Medi-Cal Waivers in California

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Medi-Cal waivers are part of the California Medicaid health care insurance program for low-income households. The Medi-Cal or Medicaid waiver program is one way that the state of California can make significant amendments to its Medicaid program, which goes by Medi-Cal. The Medi-Cal waiver program provides supplemental services to individuals who may otherwise not meet the eligible requirements for Medicaid in California. Medi-Cal waiver services provide localized services to certain areas of California and provide health care coverage to persons. There are current Medi-Cal waivers as well as ones under development that may be available soon. Expired and withdrawn Medi-Cal waivers are those no longer accessible to interested candidates.

 

California Current Medi-Cal Waivers

Current Medi-Cal waivers provide home-based or community-based specialized health care services. An example of a current Medi-Cal waiver is the Assisted Living Waiver (ALW), which is geared towards people who are eligible for assisted living as a Medi-Cal benefit. This CA Medicaid waiver works to transition residents from nursing facilities to a residential care facility or public housing. Eligibility for this waiver is only available to those enrolled in Medi-Cal who live in a California county that provides ALW services. Similar Medi-Cal waivers include the Home and Community-Based (HCB) alternatives and waiver for the developmentally disabled.

Similarly, the Multipurpose Senior Services Program (MSSP) provides in-home personal care services to seniors who would otherwise need to live in a nursing facility. Senior who qualify for this current Medi-Cal waiver are eligible for services such as housing assistance, protective supervision, communication services, minor home repair, respite care, chore services, money management, meal services and transportation. Another Medi-Cal waiver that is current is the Family Planning, Access, Care and Treatment (Family PACT) program. This waiver allows for the provision of reproductive health care and family planning to low-income families.

Other current Medi-Cal waivers include In-Home Operations (IHO), the Superior Systems Waiver (SSW), the Pediatric Palliative Care Waiver (PPC) and the AIDS Medi-Cal Waiver Program. To learn more about the current Medi-Cal waivers, download our comprehensive guide.

Pending Medi-Cal Waivers in California

A number of Medi-Cal waivers are still under development. These pending Medi-Cal waivers are approval requests for new waivers or requests for the extension of existing waivers and programs. An example of a pending Medi-Cal waiver includes the Self-Directed Services Waiver for Individuals with Developmental Disabilities (SDS-DD), which is geared towards helping the growing number of people with developmental disabilities who wish to have more choice and control over the community-based services they need. SDS-DD would allow these persons to be assessed for a Medi-Cal budget based on their individual needs, hire and supervise their support staff, have help from a support coordinator, choose supports and services to meet their individual needs and develop their own Individualized Service Plan (ISP). Other examples of pending waivers include the Center for Medicare and Medicaid Services (CMS) extension request and the Medi-Cal Waiver request for Managed Care Organization (MCO) Tax.

California’s Expired Medi-Cal Waivers

Expired Medi-Cal waivers have ended and are not operating under an extension. One example of an expired Medi-Cal waiver is the Nursing Facility A/B, which was subsequently renamed the Nursing Facility Subacute (NF SA), and provided services to people who were in need of subacute adult or pediatric nursing services for more than 180 days, as well as people who were returning home from a stay in a nursing facility. This Medi-Cal waiver was operational until 2017. Other examples of expired Medi-Cal waivers include In-Home Medical Care (IHMC), In-Home Supportive Services Plus (IHSS Plus), Developmentally Disabled – Continuous Nursing Care (DD-CNC) and the San Francisco Community Living Support Benefit Waiver (AB 2968).

Residents can find out what happens when a Medi-Cal waiver expires in our detailed guide here.

Withdrawn Medi-Cal Waivers from California

A withdrawn Medi-Cal waiver is one that was previously submitted for consideration (a pendingMedi-Cal waiver) but has been retracted. A Medi-Cal waiver may be withdrawn for a number of reason, such as it no longer being feasible due to budget and resource limitations. For instance, a Medi-Cal waiver was withdrawn when the state determined that time constraints prevent implementation.

How to Access Medi-Cal Waivers in California

In order to access the Medi-Cal waiver services, you must first establish eligible by applying for the Medi-Cal program. Since Medicaid waiver programs target certain groups of California residents who have specific health care needs, petitioners must fulfill those requirements. By means of example, the current Medi-Cal waiver for developmentally disabled residents is only extended to those who have been formally diagnosis with being developmentally disabled, such as mentally retarded, prior to being 18 years of age.

Depending on your personal needs, your initial approach to Medi-Cal waiver services may be as easy as contacting your local county human services agency. Alternatively, you may need your Medi-Cal waivers eligibility determined by a program administrator. For more information on how to access Medi-Cal waivers and other Medicaid information, download our comprehensive state guide.


What Are the Available Health Services in California?

Low-cost, and even free health benefits are available to a large number of California residents, with some being offered to low-income applicants and others being offered to elderly or disabled individuals. However, before you can access these health services, you need to submit the appropriate application and prove that you meet the necessary qualifications. To learn all about the different health benefits you can receive in California and the application procedures that you must undergo to obtain these benefits, download our free comprehensive guide.


Who Is Eligible to Obtain California Health Benefits?

California’s health programs have various eligibility requirements that applicants must meet in order to successfully enroll. Income, age and other factors are all taken into consideration in the eligibility verification process. Find out which health benefits you qualify for here.