Medi-Cal Waiver Program
Local agencies, under contract with the California Department of Public Health, Office of AIDS, provide home and community-based services as an alternative to nursing facility care or hospitalization.
The Medi-Cal Waiver Program (MCWP), formerly known as the AIDS Waiver, provides comprehensive case management and direct care services to persons living with HIV/AIDS as an alternative to nursing facility care or hospitalization. Case management is participant centered and provided using a team-based approach by a registered nurse and social work case manager. Case managers work with the participant, their primary care provider, family, caregivers, and other service providers to determine and deliver needed services to participants who choose to live in a home setting rather than an institution.
The goals of the MCWP are to:
- Assist participants with disease management, preventing HIV transmission, stabilizing overall health, improving quality of life, and avoiding costly institutional care;
- Increase coordination among service providers and eliminate duplication of services;
- Transition participants to more appropriate programs as their medical and psychosocial status improves, thus freeing MCWP resources for those in most need; and,
- Enhance utilization of the program by underserved populations.
Clients eligible for the program must be Medi-Cal recipients: whose health status qualifies them for nursing facility care or hospitalization, in an “Aid Code" with full benefits and not enrolled in the Program of All-Inclusive Care for the Elderly (PACE); have a written diagnosis of HIV disease or AIDS with current signs, symptoms, or disabilities related to HIV disease or treatment; adults who are certified by the nurse case manager to be at the nursing facility level of care and score 60 or less using the Cognitive and Functional Ability Scale assessment tool, children under 13 years of age who are certified by the nurse case manager as HIV/AIDS symptomatic; and individuals with a health status that is consistent with in-home services and who have a home setting that is safe for both the client and service providers.2023-2027 MCWP Renewal
On February 16, 2023, the Centers for Medicare & Medicaid Services (CMS) approved the renewal of the MCWP for individuals living with HIV as an alternative to nursing facility care or hospitalization. The waiver has been approved for a five-year period with a retroactive start date of January 1, 2023.Current Waiver
Approved MCWP Amendments
Telehealth Amendment Effective November 12, 2023, this amendment adds telehealth as a permanent service delivery option for the following: Psychotherapy, Case Management and Nutritional Counseling.
For further information, refer to the Office of AIDS.
