This publication provides information about California programs that help people with disabilities, including children and seniors, who receive Medi-Cal stay in their home or return home from long-term care facilities like hospitals, nursing homes, and other medical facilities. If you need help getting services to remain at home or move out of a facility, you can contact Disability Rights California toll free at (800) 776-5746 or TTY: (800) 719-5798. You can also visit our website at www.disabilityrightsca.org.

A.  In-Home Supportive Services (IHSS)

The In-Home Supportive Services (IHSS) program provides services for people with disabilities, including children, that allows them to remain safe at home instead of living in a long-term care facility like a nursing home, board and care, or other kind of facility. IHSS is statewide and the largest home care program in California. IHSS services are provided in a person’s home by an IHSS caregiver. An IHSS caregiver can be a family member or someone else chosen by the person receiving IHSS services.

IHSS Services include but are not limited to:

• Domestic and related services: house cleaning, preparing meals, laundry, grocery shopping, and taking out the garbage.
• Personal Care Services: bathing, feeding, dressing, grooming, and toileting.
• Paramedical Services: help with injections or administering other medications, bowel and bladder care, G-Tube feeding, colostomy care, tracheal suctioning, skin, and wound care.
• Protective Supervision: monitoring and verbal redirection of a person’s behaviors to prevent injury or harm, and,
• Accompaniment to medical appointments.

California residents are eligible for IHSS if they:

• Are blind, disabled, or over 65 years of age, or
• Eligible for SSI or Medi-Cal, and
• Live in their own home, and
• Need IHSS service to remain safe at home.

Individuals can contact their local County IHSS office to apply for IHSS services: https://www.cdss.ca.gov/inforesources/county-ihss-offices.  For more information about IHSS, you can visit DRC’s IHSS Self Advocacy Resource page at: https://www.disabilityrightsca.org/resources/in-home-supportive-services-ihss or the California Department of Social Services (CDSS) website at: https://www.cdss.ca.gov/in-home-supportive-services.

B.  Program for All Inclusive Care for the Elderly (PACE)

The PACE program provides medical and social services to people 55 years of age and older who qualify for nursing home care but can live at home with help.  A primary care doctor works with a care team to coordinate PACE and other community services needed for an individual to remain at home.  PACE is a health plan that takes the place of Medi-Cal, Medicare, or both depending on eligibility status.  PACE is only provided in certain California zip codes. It is not possible to receive both IHSS and PACE services at the same time.  However, PACE does provide home care services similar to IHSS.

In order to be eligible a person must:

• Be 55 years of age or older
• Eligible for nursing home care
• Can live safely in the community with support
• Live in a zip code that is served by a local PACE plan. A list of California PACE plans and the zip codes are available at http://www.dhcs.ca.gov/individuals/Pages/PACEPlans.aspx.

PACE is paid for by Medi-Cal and Medicare.  People with Medi-Cal are automatically eligible for PACE.  People who only have Medicare can pay for the portion of the monthly premium that Medi-Cal would normally pay in order for a person to get PACE services.  For married couples, where one spouse needs PACE services and the other does not, Medi-Cal spousal impoverishment rules can be used to help the one spouse establish Medi-Cal eligibility so the spouse needing PACE services can get PACE services.  Medi-Cal spousal impoverishment rules help the non-PACE/non-Medi-Cal eligible spouse keep income and assets, while allowing the other spouse to qualify for Medi-Cal.

Examples of PACE services include:

• Preventative, Primary and Specialty Medical Care
• Emergency Medical Services
• Prescription Drugs
• Dental and Vision Care
• Physical and Recreational Therapy
• Adult Day Care
• Social Work Services
• Personal Care at Home
• Medical Equipment and Supplies
• Nutritional Counseling
• Meals
• Caregiver Support
• Transportation to PACE activities and medical appointments.

For more information about the PACE Program you can review DRC’s PACE publication at: https://www.disabilityrightsca.org/publications/programs-of-all-inclusive-care-for-the-elderly-pace-services-for-regional-center or visit the California Department of Health Care Services (DHCS), PACE website at: https://www.dhcs.ca.gov/services/ltc/Pages/programofall-inclusivecarefortheelderly.aspx or California’s CalPACE website at: https://calpace.org/.

C.  Home and Community Based Services (HCBS) Waivers

California operates six Home and Community-Based Services (HCBS) Waiver programs. HCBS waiver programs are Medi-Cal programs that waive certain Medi-Cal rules, so that people can get services they need to live at home or in the community instead of living in a hospital or long-term care facility. Each waiver discussed below will contain a link where more information about the waiver can be found online. An individual can only be enrolled in one waiver at a time.

California’s six waiver programs are:

• Medi-Cal Waiver Program (MCWP), previously known as the Acquired Immune Deficiency Syndrome (AIDS) Waiver
• Assisted Living Waiver (ALW)
• Home and Community-Based Alternatives (HCBA) Waiver
• Multipurpose Senior Services Program (MSSP)
• HCBS Waiver for the Developmentally Disabled (HCBS-DD) Waiver
• Self-Determination Program (SDP)

These Waivers are described more below.

You can obtain more information about Medicaid California State waivers online at: https://www.dhcs.ca.gov/services/Pages/Medi-CalWaivers.aspx; and https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/index.html?f%5B0%5D=waiver_state_facet%3A726#content#content#content#content. 

I.  Medi-Cal Waiver Program (MCWP), formerly known as the AIDS Waiver

The MCWP waiver program serves Medi-Cal eligible adults and children living with Human Immunodeficiency Virus (HIV) or AIDS who qualify for placement in a nursing facility or hospital but can remain at home with waiver services. Individuals enrolled in the AIDS waiver may not be enrolled in another HCBS waiver program or the Medi-Cal Hospice Program. However, individuals can be simultaneously enrolled in the Medicare Hospice program.

MCWP Waiver services include:

• Case Management
• Homemaker Services (General Household Activities)
• Skilled Nursing (RN/LVN)
• Attendant Care
• Psychotherapy
• Home Delivered Meals
• Nutritional Counseling
• Specialized Medical Equipment and Supplies
• Minor Physical Adaptations to the Home
• Non-Medical Transportation

Individuals can contact the MCWP waiver agency in their area to apply: https://files.medi-cal.ca.gov/pubsdoco/publications/masters-mtp/part2/aid.pdf.

You can visit the DHCS’s website for more information about the MCWP waiver online at: https://www.dhcs.ca.gov/services/ltc/Pages/AIDS.aspx. For more general information you can review DRC’s MCWP fact sheet at: https://www.disabilityrightsca.org/publications/how-the-aids-medi-cal-waiver-can-help-you-get-the-care-you-need-at-home-instead-of-in.  For more information about the MCWP waiver you can also visit the California Department of Public Health (CDPH) website at: https://www.cdph.ca.gov/Programs/CID/DOA/Pages/OA_care_mcwp.aspx.

II.  Assisted Living Waiver (ALW)

The Assisted Living Waiver is a Medi-Cal program that pays for assisted living, care coordination, and other benefits provided to eligible seniors and persons with disabilities who qualify for placement in a nursing facility but are willing to live in an assisted living setting. Services are provided to individuals living in a Residential Care Facility for the Elderly (RCFE) or by a licensed Home Health Agency in public subsidized housing. Individuals living in an ALW facility setting are required to pay for their own room and board.

ALW facilities are available in the following counties:

• Alameda
• Contra Costa
• Fresno
• Kern
• Los Angeles
• Orange
• Riverside
• Sacramento
• San Bernardino
• San Diego
• San Francisco
• San Joaquin
• San Mateo
• Santa Clara
• Sonoma

To be eligible for ALW, an individual must:

• Be 21 years old or older,
• Be Medi-Cal eligible with no share of cost,
• Need nursing level of care, and
• Be willing to live in an assisted living facility or public subsidized housing in one of the counties providing ALW services.

ALW services include:

• Care Coordination
• Nursing Facility Transition Care Coordination
• Development/Updating of an Individualized Care Plan
• Personal Care and help with activities of daily living
• Laundry
• Housekeeping
• Facility Maintenance
• Intermittent Skilled Nursing Care
• Meals and Snacks
• Help with Self-Administration of Medications
• Providing/Coordinating Transportation
• Recreational Activities
• Social Services

To apply for the ALW Program, individuals can contact the Care Coordination Agency in their area at: https://www.dhcs.ca.gov/services/ltc/Documents/Care-Coordination-Agencies.pdf.  If the ALW is full, individuals can ask to be added to the waitlist. For more information about the ALW waiver you can visit: http://www.dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx.

III.  Home and Community-Based Alternatives (HCBA) Waiver

The HCBA Waiver provides Home and Community-Based Services (HCBS) so that eligible people with disabilities can live at home with the services they need. HCBA waiver services are provided in a person’s home in the community instead of in a hospital or another kind of nursing facility. The HCBA waiver program is statewide. Under the direction of the California Department of Health Care Services (DHCS), the HCBA waiver program is administered by HCBA Waiver Agencies based on county or zip code. In counties where there are no waiver agencies, DHCS manages waiver services for waiver recipients. A care management team which includes a nurse and a social worker create a “Plan of Care” listing services a person will receive to live in the community. A waiver participant’s doctor must also agree with the services being provided and sign the “Plan of Care.”

To be eligible for the HCBA waiver, individuals must:

• Receive Medi-Cal or would be eligible for Medi-Cal if a spouse's or parent’s income and resources are not counted, and
• Need hospital or nursing facility level of care (such as subacute facility, Intermediate Care Facilities for Individuals with Intellectual Disabilities/Continuous Nursing (ICF/DD-CN), or acute care facility).

HCBA waiver services Include:

• Case Management
• Homemaker Services
• Home Health Aide Services
• Respite Care
• Habilitation Services
• Behavioral Intervention Services, Including Crisis Support
• Community Living Arrangement Services
• Day Services
• Pre-Vocational Services
• Supported Employment Services
• Dental Services
• Occupational Therapy
• Physical Therapy
• Optometry/Optician Services
• Prescription lenses and frames
• Psychology Services
• Speech, Hearing, and Language Services
• Financial Management Services (FMS)
• Chore Services
• Communication Aides
• Community-Based Training Services
• Environmental Accessibility Adaptations
• Family Support Services
• Family/Consumer Training
• Housing Access Services
• Individual Housing Transition Services
• Individual Housing & Tenancy Sustaining Services
• Non-Medical Transportation
• Nutritional Consultation
• Personal Emergency Response Systems (PERS)
• Skilled Nursing
• Specialized Medical Equipment and Supplies
• Transition/Set-Up Expenses
• Vehicle Modifications and Adaptations
• State-operated Community Crisis Homes, Enhanced Behavioral Supports Homes, and Mobile Crisis Teams
• Intensive Transition Services (ITS

To apply for the HCBA waiver, individuals can contact the HCBA waiver agency by zip code at: https://www.dhcs.ca.gov/services/ltc/Pages/Home-and-Community-Based-(HCB)-Alternatives-Waiver.aspx.

Waiver Agency	Service Area
Access TLC	Santa Barbara County, and sections of Los Angeles and Orange Counties (click here for service area defined by zip codes)
Center for Elders' Independence	Alameda and Contra Costa Counties
Home Health Care Management	Butte, Glenn, Sacramento, San Joaquín, Shasta, Solano, Sutter, Tehama, Yolo, Yuba, Colusa, Del Norte, El Dorado, Humboldt, Lake, Lassen, Modoc, Nevada, Placer, Plumas, Sierra, Siskiyou, and Trinity Counties
Institute on Aging	San Francisco, San Mateo, San Bernardino, and Riverside Counties
Libertana Home Health	Kern, Fresno, Kings, Tulare, Madera, Mariposa, Merced, Stanislaus, Tuolumne, San Luis Obispo, Amador, Calaveras, Santa Clara, Santa Cruz, San Benito, Monterey, and sections of Los Angeles and Orange Counties (click here for service areas defined by zip code)
Partners in Care	Sections of Los Angeles County (click here for service area defined by zip codes list)
San Ysidro Health	San Diego County
Sonoma County Human Services Department	Sonoma County
Ventura County Agency on Aging	Ventura County

People who live in a county that does not have an assigned Waiver Agency can contact DHCS directly to apply by completing the form found online at: https://www.dhcs.ca.gov/services/ltc/Documents/2019HCBAApp.pdf.  For HCBA waiver applications for those who speak Spanish, please call (916) 552-9105. Completed applications should be sent to: Integrated Systems of Care Division, HCBS Programs Eligibility/Intake Unit, 311 South Spring Street, Ste 800, Los Angeles, CA 90013.

If the HCBA waiver is full, individuals can ask to be added to the waitlist. Enrollment and waitlist information is also available online at: https://www.dhcs.ca.gov/services/ltc/Pages/HCBA-Waiver-Current-Enrollment-Dashboard.aspx. For more information about the HCBA Waiver you can visit: https://www.disabilityrightsca.org/publications/the-home-and-community-based-alternatives-hcb-alternatives-waiver

IV.  Multipurpose Senior Services Program (MSSP)

The Multipurpose Senior Services Program (MSSP) provides both social and health care management services to assist individuals with remaining in their own homes and communities.

While most of the program participants also receive In-Home Supportive Services, MSSP provides on-going care coordination, links participants to other needed community services and resources, coordinates with health care providers, and purchases needed services and items with the goal to prevent or delay institutionalization. The total annual combined cost of care management and other services must be lower than the cost of receiving care in a skilled nursing facility.

A team of health and social service professionals provides each MSSP participant with a complete health and psychosocial assessment to determine needed services. The team then works with the MSSP participant, their physician, family, and others to develop an individualized care plan. Services include:

• Care management
• Adult day care
• Minor home repair/maintenance
• Supplemental in-home chore, personal care, and protective supervision services
• Respite services
• Transportation services
• Counseling and therapeutic services
• Meal services
• Communication services

MSSP is available for:

• Medi-Cal individuals who, but for the provision of such services, would require the Nursing Facility (NF) level of care, and
• Aged 65 years and older, and
• Individuals who reside in a county where MSSP is available.

More information is available here: https://aging.ca.gov/Programs_and_Services/Multipurpose_Senior_Services_Program/

V.  Home and Community-Based Services Waiver for the Developmentally Disabled (HCBS-DD)

The HCBS-DD Waiver pays for Home and Community-Based Services for people with developmental disabilities who receive California Regional Center services. There is no waitlist for the HCBS-DD waiver program. Some HCBS-DD Waiver services are only available to recipients 21 years of age and older. This is because Medi-Cal Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) may require Medi-Cal to cover these services for people under 21 years of age.  HCBS-DD waiver services should be identified and written into a regional center consumer’s Individual Program Plan (IPP).

To be eligible for the HCBS-DD waiver, individuals must:

• Meet California’s definition of developmental disability and be a regional center consumer, and
• Get Medi-Cal or would be eligible for Medi-Cal if a spouse's or parent’s income and resources are not counted, and
• Need care that would qualify the consumer for services in a Medi-Cal funded Intermediate Care Facility (ICF).

The HCBS-DD waiver services include:

• Case Management
• Homemaker Services
• Home Health Aide Services
• Respite Care
• Habilitation Services
• Behavioral Intervention Services, Including Crisis Support
• Community Living Arrangement Services
• Day Services
• Pre-Vocational Services
• Supported Employment Services
• Dental Services
• Occupational Therapy
• Physical Therapy
• Optometry/Optician Services
• Prescription lenses and frames
• Psychology Services
• Speech, Hearing, and Language Services
• Financial Management Services (FMS)
• Chore Services
• Communication Aides
• Community-Based Training Services
• Environmental Accessibility Adaptations
• Family Support Services
• Family/Consumer Training
• Housing Access Services
• Individual Housing Transition Services
• Individual Housing & Tenancy Sustaining Services
• Non-Medical Transportation
• Nutritional Consultation
• Personal Emergency Response Systems (PERS)
• Skilled Nursing
• Specialized Medical Equipment and Supplies
• Transition/Set-Up Expenses
• Vehicle Modifications and Adaptations
• State-operated Community Crisis Homes, Enhanced Behavioral Supports Homes, and Mobile Crisis Teams
• Intensive Transition Services (ITS)

Regional Center consumers normally do not need to apply for HCBS-DD waiver services because the regional center will identify people eligible for HCBS-DD waiver services.  Eligible waiver recipients must sign an informed choice form to receive HCBS-DD waiver services. However, individuals can also apply for HCBS-DD waiver services by sending a letter to the regional center.

For more information about HCBS-DD and Regional Center services you can visit the California Department of Developmental Services (DSS) website at: https://www.dds.ca.gov/rc/. You may also visit DRC’s Regional Center Self-Advocacy Resource webpage at: https://www.disabilityrightsca.org/publications or review DRC’s Rights Under the Lanterman Act manual, Chapter 11: The Medi-Cal DD Waiver at: http://www.disabilityrightsca.org/pubs/PublicationsRULAEnglish.htm

VI.  Self Determination Program (SDP)

The Self Determination Program gives regional center consumers the ability to self-direct their supportive services. The SDP program provides people with a budget to purchase services and supports needed to implement their Person-Centered Plan or Individual Program Plan (IPP).

The following 5 principles are used to guide the SDP program:

Freedom – Participants have the right to plan their own life and make their own decisions.

Authority – Participants use their budget to purchase services and supports of their choosing.

Support – Participants pick supports and people to help them live, work, and play.

Responsibility – Participants make decisions in their life and have a valued role in the community.

Confirmation – Participants are the decision-makers about their life.

To be eligible for the SDP, an individual must:

• Have a developmental disability, including autism (i.e. be a regional center client), and
• Agree to follow SDP rules, and
• Not live in a long-term care health facility (e.g. a skilled nursing facility, intermediate care facility or state developmental facility) or is transitioning into the community within 90 days.

SDP services include:

• Community Living Supports
• Employer Supports
• Homemaker
• Live-In Caregiver
• Prevocational Supports
• Respite Services
• Acupuncture Services
• Chiropractic Services
• Dental Services
• Home Health Aide
• Lenses and Frames
• Occupational Therapy
• Optometric Therapy
• Physical Therapy
• Psychology Services
• Speech, Hearing and Language Services
• Financial Management Services
• Independent Facilitator
• Behavioral Intervention Services
• Communication Support
• Community Integration Supports
• Crisis Intervention and Support
• Environmental Accessibility Adaptations
• Family Support Services
• Family/Consumer Training
• Housing Access Supports
• Individual Training and Education
• Massage Therapy
• Non-Medical Transportation
• Nutritional Consultation
• Participant-Directed Goods and Services
• Personal Emergency Response Systems (PERS)
• Technology
• Training and Counseling Services for Unpaid Caregivers
• Transition/Set up Expenses: Other Service
• Vehicle Modifications and Adaptions

To apply for SDP services, regional center consumers should contact their regional center service coordinator and let them know they wish to participate in the program.  The interested participant will need to attend an orientation to learn more about the program.  For more information about the SDP program individuals can visit the Department of Developmental Services, Self Determination Program webpage at: https://www.dds.ca.gov/initiatives/sdp/ and view its SDP - Frequently Asked Questions publication at: https://www.dds.ca.gov/initiatives/sdp/frequently-asked-questions/.  You can also view the waiver online at: https://www.dds.ca.gov/wp-content/uploads/2021/01/HCBS_Combined_Approval_and_Application.pdf

D.  California Community Transitions (CCT) Program

The CCT program helps people move out of medical facilities and into the community. Federal funding for the CCT program has been extended through January 1, 2027.

If you have been in a medical facility for at least one day and need help to get out of the facility, the discharge planner should help you with your discharge and can coordinate your discharge with the CCT program.

To be eligible for CCT program services, individuals must:

• Be Medi-Cal eligible or would be Medi-Cal eligible if a spouse’s income and resources were not counted, and
• Be in a medical facility for at least one day.

CCT services covers things like:

• Finding a place to live
• Money for a deposit and/or first month’s rent
• Household set-up costs (e.g., utilities and furniture)
• Home modifications
• Vehicle adaptions
• Assistive devices
• Help with hiring caregivers
• Home care
• Caregiver Training

To apply for CCT program services, individuals can contact the CCT Lead Organization in their area  at: https://www.dhcs.ca.gov/services/ltc/Documents/List-of-CCT-LOs-April2022.pdf.You can also email DHCS to get more information at:
California.CommunityTransitions@dhcs.ca.gov or call DHCS at 1-916-552-9105 or
(833)388-4551. For more information about the CCT program you can visit the California’s DHCS website at: http://www.dhcs.ca.gov/services/ltc/Pages/CCT.aspx.  You can also view  DRC’s publication online at: https://www.disabilityrightsca.org/publications/the-california-community-transitions-cct-program-a-way-for-a-nursing-home-resident-to.

E.  Community Based Adult Services (CBAS)

The CBAS program can help people get out-of-home help during the day. CBAS offers daytime health and social services at centers throughout California. CBAS is available for older adults and adults with disabilities who would otherwise qualify for nursing facility care or have chronic conditions that meet entrance criteria (e.g., dementia or mental health diagnosis).

CBAS program services include:

• Professional nursing services
• Physical, occupational and speech therapies
• Mental health services
• Therapeutic activities
• Social services
• Personal care
• Meals
• Nutritional counseling
• Transportation to and from the participant's residence to a CBAS center

To apply for CBAS services, contact the Area Agencies on Aging (AAA) in your county. You can locate the AAA in your county by calling 1-800-510-2020. You can also obtain this information online at: https://www.aging.ca.gov/Find_Services_in_My_County/#tblServicesInMyCounty.For more information about CBAS you can visit the California Department of Aging website at: http://www.aging.ca.gov/ProgramsProviders/ADHC-CBAS/.