California rules, explained

California caregiver requirements: HCA registry, IHSS and CNA explained

By the CaregiverConnect team · Updated 2026-10-12 · Sources checked on the same date and listed at the end.

People ask "do I need a licence to be a caregiver in California?" and get three different answers because there are three different systems. Which one applies depends on who employs you and what tasks you do. This guide lays them out side by side, citing the state agencies that run them.

The three systems at a glance

If you are…	What applies	Who runs it
Hired directly by a family for non-medical help	No licence or registration is required. You may register voluntarily as an independent Home Care Aide ($35, Live Scan background check).	CDSS Home Care Services Bureau
Employed by a licensed Home Care Organization (agency)	You must be listed on the Home Care Aide Registry before serving clients: CDSS-cleared background check, TB clearance, 5 hours of entry-level training and 5 hours a year after that.	CDSS Home Care Services Bureau
Paid through In-Home Supportive Services (IHSS)	County enrolment: in-person orientation, form SOC 426, provider agreement SOC 846, Department of Justice fingerprint check. Wages are set county by county.	CDSS IHSS + your county IHSS office / Public Authority
Doing nursing tasks or working in a facility	Certified Nursing Assistant (CNA) or Home Health Aide (HHA) certification, with a state exam and clinical hours.	California Department of Public Health

Everything in the first three rows is non-medical care: bathing, dressing, grooming, toileting, transfers, meal preparation, housekeeping, transportation, companionship and reminders to take self-administered medication. CDSS lists exactly those tasks as "home care services" and states that registered aides may not perform medical services such as injections, catheter care, wound care or monitoring vital signs.

Independent caregivers hired by a family

California's Home Care Services Consumer Protection Act (effective January 1, 2016) licenses organizations and registers their aides. In CDSS's own words, an affiliated aide "must be listed on the registry before providing home care services to a client", while an independent aide is "not employed by a HCO; however, they have chosen to be listed on the HCA Registry". The choice is yours; the Act does not make a private hire illegal without it.

Registering anyway is worth considering. It costs $35 (renewal also $35), uses Live Scan fingerprinting, and puts your name in a public registry that any family can search. On a marketplace where families screen you themselves, a registry listing answers the first question they will ask. Independent aides apply online through CDSS's Guardian system using the independent-aide PIN published on the CDSS application page.

Two obligations apply regardless of registration. First, anyone who has assumed responsibility for the care of an elder or dependent adult in California, paid or not, is a mandated reporter of elder abuse under Welfare and Institutions Code §15630. Second, if a family employs you directly for more than casual hours, you are a household employee: the family handles payroll taxes under IRS rules for household employers, and California's Domestic Worker Bill of Rights gives personal attendants overtime at 1.5× after nine hours in a day or 45 hours in a week.

Agency (Home Care Organization) aides

If you work for a licensed Home Care Organization, the organization must ensure you are cleared on the registry before you have contact with clients (Health & Safety Code §1796.43). You complete five hours of entry-level training before your first client (two hours of orientation and three hours of safety topics), five hours of annual training, and a tuberculosis screening within 90 days before or 7 days after hire. The agency is the employer, sets your schedule and bills the family; the family's hourly rate includes the agency's margin.

IHSS providers

In-Home Supportive Services pays providers to care for eligible low-income older adults and people with disabilities who receive Medi-Cal. The recipient chooses the provider, often a relative. CDSS's provider orientation page lists the steps: attend an in-person county orientation, complete and return the SOC 426 enrolment form to the county IHSS office or Public Authority, sign the SOC 846 provider enrolment agreement, and be fingerprinted for a California Department of Justice criminal background check.

Pay is set per county and published by CDSS. Examples effective 2026 from the CDSS wage table: Imperial County $18.83 per hour and San Diego County $20.40 per hour (the California minimum wage is $16.90). Hours are authorised per recipient by the county, so IHSS income is capped by the recipient's assessment; many providers combine an IHSS case with private clients.

CNA and Home Health Aide certification

Certified Nursing Assistant and Home Health Aide certificates are issued by the California Department of Public Health, which certifies nurse assistants under Health and Safety Code §1337–1338.5. A CNA course is typically one semester at a community college (Imperial Valley College runs AHP 060, for example), followed by the state competency exam; HHA certification adds classroom and clinical hours on top of an active CNA certificate. You need these for nursing tasks and most facility jobs. You do not need them for non-medical home care, but many families value them and the pay for certified roles is higher: nursing assistants in the El Centro metro earned a median $21.48 per hour in May 2025 versus $16.50 for home health and personal care aides.

A practical checklist

Decide which system fits you: private clients (no mandatory registration), agency employment (registry required), IHSS (county enrolment), or certified roles (CNA/HHA).
If you take private clients, consider voluntary Home Care Aide registration ($35, Live Scan) and say so on your profile.
Get CPR and first aid certification; families ask for it and it is inexpensive.
Know your mandated-reporter duty and your county's Adult Protective Services number (Imperial County: (760) 337-7878).
Keep written agreements with each family on duties, schedule, rate and overtime.

Sources

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