AB 2081: Medi-Cal: Home and Community-Based Alternatives Waiver.

Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.

Under existing law, home- and community-based services (HCBS) approved by the United States Department of Health and Human Services are covered for eligible individuals to the extent that federal financial participation is available for those services under the state plan or waivers granted in accordance with certain federal provisions. Existing law authorizes the Director of Health Care Services to seek waivers for any or all approvable HCBS.

Existing law sets forth provisions for the implementation of the Nursing Facility/Acute Hospital Transition and Diversion Waiver, which is the predecessor of the Home and Community-Based Alternatives (HCBA) Waiver, for purposes of providing care management services to individuals who are at risk of nursing facility or institutional placement, subject to federal cost neutrality. Existing law authorizes the director to propose that the waiver provide for achievement of annual cost neutrality in the aggregate to allow enrollment and authorization of waiver services based on medical necessity, and to require care management contractors to enroll at least 60% of all total annual enrollments from certain health care settings or populations. Existing law additionally sets forth provisions authorizing the director to expand the number of waiver slots up to 5,000 additional slots.

This bill would recast the above-described waiver provisions to refer to the HCBA Waiver. The bill would authorize the director, beginning January 1, 2027, to semiannually evaluate the populations receiving the priority enrollment described above, and to designate additional populations to receive priority enrollment based on this evaluation, subject to applicable cost-neutrality requirements. The bill would delete the provision relating to the 5,000 slots. The bill would instead require the department, beginning in 2027, and for the HCBA Waiver period, to increase the total number of waiver slots by 5,000, in addition to any planned expansion of waiver slots federally approved as of January 1, 2026, as specified, consistent with the above-described requirements.