Common questions
Is PCHS really free?
Yes, for eligible members. There is no copay and no bill. Your Medi-Cal health plan decides who qualifies and approves every service.
Can I have PCHS and IHSS at the same time?
Yes. PCHS can help while you wait for IHSS. It can also add hours when IHSS is not enough. IHSS stays your main program. PCHS works with it, never instead of it.
How many hours will the plan approve?
There is no set number for PCHS. The health plan looks at your needs and sets the hours. Respite is capped at 336 hours per calendar year, as the plan approves. If your hours feel too low, you can ask for a new review or file a complaint.
Can a family member be paid to provide PCHS?
Usually no. Agencies like Divine Agape provide PCHS. IHSS is the program that lets you hire your own helper, often a family member. Spouses and minor children usually cannot be hired.
What if I have fee-for-service Medi-Cal?
This help only comes through Medi-Cal managed care plans. Call Health Care Options at 1-800-430-4263 to join Ventura County's Medi-Cal health plan. You can also call the Medi-Cal helpline at 1-800-541-5555.
What's the difference between ECM and Community Supports?
ECM is short for Enhanced Care Management. It gives a personal care manager to Medi-Cal members with the most complex needs. Community Supports are the services themselves, like PCHS and Respite. They often work together, but the plan approves each one on its own. An ECM care manager can refer you for these services.
Which Community Supports does my health plan offer?
The list changes over time. It includes Personal Homemaker Services (that is PCHS) and Respite Care. Call the plan's CalAIM line at 1-805-437-5911 for the current list.
What if the plan denies the service?
You can appeal with the plan. You can ask the DMHC for an outside review at 1-888-466-2219. You can also ask for a State Hearing. A plan cannot say no just because of your diagnosis.
How is Respite different from regular home care?
Respite is based on the family caregiver's need for rest. A trained caregiver steps in for the person who usually helps. PCHS is based on the member's own needs. The plan must approve both.
Official links
Key phone numbers
| Divine Agape | (805) 951-1121 |
| Your Medi-Cal health plan's Member Services | 1-888-301-1228 (TTY 711) |
| The plan's CalAIM line | 1-805-437-5911 |
| Medi-Cal helpline | 1-800-541-5555 |
| Ventura County Medi-Cal (HSA) | 888-472-4463 |
| Ventura County IHSS applications | 805-654-3236 |
| Health Care Options | 1-800-430-4263 |
| DMHC (appeals / IMR) | 1-888-466-2219 |
Plain-word glossary
Medi-Cal: Medi-Cal is California's free or low-cost health insurance for people with lower incomes.
CalAIM: CalAIM is a Medi-Cal program. It can pay for extra help at home, so you pay nothing. The full name is California Advancing and Innovating Medi-Cal.
Community Supports: Extra services that Medi-Cal health plans can offer, like PCHS and Respite. There are 15 statewide. Each plan picks which ones to offer.
PCHS: PCHS is short for Personal Care and Homemaker Services. It means help with bathing, dressing, meals, and cleaning. Medi-Cal pays for it. Your health plan may call it "Personal Homemaker Services."
Respite: Respite means a short break. A trained caregiver steps in so a family caregiver can rest. Up to 336 hours per calendar year, as the plan approves.
Managed care plan (MCP): A managed care plan is the company that runs your Medi-Cal.
Referral: A referral is a request asking the health plan to approve services for a patient.
Authorization: An authorization is the health plan's written OK to start services.
ECM: Short for Enhanced Care Management. It gives a personal care manager to members with the most complex needs.
IHSS: IHSS is short for In-Home Supportive Services. It is a county program that pays someone, often a family member, to help you at home.
SOC 295: The form you fill out to apply for IHSS.
SOC 873: The form your doctor fills out for IHSS. The county needs it to approve you.
NOA: Short for Notice of Action. The county's letter with its IHSS decision: yes or no, and how many hours.
ADLs: Short for Activities of Daily Living. Daily activities like bathing, dressing, using the toilet, eating, and moving around.
IADLs: Short for Instrumental Activities of Daily Living. Chores like meals, groceries, cleaning, laundry, and handling money.
DHCS: The state office that runs Medi-Cal.
DMHC: The state office where you can ask for an outside review if your plan says no.
SNF: Short for Skilled Nursing Facility. That means a nursing home.
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