How to Get More IHSS Hours: The Reassessment and Increase Request Process

If your IHSS hours no longer cover the care you need, you have the right to request a reassessment at any time — not just at your annual review. Getting more IHSS hours requires understanding how the state scores your care needs, what documentation strengthens your case, and what to say to your county social worker. This guide explains the full process from request to decision, including what to do if your request is denied.

Understanding How IHSS Hours Are Calculated

Before requesting an increase, it helps to understand how hours are determined in the first place. IHSS authorized hours are not set arbitrarily — they are calculated through a structured IHSS Assessment Tool administered by your county social worker during an in-home visit.

The assessment evaluates the recipient’s ability to perform Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) across multiple service categories, including:

Personal care services: bathing, dressing, grooming, feeding, toileting, bowel/bladder care
Domestic services: meal preparation, laundry, housecleaning, shopping
Paramedical services: medication assistance, wound care, range-of-motion exercises
Protective supervision: for recipients with cognitive or behavioral conditions who cannot be safely left alone
Accompaniment to medical appointments

For each task, the social worker assigns a functional index ranking from 1 to 5 based on how independently the recipient can perform it:

Score	Meaning
1	Independent — can perform without help
2	Requires verbal guidance only
3	Requires some physical assistance
4	Requires substantial physical assistance
5	Completely dependent — cannot perform at all

Higher scores translate into more authorized minutes per task per week. The total across all scored tasks determines the recipient’s monthly authorized hour ceiling. The SOC 293 form (IHSS Program Reassessment) is the official document used to record these scores and request changes to a recipient’s authorized services.

What Triggers a Successful Hours Increase

Not every reassessment request results in more hours. The strongest cases involve documented, verifiable changes in the recipient’s condition or living situation. Common triggers that lead to successful increases include:

New medical diagnosis: A diagnosis of a progressive condition (Parkinson’s, ALS, multiple sclerosis, advanced diabetes, dementia stages, etc.) that directly affects ADL independence
Worsening of an existing condition: A documented decline — confirmed by a physician — in the recipient’s ability to perform tasks they previously managed independently or with minimal help
Post-hospitalization or post-surgery status: A recent hospitalization often changes the functional picture significantly; request a reassessment immediately upon discharge
New ADL limitations: Specific tasks the recipient could previously perform that they now cannot — for example, previously able to bathe independently, now requires full physical assistance
Change in living situation: Moving to a new residence, the departure of another caregiver from the household, or a change in the recipient’s support network can all affect care needs
Physician-prescribed paramedical services: If a doctor has prescribed specific medical tasks (wound care, catheter management, range-of-motion exercises), these can be added to the authorized service plan and significantly expand total hours

How to Request a Reassessment

The formal process for requesting additional IHSS hours is straightforward:

Call your county IHSS office and ask to speak with your assigned social worker. Alternatively, call the main IHSS line and request that a reassessment be scheduled for the recipient.
State the reason for the request: “The recipient’s condition has changed and their current authorized hours are no longer sufficient to meet their care needs.” Be specific — name the condition, the tasks that have become more difficult, and when the change occurred.
Request a home visit: Reassessments are conducted in person. The social worker visits the recipient’s home, observes the environment, and conducts the structured assessment interview.
Confirm the request in writing: After your call, follow up with a brief written note (email or letter) to the county IHSS office confirming that a reassessment was requested and the date of your call. This creates a record.

Counties are required to complete reassessments within a reasonable timeframe. If you do not hear back within two weeks of your request, call again and ask for a supervisor.

What to Say and Document During the Assessment

The reassessment interview is your opportunity to make the strongest possible case. Social workers are required to score based on what they observe and what is documented — not on general impressions. Come prepared:

Describe specific tasks in detail:

Instead of “bathing is harder,” say: “The recipient requires me to physically support their weight throughout the entire bathing process — they cannot stand without falling. This takes approximately 45 minutes every time.”
Instead of “they need help with meals,” say: “The recipient cannot safely use the stove or handle hot liquids due to tremors and has burned themselves twice in the past three months.”

Estimate time accurately:

Social workers calculate time-per-task when scoring. Tracking how long each care task actually takes for a week before the assessment gives you precise numbers to report.

Bring physician documentation:

A letter from the recipient’s primary care physician or specialist describing the condition, its progression, and specific functional limitations carries significant weight. Request this letter before the assessment appointment.
Relevant medical records, hospital discharge summaries, and prescription changes all support your case.

If the recipient has cognitive impairments:

Document confusion, wandering, inability to recognize danger, or behavioral issues that require supervision even when no physical task is being performed. These support an increase in protective supervision hours.

Paramedical Services: How They Can Add Hours Beyond Personal Care

Paramedical services are medical tasks that a physician has prescribed and that would otherwise need to be performed by a licensed medical professional. When a physician authorizes a non-medical IHSS provider to perform these tasks, they can be added to the service plan and increase total authorized hours significantly.

Examples of paramedical services that can expand hours:

Range-of-motion exercises (prescribed by a physical therapist or physician)
Wound care and dressing changes
Catheter care and irrigation
Medication management and administration
Bowel programs

To add paramedical services, the recipient’s physician must submit a physician’s order or medical justification to the county IHSS office. The social worker then includes these tasks in the SOC 293 reassessment. Because paramedical services are scored separately from personal care, they can add hours on top of the standard ADL/IADL authorization — making them one of the most effective ways to increase total monthly hours for medically complex recipients.

What Happens After the Reassessment

After the social worker completes the reassessment, the county will issue a Notice of Action (NOA) informing the recipient of the new authorized hours. This typically takes 2–4 weeks after the home visit. The NOA will state whether hours increased, stayed the same, or were reduced (a reduction requires separate notice and appeal rights).

If the increase is less than expected: Review the NOA carefully. It should itemize authorized hours by service category. If the social worker scored tasks lower than the evidence supports, you can challenge specific scores.

If the request is denied or hours are cut: You have the right to appeal. Request a State Hearing (also called a fair hearing) within 90 days of the NOA date. You can request a hearing by calling 1-800-952-5253 or writing to the California Department of Social Services. See the related appeals guide linked below for a detailed walkthrough of the hearing process.

Frequently Asked Questions

Q: How often can I request a reassessment? A: There is no limit on how many times a recipient can request a reassessment. IHSS conducts mandatory annual reassessments, but you can request an additional reassessment at any time when there has been a change in the recipient’s condition or care needs. Repeated requests without documented changes are unlikely to result in increases, but they are not penalized.

Q: Can the reassessment result in fewer hours? A: Yes. A reassessment can result in an increase, no change, or a reduction in authorized hours based on what the social worker observes and documents. If the social worker determines that the recipient’s functional ability has improved, hours may be reduced. If you believe a reduction is incorrect, appeal it using the State Hearing process within 90 days of the Notice of Action.

Q: Is there a maximum number of IHSS hours a recipient can receive? A: IHSS does not publish a single fixed maximum for all recipients, but practical ceilings exist. Standard personal care and domestic services are generally authorized up to the equivalent of approximately 195 hours per month for recipients with the highest care needs scoring. Paramedical services, protective supervision, and accompaniment hours are calculated separately and can push total monthly hours higher. Recipients with the highest medical complexity may be authorized for amounts approaching or exceeding 283 hours per month in some counties when all categories are combined.

For the most current information on IHSS reassessments, county contacts, and authorized service categories, visit unifiedsavers.com — California’s dedicated IHSS resource site. If your hours were reduced or you need help preparing for a fair hearing, contact SEIU 2015 at 1-855-810-1699 for provider support.