in job training for at least 80 hours a month, or earn at least $580 a month from work.
- Eligibility checks every six months starting Mar. 1, 2027, instead of once a year.
Paid IHSS work is work. A provider who earns $580 or more a month from IHSS meets the earnings standard.
Many caregivers are also excluded from the work rules altogether. The federal rule the Centers for Medicare & Medicaid Services (CMS) issued in June 2026 excludes a family caregiver of a person with a disability — someone who gives regular, more-than-incidental help and who either lives with that person, is related to them, or gives at least 80 hours of help a month. Parents and guardians of a person with a disability are excluded too. The rule uses the Americans with Disabilities Act definition of disability, and the person you care for does not have to be on a disability program to count.
Flag
DHCS’s consumer page lists “parents and caregivers of children ages 0–13” and “people with disabilities” among those the work rules do not apply to. It does not separately list people who care for an adult with a disability. The federal regulation, 42 CFR 435.554, does.
If a county letter says you must meet the work rules and you provide regular care to someone with a disability, tell the county you are a family caregiver and ask them to review that exclusion. The federal rule is an interim final rule and could still change.
Watch your mail. DHCS says it will send a letter if the work rules apply to you. Open it right away, answer quickly, and keep your contact information current with your county Medi-Cal office.
Changes tied to immigration status
Warning
Since Jan. 1, 2026, some adults can no longer newly enroll in full-scope Medi-Cal because of their immigration status. If you already have it, you can keep it — but you must renew on time. If your coverage ends, you have three months to get it back. After that, only restricted-scope Medi-Cal (emergency, pregnancy, and nursing home care) is available.
More changes follow. On Jan. 1, 2027, some members move from a health plan to fee-for-service Medi-Cal. On July 1, 2027, some lose full-scope dental coverage and some must pay a monthly premium to keep full-scope Medi-Cal.
For free, confidential help, call the Health Consumer Alliance at 1-888-804-3536.
If you are 65 or older or have a disability
Medi-Cal for older adults and people with disabilities counts assets. Through June 30, 2027, the limit is $130,000 for one person, plus $65,000 for each additional household member. DHCS says that starting July 1, 2027, the limit drops to $21,000 for one person and $31,000 for two. Your home, one vehicle, and household items do not count.
Route 3: Covered California
Covered California is the state’s marketplace for private health plans. Open enrollment runs Nov. 1, 2026 through Jan. 31, 2027. Enroll by Dec. 31 for coverage that starts Jan. 1; enroll in January and coverage starts Feb. 1. The same application tells you whether you qualify for Medi-Cal instead.
What’s different for 2027
- The extra federal help is gone. Enhanced federal premium tax credits ended Dec. 31, 2025. Regular federal help is still available.
- California expanded its own help. For 2027, the state subsidy reaches people with incomes up to 200 percent of the poverty level — $31,920 for one person. Covered California projects more than 500,000 people will get it.
- Prices are rising. Covered California announced a preliminary statewide average rate increase of 9.9 percent for 2027. Final rates are subject to review by the Department of Managed Health Care, and your cost depends on your age, region, income, and plan. Shopping matters: switching to the lowest-cost plan in the same tier would have averaged a 0.2 percent decrease statewide.
- Immigrant eligibility for financial help narrows. Starting Jan. 1, 2027, only certain immigrant groups, such as lawful permanent residents, can get financial help.
- Repayment is no longer capped. Starting with the 2026 tax year, if you receive more financial help than you qualify for, you may have to pay back the full difference.
IHSS hours can change when your recipient is reassessed. Because financial help is based on the income you report, update Covered California when your hours or pay change.
Flag
If your county offers you an IHSS health plan, tell Covered California about it on your application. Under federal rules, an offer of job-based coverage that counts as affordable can make you ineligible for premium tax credits.
We could not confirm how Covered California treats each county’s IHSS provider plan. Ask Covered California or a certified enroller before you turn a county plan down.
Route 4: Medicare
If you are 65 or older, or you qualify for Medicare because of a disability, Medicare Open Enrollment runs Oct. 15 through Dec. 7. During that window you can join, switch, or drop a Medicare Advantage plan or a drug plan, or move between Medicare Advantage and Original Medicare. Changes take effect Jan. 1, and the plan must receive your request by Dec. 7.
If your income is limited, you may qualify for Medi-Cal as well as Medicare. California’s Health Insurance Counseling and Advocacy Program (HICAP) gives free, unbiased Medicare counseling at 1-800-434-0222.
Route 5: A family member’s plan or another job
If your spouse, domestic partner, or parent has health coverage through work, ask that employer’s benefits office whether you can be added and when. If you have a second job that offers coverage, compare it with the other routes here. Remember that an affordable offer from another job can also affect your Covered California financial help.
Which route fits you?
| Route | Usually fits | When to enroll | Where to start |
|---|---|---|---|
| County IHSS plan | Providers who work enough authorized hours in a county that offers one | When your Public Authority says you qualify | Your county Public Authority |
| Medi-Cal | Lower-income caregivers, including many part-time and live-in providers | Any day of the year | BenefitsCal.com, CoveredCA.com, or your county office |
| Covered California | Caregivers who earn too much for Medi-Cal and have no affordable job-based offer | Nov. 1, 2026 – Jan. 31, 2027, or 60 days after a major life change | CoveredCA.com or (800) 300-1506 |
| Medicare | Caregivers 65 or older, or who qualify through a disability | Plan changes Oct. 15 – Dec. 7 | Medicare.gov; HICAP for free help |
| Family or another job | Caregivers with a spouse, partner, or parent whose job offers coverage, or a second job | Set by that employer | That employer’s benefits office |
What to have ready before you apply
Before you apply, gather:
- Recent IHSS pay stubs, and pay stubs from any other job
- Your most recent W-2 — if you live with your recipient, check Box 12 for code II
- Names, birth dates, and tax filing status for everyone in your household
- Social Security numbers, or immigration documents, for the people applying
- Information about any coverage you have now, and any letter offering you a county IHSS health plan
- The county where your IHSS recipient lives, so you know which Public Authority to call
Where to get free help
Free help choosing and keeping coverage
These services are free to use.
- Covered California(800) 300-1506Plans, financial help, and free certified enrollers
- Health Consumer Alliance1-888-804-3536Free help with Medi-Cal and Covered California problems
- Medi-Cal Member Helpline(800) 541-5555General Medi-Cal questions
- HICAP (Medicare)1-800-434-0222Free, unbiased Medicare counseling
For county IHSS health benefits, call your county’s IHSS Public Authority or your union. For legal help with a denial, find a legal aid office at LawHelpCA.org.
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: org
- Health Consumer Alliance (free help with Medi-Cal and Covered California): 1-888-804-3536
- Covered California: (800) 300-1506
Figures reflect the 2027 Covered California plan year and Medi-Cal rules announced as of September 2026. Verified September 2026.
Sources
- UC Berkeley Labor Center — Analysis of the Potential Impacts of Statewide or Regional Collective Bargaining for IHSS Providers (final report to CDSS, Dec. 2024)Health benefits offered in 28 of 58 counties; about 110,000 providers (16%) enrolled; two-thirds in Los Angeles, San Francisco, and Santa Clara; bargaining with county Public Authorities; SEIU and UDW representation. Data as of 2024.
- CalMatters Digital Democracy — AB 283 (Haney), In-Home Supportive Services Employer-Employee Relations ActBill would have moved IHSS bargaining to the state; ordered to the Senate inactive file Sept. 9, 2025.
- Personal Assistance Services Council (PASC) — Health Care Plan Frequently Asked QuestionsLos Angeles County plan: 74+ authorized hours for two consecutive months, active payroll at enrollment, residence in LA County or within 15 miles, enrollment packet, PASC Health Plan Call Center number, L.A. Care as carrier.
- PASC — Provider InfoConfirms the 74-hour, two-consecutive-month eligibility rule for the PASC-SEIU Homecare Workers Health Care Plan.
- CWDA — IHSS Main Contact Lines by County (rev. Aug. 2024)Phone numbers and websites for every county IHSS program, for readers who need to find their Public Authority.
- DHCS — Medi-Cal Changes (updated Sept. 2, 2026)Work rules from Jan. 1, 2027 ($580/month or 80 hours); DHCS list of who the work rules do not apply to; six-month checks from Mar. 1, 2027; immigration-related enrollment freeze, three-month window, fee-for-service transition, dental and premium changes; asset limits for older adults and people with disabilities ($130,000 through June 30, 2027; $21,000/$31,000 from July 1, 2027).
- DHCS — ACWDL 26-01, 2026 Federal Poverty Levels (Jan. 21, 2026)2026 FPL figures effective Jan. 1, 2026 for MAGI Medi-Cal. The $1,836 monthly figure in this article is 138% of the 2026 one-person guideline ($15,960), rounded up to the next dollar as DHCS does.
- DHCS — MEDIL I 16-17, MAGI and In-Home Caregiver Wages of Resident Caregivers (Sept. 21, 2016)IHSS wages are not counted for MAGI Medi-Cal when the provider lives with the recipient, regardless of relationship.
- CDSS State Hearings Division — E-Notes 133–143 (E-Note #143, Nov. 22, 2016)Live-in personal care wage exclusion applies to MAGI Medi-Cal and Covered California programs; conditions for the exclusion.
- CDSS — Live-In Provider Self-Certification InformationSOC 2298 self-certification; W-2 Box 12 code II; option to include live-in wages to claim CalEITC and other credits.
- Federal Register — Medicaid Program; Community Engagement Requirement for Certain Individuals, CMS-2454-IFC (June 3, 2026)Interim final rule implementing the Medicaid work requirement, including the specified-excluded-individual rules at 42 CFR 435.554.
- 42 CFR 435.554, Specified excluded individuals (regulation text via CustomsMobile eCFR mirror)Definitions of family caregiver and disabled individual (ADA definition); family caregivers excluded if they live with, are related to, or provide 80+ hours a month of help to a disabled individual.
- CMS — Community Engagement Requirement IFC Overview (July 2026)CMS summary of the interim final rule and its statutory basis (Section 71119 of Public Law 119-21).
- Covered California — Rates and Plans for 2027 (news release, July 21, 2026)Preliminary 9.9% average rate change, subject to DMHC review; state subsidy expanded to 200% FPL ($31,920 for one person) for 2027; 500,000+ projected state-subsidy recipients; open enrollment Nov. 1 – Jan. 31, 2027; renewals open Oct. 1.
- Covered California — Federal Changes to Your Health Insurance (updated June 15, 2026)Enhanced federal premium tax credits ended Dec. 31, 2025; immigrant eligibility for financial help narrows Jan. 1, 2027; full repayment of excess help starting with the 2026 tax year.
- Covered California — Open EnrollmentEnroll by Dec. 31 for Jan. 1 coverage; January enrollment starts Feb. 1; one application for Covered California and Medi-Cal; 60-day special enrollment after a major life change such as losing insurance.
- CalPERS — Health Insurance Marketplace Coverage Options noticeGeneral rule that an offer of affordable, minimum-value job-based coverage makes a person ineligible for marketplace premium tax credits. Used for the general rule only.
- Medicare.gov — Open EnrollmentMedicare Open Enrollment Oct. 15 – Dec. 7; changes effective Jan. 1; plan must receive the request by Dec. 7.
- California Department of Aging — Answers About Medicare (HICAP)HICAP free, unbiased Medicare counseling; (800) 434-0222.
- Health Consumer Alliance — What Is the HCA? (Aug. 2026)Free help getting and keeping Medi-Cal or Covered California; statewide number 1-888-804-3536.
- Health Consumer Alliance — home pageMedi-Cal Member Helpline (800) 541-5555; free, confidential consultation.
- IHSS Connect — IHSS Pay Rates by County in California (2026)County pay-rate range used for the income example; unions by county.
DHCS and Covered California are the primary authorities throughout. Where a DHCS summary page and the federal regulation differ, the regulation governs.
