The following is a list of IHSS-like (In-Home Supportive Services) for all US States. IHSS is a specific term used in California – other states will have different names for their Support Service programs. IHSS type services allow you to either find a caregiver who is funded by the state to assist you with your family member; or you can apply to be a “provider” (caregiver) and get paid an hourly wage in order to care for your own family member.
Last updated 5/28/2026.
Additional notes:
General trends across the U.S.
Programs that tend to be considered the most flexible for family caregivers:
- California (IHSS)
- New York (CDPAP)
- Colorado (CDASS/IHSS)
- Wisconsin (IRIS)
- Oregon (K Plan / ICP)
States most commonly criticized for:
- long waiver waitlists,
- restrictive paid-parent rules,
- or low reimbursement rates:
- Georgia
- Florida
- Texas
- Mississippi
A major difference between states is whether the program is an entitlement (like much of California IHSS) or a waiver program with capped enrollment and waitlists.
Most states now use some variation of Medicaid “self-directed” or “consumer-directed” care models, even though the names differ substantially.
Hope this helps!
– Unfiltered Autism Dad
| State | Main Program | Common Benefits | Common Drawbacks | Official Site |
|---|---|---|---|---|
| Alabama | Personal Choices / E&D Waiver | Family caregiver flexibility | Limited availability | Alabama Medicaid HCBS |
| Alaska | Personal Care Services (PCS) | Broad in-home supports | Geographic access issues | Alaska PCS |
| Arizona | Self-Directed Attendant Care | Strong self-direction | Managed-care complexity | Arizona ALTCS |
| Arkansas | Independent Choices | Consumer-directed model | Staffing shortages | Arkansas Independent Choices |
| California | IHSS | Very family-friendly, broad hours possible | County-by-county administration | California IHSS |
| Colorado | IHSS / CDASS | Strong self-direction | Administrative burden | Colorado IHSS |
| Connecticut | Community First Choice | Family participation allowed | Complex eligibility | Connecticut CFC |
| Delaware | Attendant Services | Supports independent living | Limited hours | Delaware Attendant Services |
| Florida | Consumer Directed Care Plus | Self-directed budgets | Long waitlists common | Florida Medicaid LTC |
| Georgia | NOW/COMP Waivers | Developmental disability support | Significant waitlists | Georgia NOW/COMP |
| Hawaii | Consumer-Directed Option | Island home-care coverage | Limited family payment | Hawaii QUEST Integration |
| Idaho | My Voice My Choice | Self-directed care | Smaller program scope | Idaho Self-Direction |
| Illinois | Home Services Program | Parent caregivers possible | Paperwork-heavy | Illinois HSP |
| Indiana | Structured Family Caregiving | Family stipends | Some paid-parent restrictions | Indiana HCBS |
| Iowa | Consumer Choices Option | Consumer control | Waiver limitations | Iowa HCBS |
| Kansas | KanCare Self-Direction | Paid family caregiving | Hour limits | Kansas HCBS |
| Kentucky | Personal Care Attendant Program | Home-based focus | Limited funding | Kentucky PCAP |
| Louisiana | Community Choices Waiver | Good senior supports | Long waitlists | Louisiana HCBS |
| Maine | Consumer Directed Attendant Services | Strong self-direction | Workforce shortages | Maine Consumer Directed Services |
| Maryland | Community First Choice | Flexible home supports | Complex approval process | Maryland CFC |
| Massachusetts | PCA Program | Highly consumer-driven | Fiscal intermediary complexity | MassHealth PCA |
| Michigan | Home Help Program | Widely used family care model | Lower reimbursement | Michigan Home Help |
| Minnesota | Consumer Directed Community Supports | Very flexible budgets | County administration differences | Minnesota CDCS |
| Mississippi | HCBS Waivers | Basic home supports | More restrictive family rules | Mississippi HCBS |
| Missouri | Consumer Directed Services | Independent living focus | Fewer paid-parent options | Missouri CDS |
| Montana | Big Sky Waiver | Some paid parent care | Rural access issues | Montana HCBS |
| Nebraska | Personal Assistance Services | Expanded family caregiver options | Limited provider network | Nebraska HCBS |
| Nevada | Personal Assistance Services / Physical Disabilities Waiver | Family caregivers possible | Less expansive than CA | Nevada HCBS |
| New Hampshire | Choices for Independence | Good elder-care support | Narrower disability scope | NH Choices for Independence |
| New Jersey | Personal Preference Program | Strong consumer control | Managed care bureaucracy | NJ PPP |
| New Mexico | Mi Via Waiver | Highly self-directed | Administrative overhead | New Mexico Mi Via |
| New York | CDPAP | One of the strongest family-caregiver models | Recent regulatory changes | New York CDPAP |
| North Carolina | CAP/DA | Strong pediatric supports | Waitlists | North Carolina CAP/DA |
| Ohio | SELF Waiver / PASSPORT | Parent caregiver pathways | Agency oversight requirements | Ohio Waivers |
| Oklahoma | Independent Choices | Consumer-directed | More limited scale | Oklahoma HCBS |
| Oregon | K Plan / ICP | Very progressive self-direction | Case-management complexity | Oregon In-Home Services |
| Pennsylvania | Services My Way | Self-directed flexibility | Administrative complexity | Pennsylvania HCBS |
| South Carolina | Community Choices | Home-care flexibility | Workforce shortages | South Carolina HCBS |
| South Dakota | Assistive Daily Living | Adult supports | Parents of minors restricted | South Dakota HCBS |
| Tennessee | ECF CHOICES | Good employment/community integration | Smaller caregiver stipends | Tennessee ECF CHOICES |
| Texas | CDS / STAR+PLUS HCBS | Large statewide system | Long waitlists in some waivers | Texas STAR+PLUS HCBS |
| Utah | New Choices Waiver | Self-direction available | More restrictive hours | Utah HCBS |
| Virginia | Consumer-Directed Services | Paid parent care expanded | Documentation-heavy | Virginia CCC Plus |
| Washington | Consumer Directed Employer | Strong home-care infrastructure | Union/payroll complexity | Washington Consumer Directed Employer |
| West Virginia | Personal Options | Consumer-directed care | Limited provider availability | West Virginia Personal Options |
| Wisconsin | IRIS | Very flexible self-direction | Administrative learning curve | Wisconsin IRIS |
| Wyoming | Community Choices Waiver | Rural home-care support | Smaller infrastructure | Wyoming HCBS |
List of State by State Programs as a Child Gets Older
| State | Major lifelong support pathways | Important age changes | Continuous-care difficulty* | State resource |
|---|---|---|---|---|
| Alabama | Medicaid HCBS/DD waivers; personal care; respite; habilitation; employment/residential | 3 → school; 18 → adulthood/SSI; ~21–22 → school exit | 🟠 Moderate–Hard | Alabama DD Council |
| Alaska | DD waiver; Community First Choice; personal care; respite; supported living/employment | 3; 18; ~22 | 🟡 Moderate | Alaska DD Council |
| Arizona | ALTCS/DD; attendant care; habilitation; respite; residential; employment; self-direction | 3; 18; ~22 | 🟢 Favorable | Arizona DD Planning Council |
| Arkansas | Community & Employment Support waiver; personal care; respite; DD supports | 3; 18; ~22 | 🟠 Moderate | Arkansas DD Council |
| California | Regional Centers/Lanterman Act; IHSS; Protective Supervision; Medi-Cal HCBS; respite; Self-Determination; residential/day/employment | 3; 18; ~22 school exit; Regional Center continues lifelong | 🟢 Favorable | California State Council on DD |
| Colorado | DD/Supported Living/Children’s waivers; consumer-directed attendants; respite | 3; 18; ~21–22 | 🟡 Moderate | Colorado DD Council |
| Connecticut | DDS; Medicaid HCBS; respite; employment; residential services | 3; 18; ~22 | 🟡–🟠 Moderate | Connecticut DD Council |
| Delaware | DDDS; Lifespan waiver; respite; residential; employment; family supports | 3; 18; ~21–22 | 🟢–🟡 Favorable | Delaware DD Council |
| Florida | APD; iBudget waiver; respite; PCA; supported living/employment; residential | 3; 18; ~22 | 🔴 Very difficult | Florida DD Council |
| Georgia | NOW/COMP waivers; respite; community living; employment; self-direction | 3; 18; ~22 | 🟠–🔴 Difficult | Georgia DD Council |
| Hawaii | DDD; Medicaid I/DD waiver; personal assistance; respite; residential/employment | 3; 18; ~22 | 🟢–🟡 Favorable | Hawaii DD Council |
| Idaho | Medicaid DD services; self-direction; respite; supported employment/living | 3; 18; ~21–22 | 🟡 Moderate | Idaho DD Council |
| Illinois | DDD waivers; Home-Based Services; respite; residential; day/employment | 3; 18; ~22 | 🔴 Difficult | Illinois DD Council |
| Indiana | FSW/CIH waivers; attendant care; respite; residential/employment | 3; 18; ~22 | 🟠–🔴 Difficult | Indiana Governor’s Council |
| Iowa | Medicaid HCBS ID/Health & Disability waivers; consumer-directed care; respite | 3; 18; ~21–22 | 🔴 Difficult | Iowa DD Council |
| Kansas | I/DD waiver; self-direction; personal care; respite; residential/employment | 3; 18; ~21–22 | 🟠–🔴 Difficult | Kansas DD Council |
| Kentucky | Michelle P./SCL waivers; respite; personal care; community living; employment | 3; 18; ~21–22 | 🔴 Difficult | Kentucky DD Council |
| Louisiana | NOW/ROW/Supports waivers; personal care; respite; residential/employment | 3; 18; ~22 | 🔴 Difficult | Louisiana DD Council |
| Maine | Section 21/29 DD services; personal support; respite; community supports | 3; 18; school exit varies | 🟠 Moderate–Hard | Maine DD Council |
| Maryland | DDA waivers; Community Pathways; Family Supports; self-direction; residential | 3; 18; ~21–22 | 🟠–🔴 Difficult | Maryland DD Council |
| Massachusetts | DDS; MassHealth HCBS; PCA; autism services; self-direction; residential/day/employment | 3; 18; ~22 | 🟢 Favorable | Massachusetts DD Council |
| Michigan | Medicaid Behavioral Health/DD; Habilitation Supports; self-determination; respite | 3; 18; school eligibility can extend beyond typical states | 🟢–🟡 Favorable | Michigan DD Council |
| Minnesota | DD/CADI waivers; CFSS personal care; consumer direction; respite/residential | 3; 18; ~22 | 🟢 Favorable | Minnesota DD Council |
| Mississippi | ID/DD waiver; community support; respite; supported living/employment | 3; 18; ~21–22 | 🟠 Moderate–Hard | Mississippi DD Council |
| Missouri | DD Comprehensive/Community Support waivers; self-directed care; respite | 3; 18; ~21–22 | 🟡 Moderate | Missouri DD Council |
| Montana | DD waiver; self-direction; respite; residential/day/employment | 3; 18; ~21–22 | 🟠 Moderate | Montana DD Council |
| Nebraska | DD comprehensive/day waivers; respite; habilitation; supported living | 3; 18; ~21–22 | 🟡 Moderate | Nebraska DD Council |
| Nevada | ADSD/DD services; Medicaid HCBS; respite; residential/day/employment | 3; 18; ~21–22 | 🟠 Moderate–Hard | Nevada DD Council |
| New Hampshire | Area Agencies; DD waiver; self-direction; respite; residential/employment | 3; 18; ~21–22 | 🟢–🟡 Favorable | New Hampshire DD Council |
| New Jersey | DDD; Supports/Community Care; self-direction; respite; residential/employment | 3; 18; 21 major adult-DD transition | 🟡 Moderate | New Jersey DD Council |
| New Mexico | DD/Mi Via waivers; self-direction; respite; personal support | 3; 18; ~22 | 🟠 Moderate–Hard | New Mexico DD Council |
| New York | OPWDD; HCBS; Self-Direction; respite; community habilitation; residential/day/employment | 3; 18; ~21–22 | 🟢–🟡 Favorable | New York DD Planning Council |
| North Carolina | Innovations Waiver; 1915(i); personal assistance; respite; supported living | 3; 18; ~22 | 🔴 Very difficult | North Carolina DD Council |
| North Dakota | DD waiver; autism/DD services; respite; family support | 3; 18; ~21–22 | 🟢–🟡 Favorable | North Dakota DD Council |
| Ohio | County DD boards; Level One/SELF/IO waivers; self-direction; residential | 3; 18; ~22 | 🟡 Moderate | Ohio DD Council |
| Oklahoma | DDS; Community/HCBS waivers; respite; supported living/employment | 3; 18; ~21–22 | 🟠 Moderate–Hard | Oklahoma DD Council |
| Oregon | ODDS; K Plan/Community First Choice; DD waivers; in-home attendants | 3; 18; ~21–22 | 🟢–🟡 Favorable | Oregon DD Council |
| Pennsylvania | ODP; Consolidated/Community Living/PFDS waivers; self-direction; residential | 3; 18; ~22 | 🟠–🔴 Difficult | Pennsylvania DD Council |
| Rhode Island | BHDDH; Medicaid DD services; self-direction; day/residential/employment | 3; 18; ~21–22 | 🟡 Moderate | Rhode Island DD Council |
| South Carolina | DDSN; Community Supports/ID-RD waivers; respite; residential/employment | 3; 18; ~21–22 | 🔴 Very difficult | South Carolina DD Council |
| South Dakota | CHOICES/DD waiver; family support; respite; supported living/employment | 3; 18; ~21–22 | 🟢–🟡 Favorable | South Dakota DD Council |
| Tennessee | Employment & Community First CHOICES; Family Support; attendant/respite | 3; 18; ~21–22 | 🟡 Moderate | Tennessee DD Council |
| Texas | HCS, CLASS, TxHmL, DBMD waivers; attendant care; respite; residential/employment | 3; 18; ~22 | 🔴🔴 Extremely difficult | Texas DD Council |
| Utah | DSPD; Community Supports and other waivers; respite; supported living | 3; 18; ~22 | 🔴 Difficult | Utah DD Council |
| Vermont | DD Services; Medicaid; home/community support; residential/employment | 3; 18; ~21–22 | 🟢 Favorable | Vermont DD Council |
| Virginia | Building Independence, Family & Individual Supports, Community Living waivers | 3; 18; ~22 | 🔴 Difficult | Virginia Board for People with Disabilities |
| Washington | DDA; Basic Plus/Core/Community Protection waivers; IFS; respite | 3; 18; ~21–22 | 🟢–🟡 Favorable | Washington DD Council |
| West Virginia | I/DD waiver; personal care; respite; habilitation; residential | 3; 18; ~21–22 | 🟠 Moderate | West Virginia DD Council |
| Wisconsin | Children’s Long-Term Support; adult Family Care/IRIS; self-direction; respite/residential | 3; 18 child→adult transition; ~21 school exit | 🟡 Moderate | Wisconsin Board for People with DD |
| Wyoming | Supports & Comprehensive waivers; respite; supported living/employment | 3; 18; ~21–22 | 🟡 Moderate | Wyoming DD Council |