Paying for In-Home Care in California: What Families Need to Know

The first question most families ask is: how much does this cost? The honest answer is that it varies, and it is expensive. In San Diego County, professional in-home care typically runs $28–$38 per hour for non-medical companion care, with higher rates for CNAs and overnight or live-in arrangements.

But cost should not be the end of the conversation, because there are programs — some of them significant — that can reduce or eliminate the cost depending on your family's situation. This article is a plain-language overview of the main options.

Medicare

The most common misconception: Medicare does not cover ongoing in-home care for daily support and personal care. Medicare will cover skilled nursing visits or therapy services after a qualifying hospital stay, but it does not pay for a caregiver to come help with bathing, meals, and companionship on an ongoing basis.

If someone tells you Medicare will cover home care, ask them to be specific about what kind and for how long.

Medi-Cal (California Medicaid)

Medi-Cal is California's Medicaid program. If your family member has low income and limited assets, they may qualify for Medi-Cal, which can cover in-home care through IHSS (see below) and, in some circumstances, additional services through managed care plans.

Eligibility is based on income and assets. As of 2024, California has eliminated the asset limit for Medi-Cal for people 65 and older — meaning that having savings no longer automatically disqualifies someone. This is a significant change that many families are not aware of.

In-Home Supportive Services (IHSS)

IHSS is a California program that pays for in-home care for people who qualify for Medi-Cal and need help with daily activities. It is administered by counties, so you apply through the San Diego County IHSS office.

If approved, IHSS can pay for a significant number of hours of care per month — sometimes covering the bulk of what a family needs. The caregiver can be a hired professional, or in many cases a family member (including an adult child or spouse) who is authorized to be paid for the care they are already providing.

• Apply through the San Diego County IHSS office — call 1-800-339-4347
• The county will send a social worker to assess the level of care needed
• Approval and hours are based on the assessment, not on income alone
• If denied or given fewer hours than needed, you have the right to appeal

Veterans' benefits

If your family member is a veteran or the surviving spouse of a veteran, there may be meaningful benefits available through the VA. The Aid & Attendance benefit in particular can provide several hundred to over a thousand dollars per month specifically for in-home care or assisted living.

Eligibility is complex and depends on service history, health status, and income. The VA's Caregiver Support Program also provides training, support, and in some cases stipends for family caregivers of eligible veterans.

• Contact the San Diego VA Health Care System at (858) 552-8585
• The VA Caregiver Support Line is 1-855-260-3274
• The National Council on Aging (ncoa.org) has a free benefits-check tool

Long-term care insurance

If your family member purchased long-term care insurance, now is the time to read the policy. Benefits, waiting periods, and what qualifies as a covered service vary significantly by policy. Some policies cover only licensed agencies; others allow independent caregivers. Some have 30-day waiting periods; some have 90.

Do not assume the policy does not apply — call the insurer and describe the situation. An elder law attorney or a geriatric care manager can help you interpret a complex policy if needed.

Private pay

For many families — particularly those who do not qualify for Medi-Cal or whose family member did not have long-term care insurance — private pay is the reality. This means paying out of pocket for the hours of care needed.

If you are in this situation, a few practical thoughts:

• Start with fewer hours and adjust — many families start with a few hours a week and increase as needs grow
• Compare total cost across agencies, not just hourly rate — training, supervision, and backup coverage matter
• Ask about minimum hour requirements, which vary by agency
• Hiring an independent caregiver is cheaper, but you take on legal responsibilities as an employer (taxes, workers' comp, backup coverage)

Getting a clearer picture

If you are feeling overwhelmed by the options, you are not alone. A geriatric care manager or a benefits counselor can help you sort out what applies to your situation. In San Diego County, Aging and Independence Services (part of the County of San Diego HHSA) offers free consultations and can connect you with programs you may not know about. HICAP (Health Insurance Counseling & Advocacy Program) offers free Medicare and insurance counseling.

You do not have to figure this out alone, and you should not guess.