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Home and Community—Based Services Programs
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 federal Centers for Medicare & Medicaid Services (CMS) approved California's five year renewal of the HCBS Waiver for Californians with Developmental Disabilities effective March 29, 2012. Consistent with the Department's goal to maximize federal funding, approval of the HCBS Waiver secures the availability of approximately $1 billion in federal funding for regional center services. This HCBS Waiver includes new services previously not eligible for federal funding such as vouchered community-based training services, participant-directed nursing, financial management services and behavior management technician services.
- Approved Waiver Application
(Effective March 29, 2012)
- Approved Waiver Amendment
(Effective July 1, 2016. Service provider rate changes)
Public Notice – 1915(c) Home and Community-Based Services (HCBS) Waiver Renewal
It is the Department of Developmental Services' (Department's) intent to seek renewal for the 1915(c) HCBS Waiver from the federal Centers for Medicare and Medicaid Services (CMS). This notice is to inform interested parties of the plan to submit the renewal by December 29, 2016 and allow the opportunity for feedback prior to submission. A copy of the waiver can be found here.
Public comments will be considered through December 11, 2016. Comments or requests to review a hardcopy of the application can be submitted via email at firstname.lastname@example.org or in writing to:Department of Developmental Services
Community Services Division
1600 Ninth Street, Room 320 (M.S. 3-8)
Sacramento, CA 95814
ATTN: Ashley Draper
1915(i) State Plan Program
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.
- State Plan Amendment (SPA 16-047)
(Effective October 1, 2016 - September 30, 2021. Added a median rate methodology for licensed/certified residential services; participant direction as an option for existing respite, skilled nursing, and nonmedical transportation services; and new community-based training and financial management services.)
- State Plan Amendment Renewal (SPA 16-016)
(Effective October 1, 2016)
- State Plan Amendment (SPA 09-023B)
(Effective Oct 1, 2009 – Sept 30 2016. Added a median rate methodology for Community Care Facilities)
CMS Home and Community-Based Services Regulations (Rules)
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.
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.