California Medicaid Waivers & Home and Community Based Programs Overview

California, known as The Golden State, has one of the most comprehensive Medicaid Waiver and Home and Community-Based Services (HCBS) programs in the nation, designed to provide long-term care alternatives for individuals with disabilities, seniors, and those with chronic health conditions.

Administered by the California Department of Health Care Services (DHCS) and coordinated through the California Department of Developmental Services (DDS) and local Regional Centers, the state’s Medicaid program, Medi-Cal, offers multiple waiver programs. Key waivers include the Home and Community-Based Alternatives (HCBA) Waiver, the Community-Based Adult Services (CBAS) Waiver, the Self-Determination Program (SDP) under the Lanterman Act, and the Developmental Disabilities (DD) Waiver, which provides services such as in-home support, personal care, case management, and behavioral health interventions.

California is also a leader in Consumer-Directed Services, giving individuals greater control over their care providers and service choices.

Regulatory oversight in California is managed through DHCS, DDS, and the California Department of Social Services (CDSS), with licensing and compliance requirements enforced by the California Department of Public Health (CDPH) for skilled providers. Medi-Cal Managed Care Plans (MCPs) play a significant role in HCBS service coordination, integrating medical, behavioral, and home-based care under a managed care model.

The state has implemented Electronic Visit Verification (EVV) for personal care services, and providers must navigate complex Regional Center vendorization, Medicaid provider enrollment, and stringent compliance measures. Additionally, California’s In-Home Supportive Services (IHSS) Program, the largest of its kind in the U.S., allows waiver participants to hire and manage their own caregivers, including family members.

With a strong emphasis on equity, self-determination, and integrated care models, California’s Medicaid waiver system provides extensive support for diverse populations while maintaining a commitment to person-centered planning and community-based service delivery.Pennsylvania Medicaid Waivers & Home and Community Based Programs Overview.

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