MedicaidCoverageHigh impact
07-29-2026 Clarification of IHSS role in respite care IE LA SAC SD
Molina Healthcare·CA·Provider Bulletin
Effective date
Jul 29, 2026
We identified it
Aug 4, 2026
Summary
Molina Healthcare of California clarified that Caregiver Respite services cannot duplicate or replace IHSS (In-Home Supportive Services) hours. Respite care may only be authorized when it addresses distinct, non-overlapping needs separate from IHSS responsibilities. Members must coordinate with their county IHSS office for backup caregivers during IHSS-assigned hours.
Action Required
Immediately: Billing team must update authorization review procedures to prevent approval of Caregiver Respite services that overlap with IHSS-assigned hours. Before authorizing any respite care for IHSS recipients, verify with the member's county IHSS office to confirm there is no service duplication. Update internal authorization guidelines and provider encounter forms to include a required field identifying whether the member receives IHSS services. Train billing and authorization staff on the new DHCS guidance. Failure to comply will result in claim denials and potential recoupment of inappropriately authorized services. For affected Medi-Cal members in Riverside, San Bernardino, Los Angeles, Sacramento, and San Diego counties, deny respite care requests that would replace IHSS provider hours and redirect members to their IHSS county office.