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. Gather your Medi-Cal card or your Medi-Cal application confirmation showing full-scope coverage.
2. Collect recent hospital or physician records that show you need hospital-level or nursing-facility-level care. These records are required to document your medical need.
3. Gather a list of your current providers, medications, and any medical equipment you use. Having this ready will speed up the process.
4. Contact the California Department of Health Care Services to start your application. You can apply online or call 916-552-9105.
5. After your referral is accepted, an enrolled HCBA waiver agency registered nurse will schedule a care needs assessment with you. This visit is required to determine your level of care and build your individualized care plan.

What to expect: After you submit your application and complete the registered nurse assessment, the agency will review your level-of-care need and your Medi-Cal eligibility. If approved, a registered nurse from an enrolled HCBA waiver agency will work with you to build and manage a care plan tailored to your medical needs — which may include in-home skilled nursing, personal care, medical equipment, and home accessibility adaptations. Processing times vary, so ask the agency for an estimate when you apply. Enrollment must be renewed every year. At renewal, both your level-of-care need and your Medi-Cal eligibility will be re-assessed, so keep your medical records and Medi-Cal information up to date.

Renewals

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