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P. O. Box 944202
Sacramento, CA 94244-2020

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Home and Community—Based Services Programs

1915(c) Waiver

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.


This notice provides information of public interest for an amendment to the 1915(c) Home and Community-Based Services (HCBS) Waiver for Persons with Developmental Disabilities.

Proposed Waiver Amendment .pdf document

This amendment adds a provider type and two new rate methodologies under Behavioral Intervention Services and a new rate methodology under Community Living Arrangements Services.

Current Waiver

  • Approved Waiver Amendment .pdf document
    (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")

Prior Waiver


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 19-0004) .pdf document
    (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 document
    (Effective October 2, 2018. The 1915(i) State Plan was revised to add Community Crisis Homes as a Behavioral Intervention Services provider.)
  • State Plan Amendment (SPA 18-0023) .pdf document
    (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 Renewal (SPA 16-016) .pdf document
    (Effective October 1, 2016)

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. 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.

Self-Determination Program

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.

Last Updated: 10/25/2019