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 Home and Community–Based Services (HCBS) Waiver for Californians with Developmental Disabilities effective January 1, 2023. Approval of the HCBS Waiver renewal secures the availability of approximately $3 billion in federal funding for regional center services.

Public Notice

No public notices at this time.

Pending Waiver Amendments

1915(c) Waiver Amendment (CA.0336.R05.05) would add telehealth as a delivery method for specified services, add group homes for children with special health care needs as a new provider of community living arrangement services, and add participant-directed as a service delivery method for self-directed support services. See 1915(c) draft amendment here for more specific details.

1915(c) Waiver Amendment (CA.0336.R05.06) would implement the next round of rate reform adjustments effective July 1, 2024, as currently required in Welfare and Institutions Code section 4519.10. The 2024-25 Governor’s Budget proposes to return full implementation of rate reform, including this next round of adjustments, to the original date of July 1, 2025 from the accelerated date of July 1, 2024. DDS is continuing to prepare administratively for the full implementation of rate reform, subject to the final 2024-25 budget agreement. See 1915(c) draft amendment here for more specific details.

Current Waiver

Current Emergency Amendments

Approved Appendix K (Effective from February 3, 2024 to March 3, 2024, in response to the State of Emergency declared on February 4, 2024, this Appendix K provides for retainer payments for providers impacted as a result of the extreme peril posed by a powerful, slow moving, atmospheric river that struck California on February 3, 2024 in the following counties: Los Angeles, Orange, Riverside, San Bernardino, San Diego, San Luis Obispo, Santa Barbara, and Ventura.) Source: Centers for Medicare & Medicaid Services (CMS)

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.

Public Notice

No public notices at this time.

Pending State Plan Amendments

1915(i) State Plan Amendment (SPA 24-0005) would add group homes for children with special health care needs as a new provider of community living arrangement services and add participant-directed as a service delivery method for self-directed support services. See 1915(i) draft amendment here for more specific details.

1915(i) State Plan Amendment (SPA 24-0006) would implement the next round of rate reform adjustments effective July 1, 2024, as currently required in Welfare and Institutions Code section 4519.10. The 2024-25 Governor’s Budget proposes to return full implementation of rate reform, including this next round of adjustments, to the original date of July 1, 2025 from the accelerated date of July 1, 2024. DDS is continuing to prepare administratively for the full implementation of rate reform, subject to the final 2024-25 budget agreement. This SPA also proposes to add group homes for children with special health care needs as a new service provider and add participant directed as a service delivery method for Self-directed Support Services. See 1915(i) draft amendment here for more specific details.

Approved State Plan Amendments

  • State Plan Amendment (SPA 24-0001) (Effective February 1, 2024. This SPA proposes to: modify the definition of target population to include children under 5 years old without a diagnosis of developmental disability, add participant-directed goods and services as a new service, add budget authority for participant direction of services, and add additional incentive payments for assisting individuals to obtain competitive integrated employment.) PDF 
  • State Plan Amendment (SPA 23-0036) (Effective January 1, 2024. This SPA will increase rates for independent living programs, adult residential homes and participant-directed day service and supported employment.) PDF 
  • State Plan Amendment (SPA 23-0024) (Effective November 1, 2023. This SPA adds Coordinated Family Supports as a new service) PDF 
  • State Plan Amendment (SPA 22-0048) (Effective April 14, 2023. This SPA makes various flexibilities under the public health emergency permanent, as well as adding additional services, and a new provider type.) PDF 
  • State Plan Amendment (SPA 22-0058) (Effective January 1, 2023. The purpose of this amendment is to provide rate increases per the California Budget Act of 2022 (SB154)). PDF 
  • 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)
  • State Plan Amendment Renewal (SPA 21-0002) (Effective October 1, 2021) PDF Source: Centers for Medicare and Medicaid Services (CMS)

Approved State Plan Emergency Amendments

No Amendments at this time.

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

Public Notice

No Amendments at this time.

Prior Waiver

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.

2024

1915(c) Waiver Amendment (CA.0336.R05.04) would add telehealth as a delivery method for specified services, add group homes for children with special health care needs as a new provider of community living arrangement services, and add participant-directed as a service delivery method for self-directed support services. See 1915(c) draft amendment here for more specific details.

1915(c) Waiver Amendment (CA.0336.R05.05) would implement the next round of rate reform adjustments effective July 1, 2024, as currently required in Welfare and Institutions Code section 4519.10. The 2024-25 Governor’s Budget proposes to return full implementation of rate reform, including this next round of adjustments, to the original date of July 1, 2025 from the accelerated date of July 1, 2024. DDS is continuing to prepare administratively for the full implementation of rate reform, subject to the final 2024-25 budget agreement. See 1915(c) draft amendment here for more specific details.

1915(i) State Plan Amendment (SPA 24-0005) would add group homes for children with special health care needs as a new provider of community living arrangement services and add participant-directed as a service delivery method for self-directed support services. See 1915(i) draft amendment here for more specific details.

1915(i) State Plan Amendment (SPA 24-0006) would implement the next round of rate reform adjustments effective July 1, 2024, as currently required in Welfare and Institutions Code section 4519.10. The 2024-25 Governor’s Budget proposes to return full implementation of rate reform, including this next round of adjustments, to the original date of July 1, 2025 from the accelerated date of July 1, 2024. DDS is continuing to prepare administratively for the full implementation of rate reform, subject to the final 2024-25 budget agreement. See 1915(i) draft amendment here for more specific details.

2023

State Plan Amendment (SPA 24-0001) October 1, 2023

This SPA proposes to: modify the definition of target population to include children under 5 years old without a diagnosis of developmental disability, add participant-directed goods and services as a new service, add budget authority for participant direction of services, and add additional incentive payments for assisting individuals to obtain competitive integrated employment.

This notice provides information to the public regarding public input for an amendment to the 1915(c) HCBS Waiver to make changes to Financial Management Services (FMS) provided to individuals enrolled in the Self Determination Program (SDP) Waiver. See 1915(c) Waver HCBS amendment here

State Plan Amendment (SPA 23-0036).  September 1, 2023

This SPA proposes to add the following: modifying the definition of target population to include children under 5 years old without a diagnosis of developmental disability, increase rates for independent living programs, adult residential homes and participant directed Day Service and Supported Employment, add participant-directed goods and services as a new service, add budget authority for participant direction of services, and add additional incentive payments for assisting individuals to obtain competitive integrated employment.

This notice provides information to the public regarding public input for an amendment to the 1915(c) HCBS Waiver which proposes to add the following; modifying the definition of target population to include children under 5, increase rates for independent living programs, adult residential homes and participant directed Day Service and Supported Employment, add participant-directed goods and services as a new service, add budget authority for participant direction of services, add additional incentive payments for assisting individuals to obtain competitive integrated employment, and add supplemental payments for: completion of surveys for eligible providers of community living arrangement services and direct service providers as workforce capacity initiatives, certifications gained in trained employment services, and for direct service professionals who use a language or medium of communication other than English more than 50% of their time. See 1915c Amendment here for specific details.

1915(c) Waiver Amendment (CA.0336.R05.02). This notice provides information to the public regarding public input for an amendment to the 1915(c) HCBS Waiver to add Coordinated Family Supports, a service that supports adults to continue living in the family home.

State plan amendment (SPA 23-0024) This June 30, 2023, notice provides information regarding the opportunity for public input on an amendment to add Coordinated Family Supports, a service that supports adults to continue living in the family home, to the 1915(i) State Plan.

2022

This notice provides information to the public regarding input for an amendment to the 1915(i) State Plan to make flexibilities that have been submitted and/or approved through disaster relief submissions, permanent in the state plan.)

This notice provides information to the public regarding input for the renewal of the 1915(c) HCBS Waiver, effective January 1, 2023. The full draft of the renewal is available here.

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 January 1, 2023 per the California Budget Act of 2022 (SB 154).

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.

Previous Emergency Amendments

  • Approved Appendix K (Effective from August, 19th, 2023 to September, 18th, 2023, in response to the State of Emergency declared on August 19, 2023, this Appendix K provides for retainer payments for providers impacted by Hurricane Hilary, as a result of absences caused by evacuation or loss of property in the following counties: Fresno, Imperial, Inyo, Kern, Los Angeles, Mono, Orange, Riverside, San Bernardino, San Diego, Tulare, and Ventura counties.) Source: Centers for Medicare & Medicaid Services (CMS)PDF 
  • Approved Appendix K (Effective February 4, 2020, this amendment adds one-time supplemental payments for specified provider agencies.  Also, effective January 1, 2023, the state is implementing rate increases for specified services as described in Stage two of the 2019 Rate Study.) PDF Source: Centers for Medicare & Medicaid Services (CMS)
  • Approved Appendix K (Effective January 4, 2023, in response to the winter storm State of Emergency declared on January 4, 2023, this appendix K provides for retainer payments for providers impacted by the Severe winter storm as a result of absences caused by evacuation or loss of property.) PDF Source: Centers for Medicare & Medicaid Services (CMS)
  • Approved Appendix K (Effective December 20, 2022, in response to the State of Emergency declared in Humboldt County on December 20, 2022, this appendix K provides for retainer payments for providers in Humboldt county impacted by the magnitude 6.4 earthquake as a result of absences caused by evacuation or loss of property) PDF Source: Centers for Medicare & Medicaid Services (CMS)
  • Approved Appendix K (Effective July 1, 2021. This amendment adds incentive payments for Supported Employment placements in internship settings and increases incentive payment amounts for Supported Employment and Prevocational services.) PDF Source: Centers for Medicare & Medicaid Services (CMS)
  • Approved Appendix K (Effective July 1, 2021. This amendment adds Self-Directed Support services to assist and support waiver participants who self-direct their waiver services, effective July 1, 2021.) PDF Source: Centers for Medicare & Medicaid Services (CMS)
  • Approved Appendix K (Effective September 1, 2020, this application temporarily implements modification of the service scope and changes billing processes for selected services to address the changing needs of waiver participants during the PHE, maintain a stable workforce and provider pool, and preserve significantly impacted HCBS provider networks for non-residential services) PDF Source: Centers for Medicare & 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 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

Previous State Plan Emergency Amendments

  • Disaster Relief State Plan Amendment (SPA 22-0050) (Effective March 1, 2020. This amendment expands participant direction for habilitation services.) PDF  
  • Disaster Relief State Plan Amendment (SPA 22-0038) (Effective July 1, 2021. This amendment proposes to add Self-Directed Supports and Technology Services, as well as increases to incentive payments for Prevocational Supports and Supported Employment Services.) PDF 
  • Disaster Relief State Plan Amendment (SPA 22-0037) (Effective March 1, 2020. This amendment proposes a temporary modification of the service scope for selected services in response to the public health emergency.) PDF 
  • 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


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Last modified: April 19, 2024