By the Unified Savers Editorial Team
IHSS and ADHC policies are set by CDSS and county offices. This article provides general guidance. Contact your county IHSS office and your Medi-Cal managed care plan for information specific to your situation.
Adult Day Health Care (ADHC) and IHSS are two separate California Medi-Cal programs that serve many of the same recipients but in different settings. IHSS provides in-home personal care services. ADHC provides supervised health, therapeutic, and social services at licensed adult day health care centers during daytime hours. Recipients can and often do use both programs simultaneously — IHSS covering morning, evening, and weekend care while ADHC provides structured daytime programming on weekdays. Using both programs together can extend total care coverage for recipients with significant functional limitations.
What Is Adult Day Health Care (ADHC)?
Adult Day Health Care is a Medi-Cal-funded program that provides comprehensive health, therapeutic, and social services to adults with functional limitations at licensed community-based centers. ADHC centers are licensed by the California Department of Health Care Services (DHCS) and must meet specific staffing, safety, and service standards.
Services available through ADHC centers typically include:
- Health monitoring: Nursing assessment, vital signs monitoring, medication management
- Physical therapy and occupational therapy: On-site therapeutic services for mobility, strength, and daily living skill maintenance
- Nutritional services: Hot meals and dietary counseling
- Social services: Case management, care planning, community resource referrals
- Transportation: Many ADHC centers arrange or provide transportation to and from the center for enrolled participants
- Social and recreational activities: Group programming, cognitive stimulation, peer interaction
- Caregiver respite: The time a recipient spends at ADHC gives family caregivers time for work, rest, or other responsibilities
ADHC differs from IHSS in a fundamental way: IHSS brings a care provider to the recipient’s home; ADHC brings the recipient to a licensed center. The programs serve the same population but in different environments and for different parts of the day.
Who Qualifies for Adult Day Health Care?
ADHC eligibility requires:
- Active Medi-Cal enrollment (same basic requirement as IHSS)
- Functional limitations that create a need for ongoing health services and supervision
- Medical necessity — a physician must document that ADHC services are medically necessary for the participant
- Assessment by the ADHC center: Each licensed center conducts its own intake assessment to determine whether its specific program meets the applicant’s needs
Common conditions among ADHC participants include:
- Alzheimer’s disease and other dementias
- Parkinson’s disease
- Stroke recovery
- Chronic conditions requiring regular health monitoring (congestive heart failure, COPD, diabetes)
- Physical disabilities requiring ongoing therapy
- Mental health conditions requiring structured programming
ADHC is designed for individuals who need more supervision and health services than can be delivered purely through IHSS in-home care, but who do not require 24-hour nursing home care.
How IHSS and ADHC Work Together
Many recipients qualify for and use both programs concurrently. The two programs are complementary, not competitive:
A typical combined care schedule:
- Weekday mornings (before ADHC transport): IHSS provider assists with bathing, dressing, meal preparation, and other personal care tasks
- Weekday daytime (at ADHC center): Recipient receives nursing, therapy, meals, and social programming at the ADHC center (typically 4–8 hours)
- Weekday evenings (after returning home): IHSS provider assists with dinner, hygiene, medications reminder, and preparation for bed
- Weekends and non-ADHC days: IHSS covers the full day’s personal care needs
This combined model allows recipients with high care needs to receive comprehensive services without institutional placement. It also provides family caregivers meaningful respite during weekday hours.
IHSS hours and ADHC: Enrollment in ADHC does not automatically reduce a recipient’s authorized IHSS hours. IHSS hours are assessed based on the tasks the recipient needs assistance with at home — those tasks continue regardless of ADHC enrollment. However, some county social workers may note ADHC enrollment during reassessments and evaluate whether IHSS hours for tasks now covered by ADHC should be adjusted. Recipients should be prepared to explain which in-home tasks remain unmet by ADHC services.
How to Access Adult Day Health Care
Step 1: Confirm Medi-Cal enrollment ADHC is a Medi-Cal benefit. Confirm your Medi-Cal plan and whether ADHC is a covered benefit under your specific plan (fee-for-service Medi-Cal vs. managed care plans may have different processes).
Step 2: Get a physician referral Ask your primary care physician or specialist to assess whether ADHC is appropriate for your medical needs. The physician completes a medical evaluation form (LIC 302 or equivalent) that the ADHC center requires for enrollment.
Step 3: Contact ADHC centers in your area California has licensed ADHC centers throughout the state, with higher concentrations in urban counties. The DHCS maintains a directory of licensed ADHC centers. Contact centers to inquire about availability, transportation services, and whether they can meet your specific care needs.
Step 4: Complete the center intake assessment Each ADHC center conducts its own intake assessment to evaluate whether its program is appropriate for the applicant. This typically involves a visit to the center, review of medical records, and a care planning meeting.
Step 5: Begin services Once enrolled, the center works with your Medi-Cal plan to authorize services. Most ADHC centers arrange transportation from your home to the center and back, though the extent of transportation services varies by location.
The Community-Based Adult Services (CBAS) Successor Program
In 2012, California restructured the ADHC program into the Community-Based Adult Services (CBAS) program under Medi-Cal managed care. CBAS largely covers the same services as the original ADHC program — health, therapy, social services, and meals at licensed centers — but operates through Medi-Cal managed care plans rather than directly through DHCS for most beneficiaries.
Key points about CBAS vs. ADHC:
- The licensed centers are essentially the same facilities; many retained ADHC in their names
- Access is now primarily through your Medi-Cal managed care plan, not through a separate DHCS enrollment process
- Fee-for-service Medi-Cal (for recipients not yet in managed care) may still access through the traditional ADHC process
- Contact your specific Medi-Cal plan for the correct enrollment process
IHSS Provider Role When Recipients Attend ADHC
If an IHSS recipient begins attending an ADHC or CBAS center on weekdays, the IHSS provider’s role typically shifts:
- Mornings: Preparing the recipient for the day, assisting with hygiene and dressing before transport arrives
- Evenings: Assisting with post-center personal care, meals, and nighttime preparation
- Non-center days: Providing full daily coverage as before
IHSS providers do not accompany recipients to ADHC centers — ADHC staff provides all care during center hours. Timesheets should reflect only the hours the IHSS provider actually worked at home.
Frequently Asked Questions
Q: Does enrolling in ADHC reduce my IHSS hours? A: Not automatically. Your IHSS authorized hours reflect the in-home tasks you need assistance with, which continue whether or not you attend ADHC. However, at your next IHSS reassessment, the social worker may ask about your ADHC schedule. Be prepared to document which specific in-home tasks remain unmet by ADHC services to support your current hour authorization.
Q: Does ADHC cover transportation to the center? A: Many ADHC and CBAS centers arrange or directly provide transportation for enrolled participants. Transportation availability and service area vary by center. Confirm transportation arrangements with the specific center during the intake process. Medi-Cal Non-Emergency Medical Transportation (NEMT) may also cover transportation to ADHC centers for eligible recipients.
Q: Is there a waiting list for ADHC programs in California? A: Wait times vary significantly by location and center. Urban areas generally have more ADHC centers than rural areas. Contact centers directly to ask about current enrollment capacity and wait times. If one center has a long wait, others in the area may have openings. Your county’s IHSS social worker or Area Agency on Aging may also be able to identify centers with current availability.
Related Resources on Unified Savers:
- What Services Does IHSS Cover — Full overview of authorized IHSS service types
- IHSS Protective Supervision — Supervision services for recipients who cannot be left alone safely
- IHSS Mental Health Services Covered — Mental health-related IHSS services
- IHSS Reassessment Process — What happens at IHSS reassessment visits
- Medi-Cal IHSS Connection — How Medi-Cal and IHSS eligibility are linked
- IHSS Maximum Hours Per Month — How monthly IHSS hour limits work and what ADHC enrollment means for your authorized hours at reassessment
- How to Request an IHSS Reassessment — When ADHC enrollment changes your care picture, how to initiate an IHSS reassessment to protect your authorized hours