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.
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.
The CBAS program replaced California’s Adult Day Health Care (ADHC) program in 2012. After significant controversy, the ADHC program ended on March 31, 2012. CBAS is jointly administered by the CA Department of Aging, the CA Department of Public Health and the Department of Health Care Services.
Did you know?
A recent Genworth national survey of adult day care and home care found that adult day care averages about half the cost of home care for the same amount of care hours.
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 resources, both income and assets, are the second major eligibility consideration. CBAS is a Medi-Cal program, and beneficiaries must qualify for Aged and Disabled Medi-Cal. Income and asset limits change annually in April. Individuals or couples over these limits will have a share of cost to pay monthly toward their care services.
Please note: When only one spouse of a married couple is applying for Medicaid, only the income of the applicant spouse is counted. Said another way, the non-applicant spouse’s income does not impact the eligibility of the applicant spouse. Unlike with income, assets of a married couple are considered jointly owned, even when only one spouse of a married couple is applying for Medicaid. Learn more here. While the countable asset limits are quite low, many assets are exempt from being counted. Most importantly, one’s home, household furnishings, personal items, and a vehicle are exempt.
|Medi-Cal April 2022 – March 2023 Income and Assets Limits for the Elderly
|*When both spouses are applying.
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
- 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.