What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through Medicaid Waivers, which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.
Waiver Description
This program provides day time care with the intention of minimizing nursing home placements.
The Medi-Cal funded, Community-Based Adult Services or CBAS (pronounced like Seabass) offers a variety of assistance services to low income, elderly or disabled individuals. Participating seniors and disabled individuals receive services in the community at adult day care centers as well as at other specialized care centers. This program was designed with the intention to minimize placement of needy persons in nursing homes.
State social workers assess applicants’ needs and develop a personalized care plan for them. A broad team of medical and care professionals oversee services at the licensed adult day health care facilities. Under the CBAS program, services are provided by private, managed care organizations at specific centers around the state. The California Department of Aging maintains contact information on approximately 266 licensed adult care centers throughout the state.
Eligibility Guidelines
General Requirements
In addition to being a resident of California who is at least 18 years old, functional need is one of two major eligibility factors that CBAS considers when evaluating applicants. This program has more rigid functional need requirements than its predecessor, Adult Day Health Care, which was the cause of much of the controversy surrounding its creation.
To qualify, candidates must be at risk of requiring nursing facility level of care or have a severe cognitive impairment. Typically, this means a progressive disorder such as dementia or Alzheimer’s. This also includes individuals who have had a brain injury or a major stroke. However, persons in the earlier stages of progressive disorders do not automatically qualify. They must be diagnosed and need assistance to perform at least two of the activities of daily living.
Financial Requirements
Income Limits
Income is the second major eligibility consideration. As of April 2024, the monthly income limit is set at $1,732 for a single applicant and at $2,351 for a married couple who are both applying for benefits. These income limits will increase in April of 2025 and reflect 138% of the Federal Poverty Level figures.
When only one spouse is applying, the non-applicant’s spouse’s income is not considered. Furthermore, the applicant spouse may be able to transfer monthly income in his / her name to the non-applicant spouse to prevent spousal impoverishment. As of 2024, the maximum amount that is allowed to be transferred is $3,853.50 a month. This is called a monthly maintenance needs allowance. If the non-applicant spouse already has monthly income equal to or above this figure, a transfer of income is not permitted from the applicant spouse.
Asset Limits
As of 2024, California no longer has asset limits.
Over the Financial Limits?
Person(s) over these limits may still become eligible through Spend Down or Share of Cost Medicaid. Alternatively, they can work with a Medicaid Planner who can help re-structure their finances to help them qualify.
Benefits and Services
Services under CBAS are provided on the managed care model. This means a single care provider is responsible for evaluating requirements and providing all forms of assistance in the program. Typically, participants will receive all services in a single location at adult day care centers or other specialized care centers located throughout the state. The types of benefits projected to be available include:
- Personal care during daytime hours
- Skilled nursing care (but not residential)
- Social, therapeutic, and recreational activities
- Meals
- Nutritional guidance
- Physical, speech, and occupational therapies
- Mental health services
- Transportation to and from the senior’s residence and the daytime facility
- Caregiver support and training
How to Apply / Learn More
The CBAS program is available statewide, with approximately 266 care centers located throughout California. Most counties have more than one care center. To see a complete list of participating centers, click here.
Some additional, but limited, program information is available here.
To learn more about applying, one should contact their local California Area Agency on Aging.
