California became the first state to offer full Medi-Cal coverage to adults of any age regardless of immigration status, a milestone completed in January 2024. For thousands of undocumented elderly and disabled residents, that change unlocked access to In-Home Supportive Services for the first time. Now, with California facing a multi-billion-dollar budget deficit and the federal government escalating immigration enforcement, the future of that coverage is under real pressure.
How Undocumented Californians Access IHSS
IHSS eligibility in California requires active Medi-Cal enrollment. Since January 2024, any California resident who meets the income and functional need requirements for Medi-Cal may enroll — regardless of immigration status. For undocumented elderly or disabled individuals who qualify, this means access to the IHSS assessment process, social worker evaluations, and if authorized, paid in-home care.
The critical difference from standard IHSS: coverage for undocumented Medi-Cal enrollees is funded entirely by the California state government. There is no federal Medicaid matching payment for this population. Every dollar of IHSS wages paid to a provider caring for an undocumented recipient comes from the California General Fund alone — no 50% federal match.
California’s Department of Finance estimates the state-only Medi-Cal coverage for undocumented adults costs approximately $3 billion to $4 billion per year in total Medi-Cal expenditures, with IHSS representing a growing share as awareness of the expanded eligibility spreads through community health networks.
The Budget Pressure
In a year of significant deficit, state-funded programs without federal matching dollars are among the first to draw scrutiny from budget negotiators. Several proposals have circulated in budget discussions through early June 2026:
- Limiting state-funded IHSS for undocumented recipients to personal care and protective supervision only, excluding domestic services (cooking, cleaning, shopping)
- Applying a stricter functional index score threshold before undocumented recipients can access IHSS — a higher bar than the standard assessment used for all other enrollees
- Reinstating a waiting period before newly enrolled undocumented Medi-Cal beneficiaries can begin accessing IHSS
None of these proposals has formally passed the Legislature as of early June 2026, but disability rights advocates and immigrant rights organizations report that the discussions are active and serious in Budget Conference Committee proceedings.
Federal Enforcement and the Chilling Effect
Beyond the budget, federal immigration enforcement is creating a distinct and immediate threat to IHSS access. The current administration’s expanded Immigration and Customs Enforcement operations — including increased data-sharing requests to state and local agencies — have led some undocumented Californians to voluntarily disenroll from Medi-Cal out of fear that enrollment data could be used for immigration enforcement.
California law, including Health and Safety Code Section 130, prohibits state agencies from sharing personal health information with immigration authorities absent a court order. CDSS has reaffirmed that IHSS enrollment records are confidential and not shared with federal immigration agencies.
Despite these protections, community health workers in Los Angeles, the Central Valley, and the Inland Empire report a measurable increase in undocumented residents declining to re-certify for Medi-Cal. Individuals who let Medi-Cal lapse lose their IHSS authorization — which can mean an elderly or disabled person loses their caregiver without warning, with no planned transition.
What Advocates Are Saying
The California Immigrant Policy Center and Disability Rights California have issued a joint statement urging the Legislature to maintain full IHSS access for all Medi-Cal-eligible residents, arguing that cutting hours or adding special eligibility barriers for undocumented recipients would disproportionately harm elderly women and immigrants who fled countries without comparable social services — and would ultimately shift costs from IHSS into more expensive emergency medical and nursing facility services.
SEIU 2015 has noted that the undocumented IHSS recipient population is served by the same provider workforce that serves all other recipients. Cuts to authorized hours for this population directly reduce the number of paid hours available for providers to work — reducing provider income regardless of the provider’s own immigration status.
What to Do
Undocumented IHSS recipients or their family members who have questions about eligibility, privacy protections, or appeal rights can contact:
- California Immigrant Policy Center: caimmigrant.org
- Disability Rights California: disabilityrightsca.org
- ACLU of California: aclu-ca.org
For IHSS program questions and re-enrollment assistance, contact your county IHSS office or call CDSS at 1-844-237-4636. Do not delay re-certification — a lapse in Medi-Cal enrollment interrupts IHSS services and can take weeks to restore.