Home and community-based services (HCBS) waivers* allow home and community-based services to be provided as an alternative to institutional services. Eligible individuals are those who would otherwise require the level of care provided in an institution — i.e. hospital, nursing facility or intermediate care facility for the mentally retarded. But with services available under the HBCS waiver program, they can be served at home or in the community instead. HCBS must be cost-effective and necessary to avoid institutionalization. HCBS are provided in addition to all of the other services available through the state's Medicaid Plan. (In California, the Medicaid program is called Medi-Cal.)
HCBS waivers give states Medicaid reimbursement for services that do not fit within the traditional medical model. Services available include case management, homemaker or personal attendant care, home health aide services, adult day health services, respite care, day treatment, rehabilitation and clinical services for individuals with psychiatric disabilities, and any other services requested by the state and approved by CMS.
California currently operates six (6) HCBS waivers: Nursing Facility (NF) Waiver; Model Nursing Facility (NF) Waiver, AIDS Waiver; Multi-purpose Senior Services (MSSP) Waiver; In-home Medical Care (IHMC) Waiver; and the Department of Developmental Services (DDS) Waiver. New legislation requires that the state submit an Assisted Living Waiver soon. These waivers provide a very broad range of additional services to Californians including additional attendant care, emergency response systems and home modifications. Some are available to all Medi-Cal recipients who qualify and others serve distinct populations or are regional in nature. Each HCBS waiver has a separate cap on the number of people served under that particular waiver, ranging from approximately 200 under the Model NF Waiver to over 40,000 under the DDS waiver.
HCBS waivers are authorized pursuant to Section 1915(c) of the Social Security Act. They are authorized in a plan developed and submitted by the state and approved by the federal government, Center for Medicare and Medicaid Services (CMS, formerly the Health Care Financing Agency). They allow for flexibility and creativity on the part of the state to meet unique needs and fill service gaps.
*The word "waiver" is confusing in this context. What this really means is that states apply to the federal government to waive or ignore certain parts of the Medicaid Act in order to craft programs that meet states'Äô needs, fill service gaps or are directed to a specific population. For example, the Medicaid Act requires that services must be available to all recipients on an equal basis ("comparability") and that services be available throughout the entire state ("statewideness"). Waivers allow states to ignore those requirements and direct services to one region in the state or to one population (e.g. seniors, people with AIDS) and not others.