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CA Department of Developmental Services - Agency through which the State of California provides services and supports to individuals with developmental disabilities.

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1915(C) Waiver

1915(i) State Plan Program

CMS HCBS Regulations

Self-Determination Program

Public Notice Archive

Medicaid, known as Medi-Cal in California, is a jointly-funded, federal-state health insurance program for certain low income and needy people that includes long-term care benefits. In 1981, President Reagan signed into law the Medicaid Home and Community-Based Services (HCBS) Waiver program, section 1915(c) of the Social Security Act. The legislation provided a vehicle for California to offer services not otherwise available through the Medi-Cal program to serve people (including individuals with developmental disabilities) in their own homes and communities. The HCBS Waiver program recognizes that many individuals at risk of being placed in medical facilities can be cared for in their homes and communities, preserving their independence and ties to family and friends at a cost no higher than that of institutional care.

The HCBS Waiver Primer and Policy Manual PDF

HCBS Waiver Record Review – Updated 2022 PDF

Self-Determination Program (SDP) Record Review – Updated 2022 PDF

HCBS Waiver Monitoring Protocol PDF

HCBS Waiver for Individuals with DD Brochure (English | Spanish) PDF

The federal Centers for Medicare & Medicaid Services (CMS) approved California’s five year renewal of the Home and Community–Based Services (HCBS) Waiver for Californians with Developmental Disabilities effective January 1, 2018. Approval of the HCBS Waiver renewal secures the availability of approximately $2 billion in federal funding for regional center services.

Current Waiver

2022 Rate Study Implementation (Effective April 1, 2022. The purpose of the amendment is to begin implementation of the rate models as described in the 2019 Rate Study) PDF Source: Centers for Medicare and Medicaid Services (CMS)

Approved Appendix K  (Effective January 1, 2022, this application extends the effective period of previously implemented time-limited rate increases and implements rate increases for providers utilizing the ARM rate methodology as a result of an increase to the state minimum wage) PDF Source: Centers for Medicare & Medicaid Services (CMS)

Approved Waiver Amendment (Effective January 19, 2021, this amendment adds Intensive Transition Services as a new service and Speech Language Pathologist Assistant as a new provider type) PDF

Approved Waiver Amendment (Effective January 1, 2021, this amendment provides time-limited rate increases for Independent Living Services effective January 1, 2021 through December 31, 2021) PDF

Approved Appendix K (Effective August 1, 2020, in response to the wildfire-related State of Emergency declared on August 14, 2020, this Appendix K provides for retainer payments for providers impacted by wildfires as a result of absences caused by evacuation or loss of property) PDF

Approved Appendix K  (Effective March 1, 2020, this Appendix K is additive to those previously approved to change anticipated end date to six (6) months after the conclusion of the declared Public Health Emergency) PDF

Approved Appendix K (Effective September 1, 2020, this Appendix K provides additional flexibilities to those already approved in the June 2020 Appendix K)PDF

Approved Appendix K  (Effective July 1, 2020, this Appendix K provides additional flexibilities to those already approved in the June 8, 2020 Appendix K, to include three (3) episodes of no more than thirty (30) days of retainer payments for services that provide support for habilitation and personal care) PDF

Approved Appendix K  (Effective June 8, 2020, this waiver appendix provides federal requirement flexibilities due to the COVID-19 state of emergency) PDF

Prior Waiver

Approved Waiver Amendment (Effective April 1, 2020, this amendment adds State-operated Community Crisis Homes, Enhanced Behavioral Supports Homes, and Mobile Crisis Teams as new waiver services) PDF

Approved Waiver Amendment (Effective January 1, 2020, this amendment provides time-limited rate increases for specified services effective January 1, 2020 through December 31, 2021) PDF

Approved Waiver Amendment (Effective May 1, 2019. Added Community Crisis Homes, Community Based Adult Services, and includes authorization for a one-year rate increase of 2.1% for some providers in counties designated as “high cost”) PDF

Approved Technical Adjustment (Effective July 1, 2018) PDF

Approved Waiver Application (Effective January 1, 2018) PDF

Established as part of the Deficit Reduction Act of 2005, section 1915(i) of the Social Security Act gives states the option to provide Home and Community Based Services (HCBS) without a waiver. One of the key provisions of Section 1915(i) is that eligibility criteria for these services must be less stringent than the institutional level of care criteria required under waivers. DDS has renewed the 1915(i) State Plan Amendment (SPA) which allows DDS to access federal funding for community services provided to individuals who do not meet the eligibility criteria of the current HCBS Waiver.

Pending Federal Approval

Disaster Relief State Plan Amendment (SPA 22-0037) (Effective September 1, 2020. This amendment proposes a temporary modification of the service scope for selected services in response to the public health emergency.) PDF

Approved State Plan Amendments

State Plan Amendment (SPA 21-0040) Effective April 1, 2022. The purpose of the amendment is to begin implementation of the rate models as described in the 2019 Rate Study) PDF Source: Centers for Medicare and Medicaid Services (CMS)

Disaster Relief State Plan Amendment (SPA 21-0031) (Effective January 1, 2022. The purpose of the amendment is to increase the payment rates for Habilitation – Community Living Arrangement Services (Licensed/Certified Residential Services) – Alternative Residential Model (ARM) rate as a result of the increase to the state minimum wage. PDF Source: Centers for Medicare and Medicaid Services (CMS)

Disaster Relief State Plan Amendment (SPA 21-0050) (Effective March 1, 2020, provides time-limited rate increases for specified developmental services providers; effective April 1, 2020, adds Intensive Transition Services as a new service; and Speech Language Pathologist Assistant as a new provider type) PDF Source: Centers for Medicare and Medicaid Services (CMS)

Disaster Relief State Plan Amendment (SPA 21-0049) (Effective May 1, 2020. Adds State-Operated Mobile Crisis Teams as a new provider and new rate methodologies for State-Operated Enhanced Behavioral Supports Homes, State-Operated Community Crisis Homes, and State-Operated Mobile Crisis Teams) PDF

State Plan Amendment Renewal (SPA 21-0002) (Effective October 1, 2021) PDF Source: Centers for Medicare and Medicaid Services (CMS)

In early 2014, CMS published final regulations affecting 1915(c) waiver programs, 1915(i) State Plan programs, and 1915(k) Community First Choice State Plans for HCBS provided through Medicaid. (42 CFR Part 430, 431, et al.) The purpose of the regulations is to ensure that individuals receive HCBS in settings that are integrated in and support full access to the greater community. The regulations also aim to ensure that individuals have a free choice of where they live and who provides services to them, and that individual rights and freedoms are not restricted, among other provisions. CMS has moved away from defining HCBS settings based on specific locations, geography, or physical characteristics, to defining them by the nature and quality of the individual’s experiences. Basically, the regulations set higher standards for HCBS settings in which it is permissible for states to pay for services using federal financial participation under Medicaid. The regulations became effective March 17, 2014, and allow states up to five years to implement home and community-based settings requirements. CMS has extended California’s transition period for compliance with home and community-based settings criteria by three years, until March 2022.

More information on the new federal regulations and the activities to implement the specific requirements is available on the CMS Home and Community-Based Services Regulations webpage.

On December 31, 2014, DDS submitted an HCBS Waiver application to CMS seeking federal funding for the Self-Determination Program (SDP). Under the authority of Senate Bill (SB) 468 (Chapter 683, Statutes of 2013) and upon CMS approval, DDS will implement the SDP, allowing regional center consumers and their families more freedom, control and responsibility in choosing services and supports to help them meet objectives in their individual program plans. Under the provisions of SB 468, participation will be limited to 2,500 individuals for the first three years of implementation.

More information is available on the Self-Determination Program webpage.

Current Waiver

Approved Waiver Renewal Application PDF (Effective July 1, 2021)

Prior Waiver

Approval of Second 90 Day Extension PDF (Extends operation of SDP Waiver through December 27, 2021)

Approval of 90 Day Extension PDF (Extends operation of SDP Waiver through September 28, 2021)

Pending Waiver Application PDF (Proposed effective July 1, 2021)

Approved Waiver Application PDF (Effective July 1, 2018)

Pursuant to 42 Code of Federal Regulations § 447.205, public notices of changes in statewide methods and standards for Medicaid payment rates must be made available electronically for no less than 3 years. If you need assistance or have any questions regarding public notices, please contact the Federal Programs and Operations Section at 916-653-2300.

2021

This notice provides information to the public regarding input for an amendment to the 1915(i) State Plan to provide rate increases for specified services effective April 1, 2022 per the California Budget Act of 2021 (SB 129).

This notice provides information to the public regarding public input for an amendment to the 1915(c) HCBS Waiver to provide rate increases for specified services effective April 1, 2022 per the California Budget Act of 2021 (SB 129). The full draft of the amendment is available here.

This notice provides information to the public regarding public input for renewal of the 1915(i) State Plan.

This notice provides information to the public regarding input for the renewal of the 1915(c) HCBS Self-Determination Waiver, which is set to expire June 30, 2021. A full draft of the amendment is available here.

This notice provides information to the public regarding input for an amendment to the 1915(i) State Plan which provides for a time-limited rate increase for Independent Living Program providers pursuant to Assembly Bill 79 (2020).

2020

This notice provides information to the public regarding public input for an amendment to the 1915(i) State Plan to add Intensive Transition Services as a new service and Speech Language Pathologist Assistants as a new provider type.

This notice provides information to the public regarding an amendment to the 1915(i) State Plan for the addition of State-Operated Mobile Crisis Teams as a new provider and new rate methodologies for State-Operated facilities, including Community Crisis Homes, Mobile Crisis Teams, and Enhanced Behavioral Supports Homes.

This notice provides information to the public regarding public input for an amendment to the 1915(c) HCBS Waiver to add Intensive Transition Services as a new waiver service and Speech Language Pathologist Assistants as a new provider type. The full draft of the amendment is available here.

2019

This notice provides information to the public regarding an amendment to the 1915(i) State Plan for time-limited rate increases for specified providers.

CA.0336.R04.04 This 1915(c) waiver amendment adds State-Operated Mobile Crisis Team as a provider type under Behavioral Intervention Services. Additionally, this amendment added rate methodologies for State-Operated Mobile Crisis Team and State-Operated Community Crisis Homes, both under Behavioral Intervention Services, as well as a rate methodology for State-Operated Enhanced Behavioral Supports Homes under Community Living Arrangement Services.

CA.0336.R04.03 This 1915(c) waiver amendment provides time-limited rate increases for specified providers effective January 1, 2020 to December 31, 2021.

19-0004 This state plan amendment provides rate increases for Community-Based Day Programs, Community Care Facilities under the Alternative Residential Model, and In-Home Respite Agency Providers in high cost counties.

CA.0336.R04.02 This 1915(c) waiver amendment adds Community Crisis Homes as a new provider, Community Based Adult Services as a new waiver service, Adult Day Health Care Center as a new provider, and provides time-limited rate increases for specified providers in high cost counties.

2018

18-0054 This state plan amendment proposes to add Community Crisis Homes as a new provider for Behavioral Intervention Services, subject to utilization controls.

18-0023 This state plan amendment adds Housing Access Services, Family Support Services, Occupational Therapy, Physical Therapy, and Family/Consumer Training, as well as Enhanced Behavioral Supports Homes as a new provider type. The amendment also removes Specialized Therapeutic Services and unbundling of its components, now available as Extended State Plan or other distinct services within the HCBS Waiver for the Developmentally Disabled.

2017

CA.0336.R04.00 Renews 1915(c) HCBS Waiver.

CA.0336.R03.00 Renewal Extension Grants a 90-day extension to renew the 1915(c) HCBS Waiver.

Last modified: April 29, 2022

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State of California & Department of Developmental Services

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Home and Community-Based Services Programs - CA Department of Developmental Services

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1915(C) Waiver 1915(i) State Plan Program CMS HCBS Regulations Self-Determination Program Public Notice Archive Medicaid, known as Medi-Cal in California, is a jointly-funded, federal-state health insurance program for certain low income and needy people that includes long-term care benefits. In 198…

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Application for a §1915(c) Home and Community

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Application for a §1915(c) Home and Community

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Based Services Waiver

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Eastern Los Angeles Regional Center - Home and Based Community Based Service Programs

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Eastern Los Angeles Regional Center - Home and Based Community Based Service Programs

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Home and Community-Based Services (HCBS) | Eastern Los Angeles Regional Center

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ASL VERSIONS | HCBS FINAL RULE : THE ANIMATED SERIES | FOR PEOPLE RECEIVING SERVICES

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A series of fun animated shorts, designed to help you better understand your rights under the HCBS Final Rule. ASL translation provided.

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Home & Community Based Services | Medicaid

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In 2014, 53% of all Medicaid long term care spending was on home & community based services.

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Every state's Medicaid and CHIP program is changing and improving - most states are expanding coverage for low-income adults; all states are modernizing their Medicaid/CHIP eligibility, enrollment and renewal processes and systems, and taking advantage of many of the new flexibilities provided by the Affordable Care Act. Finally, states are coordinating the application and enrollment process with the messaging and policies for the Health Insurance Marketplace operating in their state to ensure that there is no wrong door to coverage.

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Every state's Medicaid and CHIP program is changing and improving - most states are expanding coverage for low-income adults; all states are modernizing their Medicaid/CHIP eligibility, enrollment and renewal processes and systems, and taking advantage of many of the new flexibilities provided by the Affordable Care Act.

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Second ​Temporary Extension of the 2017-2021 HCBA Waiver Term

On March 23, 2022, the Centers for Medicare & Medicaid Services (CMS) approved DHCS' request to extend the current term of the HCBA waiver for an additional 90-day period. The initial waiver extension was scheduled to expire on March 31, 2022. This temporary extension allows the HCBA Waiver to continue operating through June 29, 2022.

Temporary Extension of the 2017-2021 HCBA Waiver Term

On December 22, 2021, the Centers for Medicare and Medicaid Services (CMS) approved DHCS' request to extend the current term of the HCBA Waiver for 90-days. The Waiver was scheduled to expire on December 31, 2021, and the temporary extension allows the HCBA Waiver to continue through March 31, 2022. The extension provided CMS with additional time to review the HCBA Waiver renewal application, and allows the State time to respond to CMS' formal Request for Additional Information, and resubmit a revised waiver renewal application.

HCBA Policy Letter #21-001: COVID-19 Vaccine Administration

DHCS is issuing HCBA Policy Letter #21-001 to notify HCBA Waiver Agencies about the update to California's vaccine administration prioritization, effective March 15, 2021, and to provide Waiver Agencies with instructions for the HCBA Waiver Agency participant notification plan, in advance of the March 15, 2021, effective date.

2022-2026 HCBA Waiver Renewal

The HCBA Waiver term ends December 31, 2021 and DHCS and has begun efforts to develop a waiver renewal application to submit to the Centers for Medicare and Medicaid Services (CMS) for reauthorization. The reauthorization process allows CMS to evaluate states' Medicaid waiver programs for compliance with waiver assurances and federal requirements. In addition, the waiver renewal process allows states to make changes to the waiver to include best practices, respond to changing needs of the population, address state and federal law and regulations, etc. DHCS is committed to engaging the public for input on the waiver renewal and has created a webpage to provide information on the waiver renewal process, including information on the ways in which the public can submit input to DHCS. Access the HCBA Waiver Renewal Webpage.

COVID-19 Response Guidance

In response to the COVID-19 public health emergency (PHE), DHCS has submitted requests to CMS to implement flexibilities to help protect the health and safety of the public. Approved requests, a well as guidance on the implantation of the temporary flexibilities is available on DHCS' COVID-19 Information for Providers & Partners webpage.

COVID-19 Hotspot Enrollment

On September 17, 2020, the Centers for Medicare and Medicaid Services (CMS) authorized California's request to temporarily modify 1915(c) Waiver enrollment policy for the HCBA Waiver to prioritize intake processing of waiver applicants residing in hospitals and skilled nursing facilities in areas of the state identified as "hotspots." The temporary enrollment flexibility is available waiver-wide but only applies to individuals within counties with the highest rates of new COVID-19 infections. For more information on the Appendix K temporary authorization of prioritized enrollment of applicants in COVID-19 "hotspots," please visit DHCS' COVID-19 Information for Providers & Partners webpage.

HCBA Waiver Overview

The HCBA Waiver (formerly the Nursing Facility/Acute Hospital (NF/AH) Waiver) was approved by the Centers for Medicare and Medicaid Services (CMS) on May 16, 2017. Medicaid's Home and Community-Based Services (HCBS) Waiver programs, including the HCBA Waiver, are authorized under Section
1915(c) of the Social Security Act; governed by Title 42, Code of Federal Regulations (CFR); and administered by CMS.

The HCBA Waiver provides care management services to persons at risk for nursing home or institutional placement. The care management services are provided by a multidisciplinary care team comprised of a nurse and social worker. The care management team coordinates Waiver and State Plan services (e.g., medical, behavioral health, In-Home Supportive Services, etc.), and arranges for other available long-term se​rvices and supports available in the local community. Care management and Waiver services are provided in the Participant's community-based residence. This residence can be privately owned, secured through a tenant lease arrangement, or the residence of a Participant's family member.

HCBA Waiver Current Enrollment

Current enrollment and waitlist information for the HCBA Waiver can be found on the enrollment dashboa​r​​d​, which is updated monthly. New applicants to the HCBA Waiver should be aware the number of available slots is limited. Waiver Agencies in areas with waitlists are working diligently to enroll as many new participants as their capacity allows. Waiting periods for waiver enrollments are expected to decrease over time. Special circumstances may qualify an applicant for priority enrollment; please contact the Waiver Agency in your area for more information.

​HCBA Waiver Agencies

Most Service Areas are identified by County, and include all of the zip codes within the County. However, individuals residing in Los Angeles and Orange Counties should refer to the links below to identify the Waiver Agency that covers your zip code.

Santa Barbara County, and sections of Los Angeles and Orange Counties

Kern, Fresno, Kings, Tulare, Madera, Mariposa, Merced, Stanislaus, Tuolumne, San Luis Obispo, Amador, Calaveras, Santa Clara, Santa Cruz, San Benito, Monterey, and sections of Los Angeles and Orange Counties

Authorized Waiver

Participant Enrollment Information

How to Submit Applications for the HCBA Waiver:

1. Refer to the table above to see which Waiver Agency serves your county/zip code. Click on the Waiver Agency name to be directed to their webpage

2. Contact the Waiver Agency to request an application

3. Complete the application and submit it to the Waiver Agency

If you live in one of the seven counties listed below, you will submit your application to the state. Use the HCBA Waiver Participant Application and follow the instructions on the application to mail it to DHCS.

​Alpine, Imperial, Inyo, Marin, Mendocino, Mono, Napa

Participant Information

Additional Resources

Waiver Personal Care Services Resources

Waiver participants and providers, please email your comments and questions regarding the HCBA Waiver to: HCBAlternatives@dhcs.ca.gov or call toll-free (833) ​388-4551.

​​​​​WPCS participants and providers can call the WPCS Hotline (916) 552-9214.​

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Home and Community Based (HCB) Alternatives Waiver

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On March 23, 2022, the Centers for Medicare & Medicaid Services (CMS) approved DHCS' request to extend the current term of the HCBA waiver for an additional 90-day period. The initial waiver extension was scheduled to expire on March 31, 2022. This temporary extension allows the HCBA Waiver to continue operating through June 29, 2022.

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The Home and Community Based Alternatives (HCB Alternatives) Waiver | Disability Rights California

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California has programs called “home and community-based services waivers.” They help people get Medi-Cal services at home. This pub tells you about one of the programs. It is the Home and Community-Based Alternatives (HCBA) Waiver. The pub tells you how to get one. It tells you who can help you get one.