California Medi-Cal Waiver Program: Types, Eligibility, and Applying

The California Medi-Cal waiver program is a set of Home and Community-Based Services (HCBS) waivers that pay for long-term care in your home or community instead of a nursing facility or hospital. California runs four main waivers, each for a different population: the Home and Community-Based Alternatives (HCBA) Waiver for medically fragile people of any age, the Assisted Living Waiver (ALW) for adults who want to live in a residential care facility, the HCBS Waiver for Developmental Disabilities (HCBS-DD) for regional center clients, and the Multipurpose Senior Services Program (MSSP) for seniors 60 and older. To qualify for any of them, you need full-scope Medi-Cal and a clinical finding that you would otherwise need institutional care.

Which Waiver Fits Your Situation

The waivers do not overlap much. Picking the right one is the first real step.

Home and Community-Based Alternatives Waiver

The HCBA Waiver (formerly the NF/AH Waiver) serves people of any age who are medically fragile or technology-dependent and need skilled-nursing or hospital-level care. Services are delivered in your own home or a family member’s home and include private-duty nursing, case management, family training, home health aides, habilitation services, respite care, and help transitioning out of an institution.¹ It is available statewide, but the program hit maximum capacity in July 2023 and now operates a waitlist.²

Assisted Living Waiver

The ALW covers care coordination, personal care, and residential support for Medi-Cal beneficiaries 21 or older who need nursing-facility-level care but prefer to live in an assisted living setting. Eligible settings include Residential Care Facilities for the Elderly, Adult Residential Facilities, and certain publicly subsidized housing. The ALW is not statewide. In the current waiver term (March 2024 through February 2029), it operates in 15 counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma.³ You need zero Share of Cost and must be willing to live in one of those counties.

HCBS Waiver for Developmental Disabilities

The HCBS-DD Waiver serves people with autism, intellectual disabilities, or other developmental disabilities who are regional center clients and meet an intermediate care facility level of care. It covers behavioral intervention, supported employment, day programs, environmental modifications, skilled nursing, specialized equipment, and vehicle modifications, among many others.⁴ Referrals go through your local regional center, which handles the initial evaluation before the county determines Medi-Cal eligibility.

Multipurpose Senior Services Program

MSSP is for Medi-Cal beneficiaries 60 and older who qualify for nursing facility care but can stay safely at home with support. It centers on case management and adds personal care, respite, chore services, home-delivered meals, adult day care, transportation, and personal emergency response systems.⁵ MSSP sites operate through local Area Agencies on Aging.⁶

Financial Eligibility

Before you can enroll in a waiver, you need full-scope Medi-Cal, generally with zero Share of Cost. For aged, blind, or disabled applicants, the income ceiling is 138% of the Federal Poverty Level, which works out to about $1,835 per month for a single person in 2026.⁷

No More Asset Test

California eliminated the Medi-Cal asset test on January 1, 2024. Bank accounts, savings, a second vehicle, and other resources no longer count toward eligibility, and Medi-Cal applications no longer ask for asset information.⁸ Before this change, most applicants faced a $2,000 individual resource limit that disqualified many people with modest savings.

Spousal Impoverishment Protections

When one spouse applies for waiver services and the other stays in the community, federal spousal impoverishment rules protect the at-home spouse. In 2026, the community spouse can keep combined countable resources up to a Community Spouse Resource Allowance of $162,660, and a portion of the applicant spouse’s income can be shifted to bring the community spouse’s total up to a Maximum Monthly Maintenance Needs Allowance of $4,066.50.⁹

Institutional Level of Care

Meeting the financial rules is only half the test. Every waiver applicant has to demonstrate an Institutional Level of Care: a clinical assessment must confirm that without waiver services, you would need the kind of care a nursing facility or hospital provides. A multidisciplinary team, usually a nurse and a social worker, does the assessment using tools like the MC 604 form.

The team looks at whether you need substantial help with activities of daily living, have complex medical needs requiring skilled oversight, or face safety risks that make living independently unsustainable without support. You also have to be a California resident.¹

What Waivers Actually Pay For

Service menus vary by waiver, but most programs cover the same core categories:

Case management and care coordination, with a team that builds and monitors your individualized service plan.
Personal care: hands-on help with bathing, dressing, eating, and toileting.
Respite care to give unpaid family caregivers a break, either in your home or at an outside facility.
Environmental accessibility adaptations like ramps, widened doorways, and grab bars.
Habilitation services to develop or maintain self-help, socialization, and daily living skills.
Private-duty nursing for medically complex needs.
Non-medical transportation to appointments and community activities.
Specialized medical equipment not covered by standard Medi-Cal.

The HCBS-DD Waiver adds supported employment, behavioral intervention, and vehicle modifications.⁴ Some waivers let participants self-direct their services, which means you have a say in hiring, training, and scheduling your own caregivers, with a state-provided financial management service handling payroll and taxes.¹⁰ Self-direction is not offered in every waiver, so ask the program administrator.

How To Apply

Enrollment starts only after you already have full-scope Medi-Cal. Each waiver has its own front door: the HCBA Waiver goes through your local HCBA Waiver Agency, the ALW through a Care Coordination Agency in one of the 15 participating counties, the HCBS-DD Waiver through your regional center, and MSSP through your local Area Agency on Aging. That agency handles the application, arranges the level-of-care assessment, and walks you through the paperwork.

Once you clear the assessment and a slot opens, your care team develops a Plan of Care listing every service you will receive, how often, and who provides it. Federal person-centered planning rules require that the plan reflect your preferences, that you be offered real choices about services and providers, and that you have selected the setting you live in.¹¹ Your level of care must be re-evaluated at least once a year.

Expect a Waitlist

HCBS waivers are not entitlement programs. The state caps enrollment, and when the cap is reached, qualified applicants go on a waitlist filled on a first-come, first-served basis using the date a complete request was received. The HCBA Waiver has been at capacity since July 2023.² While you wait, you remain eligible for services under the standard Medi-Cal State Plan, including personal care through In-Home Supportive Services (IHSS). Those services are usually less comprehensive than what the waiver would provide, but they can bridge the gap.

The Shrinking Asset Transfer Look-Back

Even without an asset test, California still reviews whether applicants gave away assets for less than fair market value before applying for long-term care services. The state’s look-back period has historically been 30 months, well shorter than the 60-month federal standard, and it is now shrinking by one month for every month that passes. By January 2026 the look-back covers only six months of activity (July through December 2023); by June 2026, only one month remains reviewable. After that, transfers made before January 1, 2024 fall outside the window entirely.¹²

Here is the more consequential piece: for any transfer made on or after January 1, 2024, counties do not calculate a penalty period at all.¹² California is effectively phasing transfer penalties out. If you transferred assets before 2024, a shrinking window of those transfers might still trigger a period of ineligibility, calculated by dividing the uncompensated value by the average private pay rate for nursing facility care and capped at 30 months from the transfer date.

If Your Application Is Denied

If your waiver application is denied, your services are reduced, or you are removed from a program, you can request a state fair hearing. That right covers denials based on eligibility, level of care, or the specific services in your plan.¹³ The state must send you a written Notice of Action explaining the decision and your appeal rights. You have 90 days from the date that notice is mailed to request a hearing.¹⁴

You can file in several ways:

By mail: California Department of Social Services, State Hearings Division, P.O. Box 944243, Mail Station 21-37, Sacramento, CA 94244-2430, using the request form on the back of the Notice of Action.
By fax: (833) 281-0905.
By phone: (800) 743-8525 (voice) or (800) 952-8349 (TDD).
Online, through the Department of Social Services hearing request page.

At the hearing you can review your case file, bring witnesses, present evidence, and cross-examine anyone testifying against you. The hearing officer cannot be someone involved in the original decision, and the state generally must issue a final decision within 90 days of receiving your request.¹³ If you were already receiving waiver services and you file before the effective date of the reduction or termination, your services may continue at the current level until the hearing is resolved.

Estate Recovery After Death

Most families do not see this one coming. After a Medi-Cal beneficiary who was 55 or older dies, the state can file a claim against their estate to recover the cost of nursing facility services, HCBS waiver services, and related hospital and prescription drug services.¹⁵ California limits recovery to assets that pass through probate. Property that transfers by survivorship, trust, or pay-on-death designation is not subject to a claim.¹⁶

The state will not pursue a claim if the beneficiary is survived by a spouse or registered domestic partner, a child under 21, or a blind or disabled child of any age.¹⁶ Outside those automatic exemptions, DHCS must waive its claim in whole or in part if enforcing it would cause substantial hardship to other dependents, heirs, or survivors, and it must notify families of the hardship waiver option and offer a hearing to establish eligibility.¹⁷ A family member’s home or income-producing property at stake, like a farm, strengthens a hardship argument.

Because probate is the trigger, keeping property in a living trust or ensuring it transfers by survivorship can put it out of reach of a recovery claim. Talking with an elder law attorney before or shortly after enrolling in a waiver is one of the more practical moves a family can make.

1
DHCS. 1915(c) Home and Community-Based Services Waivers
2
DHCS. Home and Community Based Alternatives Waiver
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DHCS. Assisted Living Waiver
4
Medicaid.gov. California Waiver Factsheet
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DHCS. Multipurpose Senior Services Program
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California Department of Aging. Multipurpose Senior Services Program
7
U.S. Department of Health and Human Services. 2026 Poverty Guidelines
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LACOUNTY.GOV DPSS. Medi-Cal Asset Elimination Frequently Asked Questions
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Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
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Medicaid.gov. Key Components of Self-Directed Services
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eCFR. 42 CFR 441.301 – Contents of Request for a Waiver
12
DHCS. ACWDL 23-28
13
eCFR. Subpart E – Fair Hearings for Applicants and Beneficiaries
14
DHCS. Medi-Cal Fair Hearing
15
Medicaid.gov. Estate Recovery
16
DHCS. Medi-Cal Estate Recovery
17
California Legislative Information. California Welfare and Institutions Code 14009.5