Marin County In-Home Supportive Services Program (IHSS)
The IHSS program provides services to eligible people over the age of 65, the blind and/or disabled. The goal of the IHSS program is to allow you to live safely in your own home and avoid the need for out of home care. Services almost always need to be provided in your own home. This could be a house, apartment, hotel, or the home of a relative. If you receive Supplemental Security Income (SSI) or meet all Medi-Cal income eligibility requirements, you may be able to receive IHSS services.
Phone:
(415) 473-4636
Hours:
830am -4:30pm
Fax:
(415) 473-6465
Address:
10 North San Pedro
San Rafael, CA 94903
Application Process:
1. Please call the Senior Information & Assistance Line at (415) 473-4636 to apply over the phone.
To apply online with forms included:
English Forms:
In-Home Supportive Services (IHSS) Program Notice to Applicant of Health Care Certification Requirement Form (SOC 874):
https://www.cdss.ca.gov/cdssweb/entres/forms/English/SOC874.pdf
In-Home Supportive Services (IHSS) Program Health Care Certification Form (SOC 873) : https://www.cdss.ca.gov/cdssweb/entres/forms/English/SOC873.pdf
Kaiser Permanente Authorization for Use or Disclosure Form (English):
https://healthy.kaiserpermanente.org/static/health/en-us/pdfs/cal/ca_auth_disclosure_PHI.pdf
Spanish Forms:
In-Home Supportive Services (IHSS) Program Notice to Applicant of Health Care Certification Requirement Form (SOC 874): https://www.cdss.ca.gov/cdssweb/entres/forms/spanish/soc874sp.pdf
In-Home Supportive Services (IHSS) Program Health Care Certification Form (SOC 873) https://cdss.ca.gov/cdssweb/entres/forms/Spanish/SOC873SP.pdf
Kaiser Permanente Authorization for Use or Disclosure Form:
https://healthy.kaiserpermanente.org/static/health/es-us/pdfs/cal/ca_recordsauth_spanish.pdf
2. Once a completed application is processed, the applicant will receive paperwork to return and complete. Included in the paperwork will be a Kaiser Permanente Authorization for Use and Disclosure Form (if the applicant is a Kaiser patient) and the required Health Care Certification Form (SOC 873) that will need to be returned completed by a licensed health care professional.
3. All completed forms must be returned in one of the following ways:
a. Mail:
Marin Health & Human Services
Division of Aging & Adult Services
10 N San Pedro Rd. Ste 1023
San Rafael, CA 94903-4155
b. Email: 473-INFO@marincounty.org
c. Fax: 415-473-6165
Eligibility:
Must be Medi-Cal eligible
Language:
- English
- Spanish
- Vietnamese
- Cantonese
- Interpeters available for other languages
