​​​​​​​​​Home & Community​​-Based Alternatives Waiver and​​​​​ Assisted Living Waiver Integration

 The Department of Health Care Services (DHCS) oversees six home and community-based services (HCBS) waivers authorized under Section 1915(c) of the Social Security Act (SSA), and directly administers two of the Waivers: the Home and Community-Based Alternatives (HCBA) Waiver and the Assisted Living Waiver (ALW). In an effort to reduce confusion when navigating California's complex long-term care (LTC) systems, DHCS is amending the current HCBA Waiver to integrate ALW services, in alignment with the end date of the current ALW term, February, 28, 2024.


The HCBA and ALW adhere to the same federal requirements to provide long term HCBS to populations who require the same level of care. Similarly, the State must fulfill the same federal program, administrative, and reporting requirements for each Waiver. Integrating the two waivers will reduce public confusion about long-term care options, streamline operational procedures, expand access to assisted living services statewide, and reduce administrative workload. 

To be eligible for enrollment into a 1915(c) HCBS waiver, a person must require at least skilled nursing level of care, and would otherwise need to receive care in an institution if not for the services provided through the Waivers. The HCBA Waiver provides long-term supports and services to eligible Medi-Cal beneficiaries in their home or community residence of choice. The ALW provides eligible Medi-Cal beneficiaries the choice to reside in an assisted living setting as an alternative to long-term placement in a nursing facility. The goal of both Waivers is to facilitate the transition of institutionalized beneficiaries to a less-restrictive, community-based setting, and to prevent individuals who are at imminent risk of institutionalization from being admitted. 

Expected Outcomes

By integrating the HCBA Waiver and ALW:

  1. Beneficiaries will be able to access more services through a single Waiver program;
  2. ALW services will be available statewide; and
  3. Administrative workload will be reduced, creating capacity for ongoing program improvements.

Engaging the Public

DHCS is committed to engaging the public to receive input about the waiver integration throughout the amendment planning and development process.

HCBA – AL​​W Integration Stakeholder Presentation

DHCS will be hosting a Stakeholder Presentation webinar on July 27, 2022, to provide a high-level overview about home and community-based services (HCBS) waivers, the goals for integrating the HCBA Waiver and ALW, and ways in which the public can provide feedback to DHCS to help inform the integration of the waivers.

Date: Wednesday, July 27, 2022

Time: 2 p.m. - 4 p.m.

Webinar Information​

Meeting number: 2599 158 5111  


Tap to join from a mobile device (attendees only):

 +1 (415) 655-0001,,25991585111## US Toll​

July 27th Agenda

PowerPoint Presentation

HCBA – ALW​ Integration Stakeholder Workgroup

DHCS will be soliciting stakeholder participation in a series of workgroups to obtain technical input on the integration to:

  • Identify and resolve difference between the Waivers
  • Expand what works well
  • Address challenges
  • Safeguard participant health and safety
  • Reinforce participant choice, and​
  • Improve access to waiver services

Statement of Interest Instructions​


​To submit feedback regarding the Home and Community-Based Alternatives (HCBA) Waiver
and Assisted Living Waiver (ALW) Integration, please use the Feedback Ins​truction sheet​. ​

Last modified date: 8/8/2022 8:39 AM