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, 2018. Approval of the HCBS Waiver renewal secures the availability of approximately $2 billion in federal funding for regional center services.

Pending Federal Approval

Current Waiver Amendments

  • 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)

Current Emergency Amendments

  • 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

Prior Waiver

  • 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 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.

Approved State Plan Amendments

  • 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

  • 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

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

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.

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.


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Last modified: April 27, 2023