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.

Public Notice

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.

Current Waiver

  • Approved Waiver Amendment PDF Effective April 1, 2020, this amendment adds State-operated Community Crisis Homes, Enhanced Behavioral Supports Homes, and Mobile Crisis Teams as new waiver services.
  • Approved Appendix K PDF This waiver appendix provides federal requirement flexibilities due to the COVID-19 state of emergency.

Prior Waiver

  • Approved Waiver Amendment PDF Effective January 1, 2020, this amendment provides time-limited rate increases for specified services effective January 1, 2020 through December 31, 2021.
  • Approved Waiver Amendment PDF (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”)
  • Approved Technical Adjustment PDF (Effective July 1, 2018)
  • Approved Waiver Application PDF (Effective January 1, 2018)
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 Notices

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

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.

Pending Federal Approval

  • State Plan Amendment (SPA 20-0008) PDF (Effective January 1, 2020. Provides time-limited rate increases for specified developmental services providers from January 1, 2020 to December 21, 2021.)

Approved State Plan Amendments

  • State Plan Amendment (SPA 19-0004) PDF (Effective May 1, 2019. The 1915(i) State Plan was revised to implement a one-year rate increase for community-based day programs, community care facilities under the alternative residential model and in-home respite agency providers in high-cost counties.)
  • State Plan Amendment (SPA 18-0054) PDF (Effective July 1, 2018. The 1915(i) State Plan was revised to add services and align with the 1915(c) Home and Community Based Services waiver renewal that became effective January 1, 2018.)
  • State Plan Amendment (SPA 18-0023) PDF (Effective July 1, 2018. The 1915(i) State Plan was revised to add services and align with the 1915(c) Home and Community Based Services waiver renewal that became effective January 1, 2018.)
  • State Plan Amendment (SPA 16-047) PDF (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) PDF (Effective October 1, 2016)
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.

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.

2019

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 20, 2020