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In-Home Supportive Services Program
It Is Not Providing Needed Services to All Californians Approved for the Program, Is Unprepared for Future Challenges, and Offers Low Pay to Caregivers

Report Number: 2020-109

February 25, 2021

The Governor of California
President pro Tempore of the Senate
Speaker of the Assembly
State Capitol
Sacramento, California 95814

Dear Governor and Legislative Leaders:

As directed by the Joint Legislative Audit Committee, my office conducted an audit of the In-Home Supportive Services (IHSS) program. Our assessment focused on the California Department of Social Services (Social Services) and four counties: Butte, Kern, San Diego, and Stanislaus. The following report details the audit’s findings and our conclusion that the State and these counties must take action to ensure that all Californians who are elderly and of low income or who are disabled (recipients) receive authorized IHSS services.

Our review found that the IHSS program serves more than 591,000 recipients, helping them live independently in their own homes and avoiding long-term care arrangements that would be much more costly to the State. However, a growing number of recipients—tens of thousands each month—do not receive the services for which they qualify because the State and counties alike have failed to complete mandatory annual planning activities intended to ensure care for all recipients. We further found that the counties generally do not process IHSS applications in a timely manner, nor do they ensure the timely provision of care for all recipients. Unless the State and counties address these deficiencies, the number of recipients who lack care will likely increase as the need for IHSS services grows.

Additionally, we found that caregivers throughout the State receive pay that is at or near minimum wage, and caregivers earn significantly less than a living wage in each county. In fact, many caregivers who work full time would qualify for public assistance. Moreover, the IHSS program’s funding structure is inequitable and discourages counties from significantly raising wages. These low wages could make recruiting a sufficient number of caregivers challenging both currently and in the future, especially when 32 of the 51 counties that responded to our survey indicate that they already lack enough caregivers to provide each qualified recipient with all approved services.

Respectfully submitted,

California State Auditor