Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.

Under existing law, home- and community-based services (HCBS) approved by the United States Department of Health and Human Services are covered for eligible individuals to the extent that federal financial participation is available for those services under the state plan or waivers granted in accordance with certain federal provisions. Existing law authorizes the Director of Health Care Services to seek waivers for any or all approvable HCBS.

Existing law sets forth provisions for the implementation of the Nursing Facility/Acute Hospital Transition and Diversion Waiver, which is the predecessor of the Home and Community-Based Alternatives (HCBA) Waiver, for purposes of providing care management services to individuals who are at risk of nursing facility or institutional placement. Existing law sets forth provisions authorizing the director to expand the number of waiver slots up to 5,000 additional slots.

This bill would recast the above-described waiver provisions to refer to the HCBA Waiver and would delete the provision relating to the 5,000 slots. The bill would require the department, beginning in 2027, to ensure that the HCBA Waiver provides for an annual increase of not fewer than 10,000 waiver slots for each waiver year, as specified.

The bill would require the department to prepare and submit an annual report to the Legislature that provides certain information about waiver slot numbers, waiting list numbers, demographics, and departmental efforts, as specified.

The bill would require the department, by March 1, 2027, to seek any necessary amendments to the HCBA Waiver to ensure that there is sufficient capacity to enroll all individuals who are eligible for, and express an interest in, participating in the HCBA Waiver who are currently on a waiting list. The bill would require the department to continue to monitor the capacity of the HCBA Waiver and to expand capacity, as specified.

Existing law requires the department to implement the waiver only to the extent that it can demonstrate federal cost neutrality as required under the terms of the waiver, and only to the extent any necessary federal approvals are obtained and federal financial participation is available.

This bill would recast those conditions, removing the federal cost neutrality criterion. The bill would authorize the department to seek amendments to the HCBA Waiver or take other actions as necessary to implement these provisions.