To support California's transition to a statewide, fully integrated long-term services and supports (LTSS) system, the Department of Health Care Services (DHCS) commissioned a gap analysis and multi-year roadmap of Medi-Cal home and community-based services (HCBS) and managed LTSS programs. The project objectives are to:
- Reduce inequities in access and services;
- Meet client needs
- Increase program integration and coordination;
- Improve care quality; and
- Streamline access to services.
To better meet these objectives, DHCS is asking for feedback from consumers, families, providers, health plans, and other key stakeholders. This project is supported by the Centers for Medicare & Medicaid Services (CMS) through supplemental funding from the Money Follows the Person (MFP) Demonstration. DHCS released a Request for Information (RFI) in March 2022 to identify potential consultants to conduct the gap analysis and multi-year roadmap. Mathematica and the Center for Health Care Strategies were selected as the consultants through a competitive bid process.
Gap Analysis Report
On February 14, 2025, DHCS released the gap analysis report of California's Medi-Cal HCBS and managed LTSS programs. The gap analysis seeks to outline opportunities to reduce inequities in access and services, meet member needs, increase program integration and coordination, improve care quality, and streamline access to services.
Key findings from the report include:
- California's population is aging rapidly, particularly in areas where current access to HCBS is already limited.
- In rural areas, use of institutional LTSS is higher than in more urban areas. The population of future LTSS users is expected to include a greater number of Hispanics, people ages 85 and older, and females.
- To meet the needs of a growing population of Medi-Cal members who need HCBS, the number of HCBS providers participating in Medi-Cal must increase.
- The largest reported areas of workforce needs are for direct care providers.
Based on the report's results and feedback from a broad array of stakeholders and advocates, DHCS will develop a multi-year roadmap that will outline steps to integrate HCBS services for Medi-Cal members including through managed care and through future waiver programs as appropriate, and no sooner than January 1, 2028. To learn more about the multi-year roadmap, visit the HCBS Integration page.
Download the final report and report appendices.
Stakeholder Engagement
To promote transparency and provide opportunities for input at every project stage, DHCS and its consultants will engage a wide range of stakeholders in both the gap analysis and the development of the multi-year roadmap. Engagement activities will include public meetings, listening sessions, and website and email updates. These engagement activities will give stakeholders opportunities to provide input on the project design or comment on project findings or recommendations.
In May 2025, DHCS launched the Medi-Cal HCBS Integration Planning Workgroup to solicit stakeholder feedback on the proposed transition of select HCBS programs into managed care. DHCS will also provide regular updates to stakeholders in existing forums related to managed care integration, both owned by DHCS and relevant sister agencies. To learn more about the Medi-Cal HCBS Integration Planning Workgroup and other stakeholder engagement opportunities, visit the HCBS Integration page.
Public Meetings
DHCS, in partnership with the California Department of Aging (CDA), hosted twice-yearly informational webinars on the HCBS gap analysis and multiyear roadmap project. In the meetings, DHCS updated stakeholders on its Medi-Cal Gap Analysis and CDA provided updates on its parallel Non-Medi-Cal Gap Analysis, which expands on DHCS' HCBS Gap Analysis to include an accompanying program inventory, and an analysis of utilization and demand for non-Medi-Cal HCBS programs and services.
Previous Webinars
March 13, 2025, 1:00pm-2:30pm PT
July 31, 2024
January 24, 2024
July 14, 2023
January 20, 2023
February 17, 2021
December 4, 2020
Key Documents
- CMS-Approved Application1
This project is supported by the Centers for Medicare & Medicaid Services of the U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $5M with 100 percent funded by CMS/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by CMS/HHS, or the U.S. Government.
Related Work: California LTSS Data Dashboard
The LTSS Data Dashboard, an initiative of the Home and Community-Based Services Spending Plan, tracks demographic, utilization, quality, and cost data related to LTSS in California. This dashboard links statewide long-term care and HCBS data with the goal of increased transparency to make it possible for regulators, policymakers, and the public to be informed while the state continues to expand, enhance and improve the quality of LTSS in all home, community, and congregate settings.
View the LTSS Data Dashboard
Questions
This frequently asked questions (updated in May 2024) provides responses to questions received from stakeholders regarding both the DHCS and CDA HCBS Gap Analysis and Multi-Year roadmap.
To submit questions about the HCBS gap analysis and multi-year roadmap, send an email to: HCBSGapAnalysis@dhcs.ca.gov, or by mail to the following address:
Department of Health Care Services
Integrated Systems of Care Division
P.O. Box 997437, MS 4502
Sacramento, CA 95899-7437
Attn: HCBS Section
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