California's Medi-Cal pathway for paid in-home dementia support is In-Home Supportive Services (IHSS), not a nursing facility placement. Families searching for a Medicaid waiver for dementia care are usually looking for this program, which county social services offices run under state Medi-Cal oversight. Households in San Diego and other California counties apply locally, then receive an in-home assessment that can include extra Protective Supervision hours when dementia or a severe cognitive impairment is present.
What Is California's IHSS Program?
In-Home Supportive Services (IHSS) is California's Medi-Cal program for paid help at home, administered by individual county Departments of Social Services under state Medi-Cal oversight. It is the state's main long-term care option for people who can remain in the community with authorized hours rather than moving into a nursing home. You can learn more about California IHSS for a high-level look at how the program is organized. A separate consumer overview is also available in this IHSS guide.
IHSS authorizes a set number of monthly hours after a county worker assesses need in the home. Those hours can sit alongside private personal care or memory care at home when a family wants more coverage than the county approves. Listing a public program or educational site here does not mean that any agency endorses a particular private care provider.
Dementia-Specific Eligibility and Protective Supervision
Applicants with dementia or a severe cognitive impairment can qualify for an additional IHSS service category called Protective Supervision, which adds hours above the standard monthly cap up to a combined maximum of 283 hours per month. That category is the dementia-specific eligibility threshold families should ask about during the county assessment. Protective Supervision is meant for people who need watching and cueing because cognitive impairment makes it unsafe to leave them alone.
A county social worker decides whether Protective Supervision applies and how many hours to authorize. This page does not diagnose dementia, interpret medical tests, or recommend treatment. Families looking for general information about Alzheimer's disease, the most common cause of dementia, can review educational materials from the Centers for Disease Control and Prevention.
Asset Limits for Medi-Cal and IHSS
There is currently no asset limit for Medi-Cal or IHSS in California, because the state eliminated the asset test entirely effective January 1, 2024. The same rule applies to a single applicant and to a couple, regardless of household size. A reduced asset limit is planned to be reinstated in 2027, but that change has not yet taken effect.
No asset transfer look-back period applies specifically to IHSS, which is different from the look-back rules that often apply to nursing home Medicaid. Families who are also considering a nursing facility should treat those two pathways as separate programs with different financial rules.
How to Apply for IHSS
Application is made through the county IHSS office or the California Department of Social Services, followed by an in-home assessment from a county social worker who determines authorized hours. The county Department of Social Services where the applicant lives handles the case, including offices that serve people in San Diego. After the assessment, the county issues an hour authorization that may include Protective Supervision when dementia or a severe cognitive impairment is documented in the evaluation.
The recipient or a responsible family member can then hire an IHSS provider. Hours can start only after the county completes its process, so families leaving a hospital may also arrange short-term hospital discharge care while the IHSS application is pending.