California’s state-subsidized program that pays relatives to provide in-home care has come under scrutiny amid widespread concerns of fraud and insufficient oversight. The initiative, known as In-Home Supportive Services (IHSS), currently enrolls approximately 500,000 caregivers, of whom about 370,000 are family members. Critics argue that the program’s minimal controls and generous payments have created conditions ripe for abuse.

Originally designed to reduce costs by allowing family members to provide basic care outside of nursing homes or hospitals, the program has expanded rapidly. In California, IHSS recipients—who can include extended relatives such as nieces, nephews, and cousins—are compensated for up to 283 hours of care per month, significantly exceeding the national average of 125 hours and surpassing the typical public-sector workload of 172 hours per month. The program pays minimum wages ranging from $16 to $21 per hour depending on the county, and payments made to caregivers living in the same household are exempt from both federal and state income taxes.

While the program aims to support low-income families through federally funded Medicaid, state authorities face criticism for inadequate monitoring. Initial eligibility checks are conducted by county officials, but ongoing verification appears limited. External caregivers must electronically log their hours daily, yet there is little evidence of active oversight. Family caregivers, on the other hand, generally submit only weekly timesheets, raising questions about the accuracy of reported hours and caregiving activities. The visibility of such arrangements has widened due to social media, where users openly discuss how to receive payments for at-home caregiving roles.

Spending on IHSS has surged, with California’s budget for home health care programs hitting nearly $30 billion in 2025-26—an 11.5% increase from the previous year. This growth has prompted federal officials to intervene. The Centers for Medicare & Medicaid Services (CMS), led by administrator Dr. Mehmet Oz, recently suspended $1.3 billion in Medicaid payments to California, citing the need for stronger fraud prevention measures.

The challenges faced by California are not isolated. Across the United States, state-subsidized family caregiving programs have been plagued by fraud and abuse, exacerbated by lax revalidation requirements. Under the Affordable Care Act, Medicaid providers must be revalidated at least every five years, a period deemed too long by experts who advocate for more frequent and rigorous reviews, including cross-checks against national databases of providers linked to fraud or abuse.

California has acknowledged deficiencies in its oversight system. A 2022 audit revealed instances of suspicious licensing practices, with multiple hospice and home health agencies registered at a single Los Angeles address. Despite this, meaningful enforcement has remained limited until recent federal pressure.

Observers suggest that California’s IHSS program either requires a comprehensive overhaul to introduce stringent controls or may need to be discontinued altogether. As the state grapples with balancing cost savings, support for vulnerable populations, and the integrity of public funds, the future of subsidized family caregiving remains uncertain.