Home and Community-Based Services Integration
To support California's transition to a statewide, 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. DHCS released the gap analysis report in February 2025 and is now focused on using its findings to develop a multi-year roadmap to integrate select HCBS services into managed care.
HCBS Integration Multi-Year Roadmap
To address gaps identified in the gap analysis report, DHCS is collaborating with stakeholders and sister agencies, including the California Department of Aging (CDA) and the California Department of Public Health (CDPH), to develop a multi-year roadmap to integrate select HCBS services for Medi-Cal members into managed care. By integrating these services into managed care, DHCS aims to:
- Strengthen California's success in rebalancing its LTSS system toward HCBS by giving Managed Care Plans (MCPs) the ability and incentive to offer members home and community-based alternatives to institutional long-term care
- Integrate and coordinate members' LTSS with health care services covered by MCPs
- Vest accountability in one entity (the MCP) for LTSS member outcomes (access, quality, costs)
- Create greater financial predictability of Medi-Cal HCBS costs, by including them in managed care capitation rates
Scope of the HCBS Integration Roadmap
While the HCBS Integration multi-year roadmap is still being developed, DHCS is currently considering the following HCBS programs for managed care integration:
DHCS is not considering integrating the In-Home Supportive Services (IHSS) program or any waivers administered by the California Department of Developmental Services at this time.
HCBS Integration Roadmap Development
In July 2024, DHCS began holding early-stage cross-department discussions, including with sister agencies, to explore options for HCBS integration. In March 2025, DHCS issued a call for nominations to convene a workgroup to embed stakeholder input into the multi-year roadmap development process. In early 2026, DHCS aims to draft and submit a concept paper for HCBS managed care integration to the Centers of Medicare & Medicaid Services (CMS) before finalizing the multi-year roadmap. DHCS will continue to collaborate with stakeholders throughout HCBS managed care integration implementation, which will occur no earlier than January 1, 2028. The exact timeline for managed care integration will be specified within the multi-year roadmap and dependent on federal approval.
Stakeholder Engagement for HCBS Integration
To promote transparency and provide opportunities for input at every stage of developing the HCBS Integration Roadmap, DHCS has established a two-pronged approach to updating stakeholders, including forming a dedicated workgroup to provide feedback on recommendations and engaging a wide range of stakeholders through existing forums.
Medi-Cal HCBS Integration Planning Workgroup
DHCS is convening the Medi-Cal HCBS Integration Planning Workgroup to solicit stakeholder feedback on the proposed transition of select HCBS programs into managed care. The Workgroup will foster a robust and meaningful collaboration process to ensure that the proposed integration can support the goals of ensuring access to HCBS while meeting member needs. While the Workgroup will be led by DHCS, other Departments—including CDA and CDPH—will be engaged.
Workgroup Participants
DHCS issued a call for nominations in March 2025 to identify members for the Medi-Cal HCBS Integration Planning Workgroup.
Of the nominees, DHCS selected 24 individuals from a diverse set of backgrounds and perspectives to serve on the Medi-Cal HCBS Integration Planning Workgroup with expertise in managed care and the Waivers being considered for integration. The Workgroup also includes strong representation from people receiving services and their caregivers who can provide a range of policy expertise and lived experience.
Workgroup Meetings
Beginning in April 2025, DHCS and its consultants will host regular virtual Workgroup meetings to inform the development of the multi-year roadmap. The Workgroup will review policy options for Medi-Cal HCBS waiver programs, including opportunities for integration into Medi-Cal managed care and to support services through fee-for-service as appropriate. The Workgroup will also provide feedback on proposals, including program design and implementation considerations. Input will be used to drive the development of a Statewide HCBS Roadmap that will outline the steps needed to obtain the necessary authorities as well as an implementation plan for HCBS integration. DHCS anticipates that the group will continue to meet through the implementation period for the managed care integration.
Workgroup Meetng Materials
DHCS
will post slide decks to this webpage after each Medi-Cal HCBS Integration
Planning Workgroup meeting. Please refer to this section regularly to view the
latest meeting materials.
- May 13, 2025 slide deck - Coming soon
- May 2, 2025 slide deck - Coming soon
Engaging Existing Stakeholder Forums
In addition to convening a dedicated Workgroup, DHCS will provide regular updates to stakeholders in existing forums on managed care integration, both owned by DHCS and relevant sister agencies (e.g., CDA). By leveraging existing forums, DHCS will collect and incorporate feedback from a broader range of members, partners, and advocates, while ensuring stakeholders remain informed about potential policy changes that will impact their programs. Forums for engagement will include, but are not limited to:
Questions
To submit questions about the multi-year roadmap and HCBS integration planning, send an email to: HCBSModernization@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
Related Links
Gap Analysis and Multi-Year Roadmap landing page
