Welcome to the California Department of Developmental Services
DDS Logo California Department of Developmental Services
1600 9th Street
P. O. Box 944202
Sacramento, CA 94244-2020

Info: (916) 654-1690
TTY: (916) 654-2054

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Home and Community—Based Services Programs

1915(c) Waiver

Medicaid, known as Medi-Cal in California, is a jointly-funded, federal-state health insurance program for certain low income and needy people that includes long-term care benefits. In 1981, President Reagan signed into law the Medicaid Home and Community-Based Services (HCBS) Waiver program, section 1915(c) of the Social Security Act. The legislation provided a vehicle for California to offer services not otherwise available through the Medi-Cal program to serve people (including individuals with developmental disabilities) in their own homes and communities. The HCBS Waiver program recognizes that many individuals at risk of being placed in medical facilities can be cared for in their homes and communities, preserving their independence and ties to family and friends at a cost no higher than that of institutional care.

The federal Centers for Medicare & Medicaid Services (CMS) approved California's five year renewal of the Home and Community–Based Services (HCBS) Waiver for Californians with Developmental Disabilities effective January 1, 2018. Approval of the HCBS Waiver renewal secures the availability of approximately $2 billion in federal funding for regional center services.

Current Waiver

Prior Waiver

1915(i) State Plan Program

Established as part of the Deficit Reduction Act of 2005, section 1915(i) of the Social Security Act gives states the option to provide Home and Community Based Services (HCBS) without a waiver. One of the key provisions of Section 1915(i) is that eligibility criteria for these services must be less stringent than the institutional level of care criteria required under waivers. DDS has renewed the 1915(i) State Plan Amendment (SPA) which allows DDS to access federal funding for community services provided to individuals who do not meet the eligibility criteria of the current HCBS Waiver.

CMS Home and Community-Based Services Regulations (Rules)

In early 2014, CMS published final regulations affecting 1915(c) waiver programs, 1915(i) State Plan programs, and 1915(k) Community First Choice State Plans for HCBS provided through Medicaid. (42 CFR Part 430, 431, et al.) The purpose of the regulations is to ensure that individuals receive HCBS in settings that are integrated in and support full access to the greater community. The regulations also aim to ensure that individuals have a free choice of where they live and who provides services to them, and that individual rights and freedoms are not restricted, among other provisions. CMS has moved away from defining HCBS settings based on specific locations, geography, or physical characteristics, to defining them by the nature and quality of the individual's experiences. Basically, the regulations set higher standards for HCBS settings in which it is permissible for states to pay for services using federal financial participation under Medicaid. The regulations became effective March 17, 2014, and allow states up to five years to implement home and community-based settings requirements.

More information on the new federal regulations and the activities to implement the specific requirements is available on the CMS Home and Community-Based Services Regulations webpage.

Self-Determination Program

On December 31, 2014, DDS submitted an HCBS Waiver application to CMS seeking federal funding for the Self-Determination Program (SDP). Under the authority of Senate Bill (SB) 468 (Chapter 683, Statutes of 2013) and upon CMS approval, DDS will implement the SDP, allowing regional center consumers and their families more freedom, control and responsibility in choosing services and supports to help them meet objectives in their individual program plans. Under the provisions of SB 468, participation will be limited to 2,500 individuals for the first three years of implementation.

More information is available on the Self-Determination Program webpage.

Electronic Visit Verification (EVV)

The 21st Century CURES Act, signed into law in 2016, was designed to improve the quality of care provided to individuals through further research, enhanced quality control, and strengthened mental health parity. Included in the Act was a requirement to implement an electronic system to verify when service visits occur for personal care and home health care services. Implementation of this system must be completed by January 2019 for personal care services and January 2023 for home health care services. The State intends to comply with federal law in a manner that respects recipients and providers, does not alter their Olmstead protections, and minimizes state costs relative to federal penalties. DDS is currently reviewing different EVV models to determine the model that will least impact current practices while still being compliant with the new federal requirements for EVV.

More information is available on the Electronic Visit Verification webpage.

Last Updated: 6/1/2018