Medi-Cal: Home and Community-Based Alternatives Waiver.

Plain English Breakdown

The bill summary does not provide specific details on cost or funding sources, leaving these points as unknowns.

Medi-Cal: Home and Community-Based Alternatives Waiver

This law changes how Medi-Cal covers home and community-based services for people who need them to avoid nursing facility placement, ensuring all eligible applicants can join the program.

What This Bill Does

• Changes existing rules about the Home and Community-Based Alternatives (HCBA) Waiver to refer to it instead of an older waiver called Nursing Facility/Acute Hospital Transition and Diversion Waiver.
• Removes a rule that allowed for adding up to 5,000 more spots in the HCBA program and requires all eligible people who apply to be accepted into the program.
• Requires the State Department of Health Care Services to ask for changes to the waiver by March 1, 2026, so there are enough spaces for everyone on the waiting list.
• Asks the department to study how well the HCBA Waiver pays for services and submit a report about it to lawmakers by March 1, 2026.

Who It Names or Affects

• People who need home and community-based services through Medi-Cal.
• The State Department of Health Care Services that runs the Medi-Cal program.

Terms To Know

Home and Community-Based Alternatives (HCBA) Waiver

A special permission from the federal government for California to provide certain health care services outside of nursing homes or hospitals, funded by Medi-Cal.

Medi-Cal

California's Medicaid program that helps low-income people pay for medical care and other health-related expenses.

Limits and Unknowns

• The bill does not specify how much it will cost or where the funding will come from.
• It is unclear if the federal government will approve California's request to change the HCBA Waiver rules.

Official Summary Text

AB 315, as introduced, Bonta.
Medi-Cal: Home and Community-Based Alternatives Waiver.
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 and funded by 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.
This bill would recast those provisions to refer to the HCBA Waiver. The bill would delete a provision authorizing the expansion of the number of waiver slots up to 5,000 additional slots, and would instead require the enrollment of all eligible individuals who apply for the HCBA Waiver. The bill would require the department, by March 1, 2026, to seek any necessary amendments to the waiver to ensure that there is sufficient capacity to enroll all eligible individuals who are currently on a waiting list for the waiver, as specified.
The bill would require the department, by March 1, 2026, to submit a rate study to the appropriate fiscal and policy committees
of the Legislature addressing the sustainability, quality, and transparency of rates for the HCBA Waiver. The bill would require that the study include an assessment of the effectiveness of the methods used to pay for services under the waiver, with consideration of certain factors. The bill would make related legislative findings.

Current Bill Text

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