Medi-Cal Home and Community-Based Alternatives (HCBA) Waiver (formerly Nursing Facility / Acute Hospital Waiver)

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

California Medicaid, or Medi-Cal, officials created this waiver program for the target population of physically-disabled seniors who are either currently in nursing home, intermediate care facility, or likely to need long term nursing home care within a month. Therefore, seniors who are in a skilled nursing facility on a temporary basis for rehabilitation following a hospitalization are an important target group for this waiver.

The program’s supports and services are designed to allow qualifying participants to return home or to continue living in their current residence. As such, the program assists participants in identifying and paying for their home assistance technology, emergency responses service and home accessibility modifications in addition to their personal care and home health care.

Note that the Home and Community-Based Alternatives Waiver was formerly referred to as the Nursing Facility / Acute Hospital (NF/AH) Waiver. Prior to that the old NF A/B Waiver, Nursing Facility Sub-Acute and the In-Home Medical Care Waivers were combined together under this waiver.

There are several other waivers for Californians with less severe care needs. The MSSP, ALWP and CBAS programs provide support for home care, assisted living and adult day care, respectively.

 

Eligibility Guidelines

Although open to California residents of any age, the HCBA Waiver has rigid financial and medical guidelines for qualification. The applicant must require a nursing home level of care and should be already living in a hospital or nursing facility. Qualified applicants must be able to safely and sustainably receive their required care in their homes. Applicants do not need to be currently residing in a residential care facility; however, those who are will be prioritized for funding.

Income Limits
In 2018, the income limits are $1,235 for an individual and $1,664 for a couple (should both spouses of a couple being applying for Medicaid). Individuals or couples who have gross monthly incomes that slightly exceed these limits may still qualify by deducting health insurance premiums from their countable income.

This waiver requires full Medi-Cal eligibility. Therefore, higher income individuals who only qualify for Aged and Disabled Medi-Cal with a “Share of Cost” are not eligible for services under this waiver. When a married applicant has a healthier spouse, who continues to work or has unearned income from a pension or Social Security, their income is not used to determine the applicant’s eligibility.

Asset Limits
In 2018, the asset limits are $2,000 for individuals and $3,000 for couples. The primary residence is considered exempt from their countable assets provided their home equity is valued at less than $858,000. Any home equity that the applicant has in their primary residence over the maximum will be counted towards their total assets.

Persons whose income or assets exceed the California Medicaid limits and couples where only one spouse is seeking Medicaid should consult with a professional Medi-Cal planner to structure their assets and income appropriately to enable them the best possibility of acceptance into Medi-Cal.

 

Benefits and Services

The HCBA waiver is designed to allow individuals to remain living at home or return to living in their homes after an extended stay in a skilled nursing facility. This initiative is formally referred to as California Community Transitions (CCT) Project.  As the goal is to move persons out of nursing homes, the benefits available to participants are chosen with this objective in mind. Participants may receive any of the following:

  • Case management
  • Home health aide services
  • Home modifications to enable improved access
  • Personal care
  • Medical equipment maintenance and recurring expenses
  • PERS (Personal Emergency Response service, installation and fees)
  • Respite care (both at home and in residential care on a temporary basis)
  • Skilled nursing services
  • Training for family caregivers 

  

How to Apply / Learn More

This program is current and available throughout California. However, because this is a waiver program and not an entitlement program, there can be waiting periods for services to start. The enrollment caps increase annually from approximately 3,500 participants in 2013 to approximately 4,000 in 2018.

More information and an application are available on the Department of Human Services webpage. The complete process can take between two to five months to get a care plan started and transition the patient out of the facility.

Individuals with questions about Medi-Cal eligibility should consult with their local Area Agency on Aging or a professional Medi-Cal planner prior to applying.