California expanded its Home and Community-Based Alternatives (HCBA) waiver by an additional 1,800 slots each year for the next four years, but advocates say the increase will not be enough to keep up with growing demand for home care services.
“We commend California’s increase in capacity for the Home & Community Based Alternatives Waiver. However, 7,200 slots distributed in 1800-slot increments over four years is not sufficient to address the need,” Rep. Nanette Barragán (D-CA) and Andrew Imparato, executive director of Disability Rights California, said in a December statement. “The waiting list continues to grow and the additional allocation of waiver slots will not clear the current waiting list of almost 4,000 people until 2026.”
Barragán and Disability Rights California had shown support for the waiver increase in a November letter to California’s governor, Gavin Newson (D). At the time, the waiver was completely full, leaving more than 3,000 people in need of home care services on the waiting list.
“If the state does not request a meaningful increase in slots, we are concerned that thousands of Californians will languish on an ever-growing waitlist and suffer unnecessary institutionalization,” they wrote in the October letter. More than 20 other congressional representatives also signed the letter.
California’s HCBA waiver provides care management services such as medical, behavioral health and in-home supportive services to people at risk of entering institutional or nursing home care. HCBA providers also work with long-term supportive services in patients’ local communities to coordinate care. The program began in February 2023, but due to its high utilization — particularly among older adults with Alzheimer’s or dementia who wish to age in place — lawmakers and other advocates have called for greater support.
“We continue to recommend more investment in this essential program to increase the number of HCBA waiver slots sufficient to clear the waiting list immediately, with the ability to raise the cap as needed to meet the demand for this program,” Barragán and Disability Rights California wrote in the December statement.
