How to apply for the HCBA Waiver (it's complicated)
It shouldn't be complicated! But it is.
The HCBA Waiver is a MediCal program - that means it's a state program.
But the state doesn't directly run the program (except in the places where it does).
The state contracts with regional "waiver agencies" to administer the program.
The waiver agencies have social workers and nurses who will walk you through the application process.
Most waiver agencies are non-profits, but sometimes the waiver agency is the county or the stat itself.
The logic in having waiver agencies was that local agencies would do a better job of taking care of people. Historically, the state handled everything by itself, but that wasn't really scalable. The waiver used to be handled by state employee RNs who would put together a plan of treatment... and that was about it. The state didn't have the staffing to do much besides enroll people and stamp the paperwork, they weren't providing comprehensive wraparound services. The state also had a massive backlog of paperwork that just wasn't getting done.
The waiver agencies are by and large doing a good job or providing more people with more services. With the waiver agencies, you get an RN case manager and a Social Worker and you get more ongoing contact with them. The problem with waiver agencies is that there are 9 different companies. There are a lot of complicated rules and policies involved in this - you won't always get a person who understands everything when you call.
WHO SHOULD DO THIS FOR YOU?
I wish I could say that your hospital / nursing home social worker will take care of this for you. They probably won't. Most hospital social workers don't know that this waiver exists, and even if they know about it, they don't know how to apply for it. This is very frustrating because it's literally their job! But remember, hospitals and nursing homes are in the business of being hospitals and nursing homes. They have made a business decision to have tons of people who work in the billing department for them to get paid, and a couple of overworked social workers who are supposed to help every patient with every government program.
If the social worker at the hospital/ nursing home says they will apply on your behalf - don't trust them. You should do it yourself. Here's why: all new applications are being put on a waitlist. You want your application to be submitted as soon as possible. You don't want to wait a few weeks for the social worker to get around to sending in the form, if they send it in at all. You also want to keep your own proof that things were submitted.
STEP 1:
In order to apply for the HCBA Waiver, you have to figure out which waiver agency will handle your application.
Go to the main state website for the HCBA Waiver and find your county on the list.
If you live in LA or Orange County, click through to look up your zip code to figure out which waiver agency will help you.
https://www.dhcs.ca.gov/services/ltc/Pages/Home-and-Community-Based-(HCB)-Alternatives-Waiver.aspx
But wait... not ever county is on the list. If you live in Alpine, Imperial, Inyo, Marin, Mendocino, Mono, or Napa County you don't have a waiver agency, you will deal directly with DHCS.
HCBA Intake Coordinator
Department of Health Care Services
Integrated Systems of Care Division
1501 Capitol Avenue, MS 4502
P.O. Box 997437
Sacramento, CA 95899-7437
Or submit the application by FAX: (916) 552-9149
or email to caremanagement@dhcs.ca.gov
STEP 2:
Fill out the appication.
it's a bunch of check boxes that ask about the person's medical care needs.
Answer all the questions to the best of your ability.
STEP 3:
Right now, the HCBA Waiver is putting all new applications on a waiting list.
There are three categories of people who get bumped to the top of the waiting list.
Being bumped to the top of the waiting list doesn't mean you'll be enrolled immediately, it just means your application will go on a shorter waiting list.
1. People who are transitioning from another waiver because they need skilled nursing care from the HCBA Waiver,
2. Children age 0-21*
3. Adults who have been in a facility for more than 60 days.
*The rules about children and MediCal are weird, they extend the category of "children" to 18-21 year olds in order to help young adults transition from pediatric care to adult care.
If any of these things apply to you, it's important for the state to know. Write, "this application qualifies for reserve capacity enrollment" on the application - just jam it on there in the margins. Write it in red if you can. Write "this application qualifies for reserve capacity enrollment" on a separate piece of paper and explain why and include it with your application.
If you don't qualify for reserve capacity enrollment, you should still apply!
Just know that it's going to be a while - probably several years - until you get enrolled in the program.
STEP 4:
Turn in your application, either to the waiver agency or to DHCS.
You want to keep proof that you submit the application - because the date you turn it in matters.
You can do that through certified mail, or you can just bug the waiver agency after you mail it in.
Use a notebook and write down everything about the timeline.
Write down the date, the name of the person you talked to, and what they said.
End every conversation with "just to make sure I understand..." and repeat everything back.
STEP 5:
If you are applying for an adult who already has MediCal eligibility:
Your next step is to wait. Making disabled people be on a waiting list to get the care they need to live at home is immoral and everyone should be outraged about this.
You still have the ability to access help at home through In Home Supportive Services (IHSS). IHSS can provide up to 283 hours per month of care every day - that comes out a little les than 9.5 hours a day of care. IHSS provides care from unlicensed care providers, they earn a little bit above minimum wage.
To do that, start here: https://www.cdss.ca.gov/in-home-supportive-services
If you qualify for the HCBA Waiver, it seems like you should qualify for maximum IHSS hours - but IHSS math is complicated. Instead of looking at a disabled person and saying "this person clearly needs 24 hour care" they look at a bunch of different tasks like bathing, eating, and using the bathroom and go through this whole complicated matrix assessment that decides how many hours you should get. It's weird and complicated!
If you are applying for an adult who does not have MediCal eligibility and needs to use Spousal Impoverishment rules to get MediCal eligibility:
Your next step is to wait... but there is some good news.
Spousal impoverishment is a special set of rules that applies to married couples where one person is disabled and needs care and the other spouse does not. Spousal impoverishment rules were set up to handle the situation where one person in a married couple needed to live in a nursing home and the other one didn't. Those rules were extended to include disabled people who want to get care at home as part of the Affordable Care Act.
Spousal Impoverishment MediCal tells the eligibility system to treat the married couple as two separate "budget units." That means the working / non-disabled spouse's income doesn't ruin the disabled spouse's eligibility to get MediCal. The disabled spouse has to meet the income standards for an individual (under $1676 per month). If the disabled spouse's income is over $1676... don't panic. Share of Cost MediCal means that people whose income is over the limit can still get MediCal if they're spending their "extra" money on medical care. For example: If the disabled person's SSDI income is $2000 / month, they would get MediCal eligibility but they would have to spend the "extra" $324 per month on medical care. The math can get more complicated, but in general, if a disabled person has a medium-ish income and a need for ongoing expensive care (home care is expensive) Share of Cost MediCal can work.
Adults can get Spousal Impoverishment MediCal while they are on the HCBA Waiver waitlist.
Getting MediCal eligibility doesn't solve every problem - but it opens the door to getting up to 9.5 hours of care per day from IHSS.
Married adults who qualify for IHSS but don't qualify for the HCBA Waiver can ALSO get Spousal Impoverishment MediCal.
Here is some legitimate information on Spousal Impoverishment MediCal:
https://canhr.org/wp-content/uploads/FS_MEDICAL_Spousal_Impoverishment_HCBS.pdf
If you are applying for a child who needs to use Institutional Deeming to get MediCal eligibility:
There are two ways to get institutional deeming for children that need access to MediCal funded long term care: the HCBS-DD Waiver for children with developmental disabilities and the HCBA Waiver for children with medically intensive disabilities.
Kids who need institutional deeming to access MediCal are being bumped to the top of the waitlist - but they still go on the waitlist.
If the child got eligibility for MediCal through SSI while they were in the hospital, that eligibility usually lingers in the system for a few months, that might give you enough time to get off the waitlist.
If a child is over age 3 and gets services from the Regional Center, the RC is supposed to put them on a different waiver - the HCBS-DD Waiver. That waiver does not have a waitlist. Talk to your RC case worker and ask them to do their job.
If a child age 0-3 has a syndrome that is known to cause intellectual disabilities , sometimes the Regional Center will help by putting the child on their waiver (the HCBS-DD Waiver). Sometimes they won't. It's a crapshoot. Pick a fight with the Regional Center while you're waiting on the HCBA Waiver.
Does quitting your job or scaling back to part time decrease your income enough for your disabled child to get income based MediCal? That's a terrible choice to have to make, but the waitlist is terrible.
If you are applying for a child who already has MediCal eligibility based on family income or through the Regional Center:
If a child has MediCal, they do not need to be enrolled in the HCBA Wavier to access home nursing care for your child. MediCal automatically covers home nursing for children, there is no need for children to enroll in a waiver program to access nursing care at home.
STEP 6:
Put it on your calendar to check with the waiver agency once a month or so.
If you move or change your phone number, make sure you let them know.
This isn't a situation where the squeaky wheel gets the grease - calling won't make your application be processed faster.
STEP 7:
Eventually, the waiver agency will call you and start processing your intake paperwork.
A social worker will call/zoom and ask a bunch of questions about your living situation. They will ask a bunch of really specific questions about fire alarms and exit plans and steps. They just want to verify that your house is a safe place
A nurse will call/zoom and ask a bunch of questions about your health and medical care needs.
Based on these conversations, they'll put together a "Plan of Treatment". Sometimes they call this the POT. The POT is a 20ish page document that lists all the care you need and who provides it.
The POT has to get signed by your doctor, sent back to the waiver agency, then approved by the state.
That can take like 60 days for some reason.
The HCBA Waiver can authorize two big things and a lot of little things.
The two big things are:
1. Private duty nursing - care provided by a nurse
2. Waiver Personal Care Services - WPCS - care provided by an unlicensed person.
The POT should accurately reflect how much care you need - if you are enrolled in the HCBA Waiver you need 24/7 care. The POT should plan out who is providing that care, and shouldn't assume that family members are just going to do it. The point of the HCBA Waiver is to get disabled people the help they need to live at home.
STEP 8:
Once you're enrolled in the HCBA Waiver, expect a call from the social worker every month and a long call/zoom where the re-do the POT every 6 months.
If something changes and you need more or less care - call the waiver agency and tell them. The POT isn't written in stone, it can be changed whenever you need it to be changed.