Medicaid home health care IHSS is a service-delivery option that allows a client to direct select services accessible through the Home and Community Based Services (HCBS) – Elderly, Blind, and Disabled (HCBS-EBD), Children’s HCBS (CHCBS), and Spinal Cord Injury (HCBS-SCI) waivers.

A participant-directed service-delivery option, IHSS services are provided through and managed by an agency.

The client or their Authorized Representative (AR) participates in the direction of services by selecting, hiring and training Attendants.

IHSS offers clients the flexibility and control of participant-direction while the agency provides support, supervision and financial management.

IHSS is similar to Consumer Directed Attendant Support Services (CDASS), where a client or their Authorized Representative manages the financial allocation, selects and trains attendant, and is the employer of record.

A Colorado law passed in 2014 (HB 14-1358) received approval on January 22, 2016 from Centers for Medicare & Medicaid (CMS) on changes that now allow spouses to receive reimbursement for providing In Home Support Services (IHSS). Acclaimed Home Care, an IHSS agency, is hiring spouses as paid caregivers in home health care for people with disabilities who otherwise would require a nursing facility level of care.

Colorado has two programs for participant-directed home and community based services (HCBS). HCBS waivers are Medicaid waivers that help people with disabilities of all ages remain independent within their own homes instead of a nursing home. Consumer Directed Attendant Support Services (CDASS) participants employ their own attendants, whereas In-Home Support Services (IHSS) participants use attendants that are employed by an IHSS agency, such as Acclaimed Home Care.

Previously, spouses could only be a paid caregiver under the CDASS program. While the CDASS program did pay spouses, it left the coordination up to the consumer and did not provide benefits. Now, spouses can be hired by an IHSS agency to provide all or part of the care.

As an employee of the IHSS agency, spousal caregivers can receive all the perks and benefits of being an employee. This means a person employed by an agency who is caring for their spouse can receive health and dental insurance, 401(k), and paid time off as offered by the particular employer. In addition to employment benefits for the caregiver spouse, an IHSS agency provides budget oversight and payroll management.