When California significantly changes its Medicaid program, it must take one of two steps: either (1)amend its Medicaid State Plan, the state's contract with the federal government; or (2) receive an exemption or Medicaid waiver from portions of Title XIX of the Social Security Act by the Centers for Medicare & Medicaid Services (CMS). Medi-Cal waivers are programs that provide additional services to specific groups of individuals, limit services to specific geographic areas of the state, and provide medical coverage to individuals who may not otherwise be eligible under traditional Medicaid rules.
The Department of Health Care Services (DHCS) has a number of Medi-Cal waiver programs that provide home and community-based services, family planning services, specialty mental health services, and managed care to specific groups of eligible individuals. Information found here can assist the general public in understanding the services available under Medi-Cal waivers, how to access those services, and provide general information about Medi-Cal waivers.
California Advancing and Innovating Medi-Cal (CalAIM) is a DHCS-led multiyear initiative focused on system, program, and payment reform that will allow California to take a population health, person-centered approach to providing services, with the goal of improving health outcomes for Medi-Cal and other low-income populations in the state. Between November 2019 and February 2020, DHCS conducted extensive stakeholder engagement for both CalAIM and the renewal of federal authorities under which Medi-Cal operates (i.e., Section 1115 demonstration and 1915(b) waiver). DHCS postponed the planned implementation of the CalAIM initiative (originally scheduled for January 1, 2021) so that both DHCS and its partners could focus their limited resources on the needs arising from the COVID-19 public health emergency. DHCS is now resuming the process of seeking federal approval of key elements of CalAIM. Pending negotiations with CMS, the CalAIM initiative is scheduled to begin implementation on January 1, 2022. For more information about CalAIM initiatives and the stakeholder engagement process, please visit the CalAIM homepage
and CalAIM 1115 Demonstration & 1915(b) Waiver webpage
*Provided for Reference
To Access Medi-Cal Waiver Services
Medi-Cal waiver services are geared toward specific populations and targeted groups based on need. For disabled individuals requiring Home and Community-Based Services, there may be services available for such target populations as the elderly, developmentally disabled, or Medi-Cal beneficiaries with mid- to late- stage AIDS, or who require assisted living. Some waivers offer services that assist in family planning and pregnancy prevention, as well providing personal care resources to enable disabled adults to remain in their own home. Mental health services for beneficiaries with specific diagnoses are available through Freedom of Choice Waivers.
For some waiver services, the first step to accessing benefits is as simple as contacting your local county social services office. For others, an assessment must be coordinated through the program administrator to determine eligibility. Participation in any waiver, however, requires the establishment of Medi-Cal eligibility. The review process for Medi-Cal eligibility and waiver eligibility can take place concurrently. If you identify waiver services that may be of assistance to you, a family member or friend, simply click on the link for that waiver for further eligibility requirements and contact information.