How to apply for Home and Community-Based Alternatives (HCBA) Waiver

Who it's for

The HCBA Waiver is California's Medi-Cal waiver for people with the highest level of medical need — those who would otherwise require ongoing care in a hospital or a nursing facility but can be safely served at home with intensive support. A waiver-agency registered nurse builds and manages an individualized care plan that can include in-home skilled nursing (including shift nursing for medically fragile people), care management, personal care, habilitation, family/caregiver training, medical equipment operating expenses, communication devices, environmental accessibility adaptations (wheelchair ramps, widened doorways, roll-in showers), and private-duty nursing. It is the most intensive of California's home-care alternatives and is intended to prevent or reverse institutional placement for medically complex individuals.

What you'll need

• Medi-Cal card or Medi-Cal application confirmation showing full-scope coverage
• Recent hospital or physician records documenting hospital- or nursing-facility-level of care need
• Care needs assessment by an enrolled HCBA waiver agency registered nurse (scheduled after referral)
• Documentation of current providers, medications, and equipment

Where to apply

What to say when you call

"Hello, I'm calling to ask about Home and Community-Based Alternatives (HCBA) Waiver. I'd like to know whether I may qualify, what documents I need, and whether I can apply online, by mail, by phone, or in person. I understand I may need medi-Cal card or Medi-Cal application confirmation showing full-scope coverage, recent hospital or physician records documenting hospital- or nursing-facility-level of care need, care needs assessment by an enrolled HCBA waiver agency registered nurse (scheduled after referral) — is anything else required? What is the best next step?"

Tip: have a pen ready, ask for the person's name, and write down any case or reference number they give you.

Step by step

1. Confirm that you have full-scope Medi-Cal coverage. Locate your Medi-Cal card or your Medi-Cal application confirmation showing full-scope coverage before you start.
2. Gather recent hospital or physician records that show you need hospital-level or nursing-facility-level care. These records are required to document your level of medical need.
3. Collect a list of your current providers, medications, and any medical equipment you use. Having this ready will speed up the process.
4. Apply online through the California Department of Health Care Services or call 1-833-388-4551 to start your application by phone.
5. After your referral is submitted, an enrolled HCBA waiver agency registered nurse will contact you to schedule a care needs assessment in your home. This assessment is required and cannot be done before the referral is made.
6. Work with the registered nurse during the assessment to review your medical records, providers, medications, and equipment. The nurse will use this information to build your individualized care plan.

What to expect: After submitting your application, a registered nurse from an enrolled HCBA waiver agency will reach out to schedule your in-home care needs assessment. Processing times vary, so ask the agency for an estimate when you apply. If approved, the nurse will manage your care plan, which can include skilled nursing, personal care, medical equipment support, home modifications, and more. Enrollment must be renewed every year — both your level-of-care need and your Medi-Cal eligibility will be re-assessed at that time. Watch for renewal notices so your services are not interrupted.

Renewals

annual (re-assessment of level-of-care and Medi-Cal eligibility)