The California Medi-Cal waiver program is a set of Home and Community-Based Services (HCBS) waivers that pay for long-term care at home or in community settings for people who would otherwise need a nursing facility or hospital. To qualify, you need full-scope Medi-Cal with no Share of Cost and a clinical assessment confirming you need an institutional level of care. Since January 1, 2024, there is no asset test, which has opened the door to many Californians who were previously shut out by modest savings.
What the Waivers Pay For
Standard Medi-Cal covers doctors, hospitals, and prescriptions. The waivers go further, funding the kind of hands-on support that keeps someone living at home: personal care, private-duty nursing, respite for family caregivers, home modifications like ramps and grab bars, habilitation training, specialized medical equipment, non-medical transportation, and case management. Some waivers add behavioral intervention, supported employment, or residential services in an assisted living setting.
These are optional programs under federal Medicaid law, so California can cap enrollment and limit which counties participate. Waitlists are common. Geographic availability varies.
Financial Eligibility
You must have 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 — about $1,835 per month for a single person in 2026.1U.S. Department of Health and Human Services. 2026 Poverty Guidelines
No 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. Medi-Cal applications no longer even ask for asset information.2LACOUNTY.GOV DPSS. Medi-Cal Asset Elimination Frequently Asked Questions Before this change, most applicants faced a $2,000 individual resource limit.
Protections for a Spouse Still at Home
If one spouse applies for waiver services and the other continues living in the community, federal spousal impoverishment rules protect the at-home spouse. The community spouse can keep combined countable resources up to $162,660 in 2026, and a portion of the applicant’s income can shift over to bring the community spouse’s monthly total up to $4,066.50.3Centers for Medicare and Medicaid Services. 2026 SSI and Spousal Impoverishment Standards
Medical Eligibility
Money is only half the test. A multidisciplinary team, typically a nurse and a social worker, must confirm you need an Institutional Level of Care — meaning that without waiver services you would require the kind of care provided in a nursing facility or hospital. The assessment uses tools like the MC 604 form and looks at your need for help with daily activities, complex medical needs requiring skilled oversight, and safety risks. You must also be a California resident.4DHCS. 1915(c) Home and Community-Based Services Waivers
Asset Transfers and the Shrinking Look-Back
Even without an asset test, California still reviews whether applicants gave assets away for less than fair market value before applying for long-term care services. That look-back window is actively disappearing.
Since January 2024, the reviewable period has been counting down by one month for each month that passes. By January 2026, only transfers made from July through December 2023 remain reviewable. By June 2026, only December 2023 is left. After that, transfers made before January 1, 2024 fall outside the window entirely.5DHCS. ACWDL 23-28
More important: for any transfer made on or after January 1, 2024, counties do not calculate a penalty period at all.5DHCS. ACWDL 23-28 California is effectively phasing out transfer penalties for long-term care applicants. Older transfers still inside the shrinking window can trigger a period of ineligibility, capped at 30 months from the date of the transfer and calculated by dividing the uncompensated value by the average private pay nursing facility rate.
The Main California Waivers
Each waiver targets a different population and comes with its own service menu, administrator, and footprint.
Home and Community-Based Alternatives (HCBA) 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, respite care, and community transition support for people moving out of institutions.4DHCS. 1915(c) Home and Community-Based Services Waivers The waiver is available statewide but hit maximum capacity in July 2023 and now operates a waitlist.6DHCS. Home and Community Based Alternatives Waiver
Assisted Living Waiver (ALW)
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 an assisted living setting — Residential Care Facilities for the Elderly, Adult Residential Facilities, or certain subsidized housing. For the current waiver term (March 2024 through February 2029), the program runs 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.7DHCS. Assisted Living Waiver You need zero Share of Cost and have to be willing to live in one of those counties.
HCBS Waiver for Developmental Disabilities
This 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. Services include behavioral intervention, supported employment, day programs, environmental modifications, skilled nursing, specialized equipment, and vehicle modifications.8Medicaid.gov. California Waiver Factsheet Referrals come through the local regional center, which evaluates needs before sending the case to the county for Medi-Cal eligibility determination.
Multipurpose Senior Services Program (MSSP)
MSSP serves Medi-Cal beneficiaries 60 and older who qualify for nursing facility care but can stay safely at home with the right support. The program centers on case management and wraps around it personal care, respite, chore services, home-delivered meals, adult day care, transportation, and personal emergency response systems.9DHCS. Multipurpose Senior Services Program
How to Apply
Enrollment starts only after you already have full-scope Medi-Cal. From there, you contact the right administrator for your waiver:
- HCBA Waiver: your local HCBA Waiver Agency.
- ALW: a Care Coordination Agency in one of the 15 participating counties.
- HCBS-DD Waiver: your regional center.
- MSSP: your local Area Agency on Aging.10California Department of Aging. Multipurpose Senior Services Program
The administrator arranges your clinical assessment, confirms the Institutional Level of Care, and identifies which specific services you need. Federal rules require at least one waiver service per month, or at minimum monthly monitoring to ensure your health and safety.
Waitlists
HCBS waivers are not entitlement programs. The state caps enrollment, and when the cap is reached, qualified applicants go on a waitlist filled first-come, first-served based on the date a complete request was received. The HCBA Waiver has operated at capacity since July 2023.6DHCS. Home and Community Based Alternatives Waiver While you wait, you can still get services covered under the standard Medi-Cal State Plan, including personal care through In-Home Supportive Services (IHSS).
Your Plan of Care
Once a slot opens, your care team develops an individualized Plan of Care spelling out every service you receive, how often, and who provides it. Federal person-centered planning rules require the plan to reflect your preferences, offer you real choices about services and providers, and respect your choice of setting.11eCFR. 42 CFR 441.301 – Contents of Request for a Waiver Your level of care gets re-evaluated at least annually.
Directing Your Own Services
Some waivers let participants hire, train, and schedule their own caregivers rather than relying entirely on an agency. The state provides a financial management service to handle payroll and taxes, and your plan must include a written backup plan if a caregiver does not show up.12Medicaid.gov. Key Components of Self-Directed Services Self-direction is not offered in every waiver; ask the program administrator whether it applies to yours.
If You Are Denied
If your application is denied, your services are reduced, or you are removed from a program, you can request a state fair hearing. This applies to decisions about eligibility, level of care, or the specific services in your plan.13eCFR. Subpart E – Fair Hearings for Applicants and Beneficiaries
The state must send you a written Notice of Action with the reasons for the decision and your appeal rights. You have 90 days from the mailing date to request a hearing.14DHCS. Medi-Cal Fair Hearing You can file:
- By mail, using the request form printed on the back of the Notice of Action, to California Department of Social Services, State Hearings Division, P.O. Box 944243, Mail Station 21-37, Sacramento, CA 94244-2430.
- By fax, at (833) 281-0905.
- By phone, at (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 must be someone not involved in the original decision, and the state generally issues a final decision within 90 days.13eCFR. Subpart E – Fair Hearings for Applicants and Beneficiaries If you were already receiving services and file the hearing request 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 the estate to recover what it spent on nursing facility services, HCBS waiver services, and related hospital and prescription drug costs.15Medicaid.gov. Estate Recovery Recovery reaches only assets that pass through probate. Property that transfers by survivorship, trust, or pay-on-death designation is not subject to a claim.16DHCS. Medi-Cal Estate Recovery
No claim is pursued 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.16DHCS. Medi-Cal Estate Recovery Beyond those automatic protections, DHCS must waive its claim in whole or in part if enforcing it would cause substantial hardship to other dependents, heirs, or survivors, and the agency must notify families of this hardship waiver and offer a hearing on it.17California Legislative Information. California Welfare and Institutions Code 14009.5 A family home or income-producing property at stake strengthens a hardship argument.
Planning early matters. Holding property in a living trust or arranging transfer through survivorship can keep assets outside probate and beyond the reach of a claim. Talking to an elder law attorney before or shortly after enrolling in a waiver program is one of the more practical steps a family can take.