California Home and Community-Based Alternatives (HCBA) Waiver

The Home and Community-Based Alternatives (HCBA) Waiver is a Medi-Cal waiver for people of any age who need a nursing facility level of care, or higher, and want to live at home. It is aimed at people with significant medical needs, including people leaving a hospital or nursing home. This page is part of our California Long-Term Care Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

At a glance

Item	Details
Type of program	Medicaid home and community-based services (HCBS) waiver
Who runs it	California Department of Health Care Services (DHCS), through local waiver agencies
Age	Any age
Care need	Nursing facility level of care (or higher, such as subacute)
California 2026 income rule (long-term care)	No fixed cap for nursing home care (income above allowances goes toward the cost of care)
California 2026 asset limit (single applicant)	$130,000 in countable (nonexempt) property
Waiting list	Yes. HCBA has a statewide waitlist

The HCBA Waiver in brief

To sum up, California Department of Health Care Services (DHCS), through local waiver agencies oversees the HCBA Waiver. Who it is for: any age. Care need required: Nursing facility level of care (or higher, such as subacute). As for waiting: Yes. HCBA has a statewide waitlist. Each of these points is covered in more depth below, alongside the general California rules from our state guide. Families weighing the HCBA Waiver against other California options can use the related pages at the end to compare programs side by side.

What the program is

DHCS runs HCBA through local Waiver Agencies, which provide care management by a nurse and social worker. The waiver can pay for private-duty nursing, case management and other supports that let a person with heavy care needs live at home. It is often used by people who need more than IHSS can offer, such as skilled nursing at home.

Under federal law, California can run home and community-based waivers like the HCBA Waiver, which bend some ordinary Medicaid rules so care can happen outside a facility. Expect a cap on enrollment, a written plan of care, and a coordinator who lines up providers. Participants keep their regular Medi-Cal coverage for medical care; the waiver adds long-term care services to it. See our overview of HCBS waivers.

Who qualifies in 2026

In California, the basic requirements for the HCBA Waiver are that the person:

Has full Medi-Cal
Meets a nursing facility level of care, or a higher level such as subacute or acute hospital
Can be served safely at home with waiver services at a cost the waiver allows
Lives in California and is a U.S. citizen or qualified non-citizen

Income and assets. The person must have full Medi-Cal. Medi-Cal’s income and asset rules are explained in our California guide. Figures shown above are the 2026 California long-term care limits from our state guide. The home (up to the equity limit, when the person or a spouse lives there or plans to return), one vehicle, belongings and a small burial fund are generally not counted by Medi-Cal. Married couples get extra protection in California: the spouse at home keeps a share of assets and may get some of the applicant’s income. See Spousal impoverishment rules.

About the level-of-care assessment. Medi-Cal’s assessment covers daily activities, from bathing and dressing to toileting and medications, plus memory and safety. A nurse or social worker working with Medi-Cal usually does it in person, wherever the person is living. Have a relative present to describe the hard days, and keep a medication and diagnosis list handy. See Nursing home level of care and Activities of daily living.

What services it can pay for

Services depend on the person’s assessed needs and written care plan. Depending on the plan, they can include:

Comprehensive care management
Private-duty nursing, including shared nursing
Home health aide services
Personal care beyond what IHSS provides
Environmental accessibility changes
Family training
Respite (home and facility)
Habilitation services
Community transition services
Medical equipment not otherwise covered

No program pays for everything. The HCBA Waiver services are based on assessed need, and a family caregiver who is already helping is usually counted when the plan is written. A change in health is a reason to request a reassessment.

How to apply

Getting the HCBA Waiver means passing a money test and a care test. Step by step:

Contact the HCBA Waiver Agency that serves your county (DHCS lists them), or DHCS directly in areas without one.
Get on the HCBA waitlist through the waiver agency.
When a slot is available, the waiver agency assesses the person.
Medi-Cal eligibility is confirmed and a care plan is written.
Services start, often in coordination with IHSS.

Before contacting Medi-Cal, see Applying for a waiver and the documents checklist for what to gather.

Waiting lists

HCBA has reached capacity and keeps a statewide waitlist; you apply through the waiver agency assigned to your area. Reserved slots go first to certain groups: people moving from another HCBS waiver, people under 21, and people who have been in a skilled nursing or acute care facility for at least 60 days when they apply. Community applicants are offered slots after those groups.

General advice is in Waiver waiting lists.

How it relates to nursing home Medicaid

HCBA serves people who would otherwise be in a nursing home or even a subacute unit. The financial rules follow Medi-Cal’s rules described in our California guide. For people with a spouse at home, spousal protections can apply.

Where the nursing home rules still apply. As in nearly every state, California’s financial rules for home and community programs follow its nursing home rules closely. Gifts and below-value transfers in the five-year look-back can trigger a penalty period for home care as well as nursing home care. After death, estate recovery can reach services paid from age 55 on. Some participants pay a monthly share of income toward services.

Income in a nursing home. In 2026, California lets a nursing home resident keep $35 a month for personal needs; the rest of their income mostly pays toward care. Our state guide covers the nursing home rules in detail.

Tips for families

Start early. If there is a waiting list or a slow assessment, the clock usually starts when you ask, not when the crisis comes.
Keep a paper trail: copies of forms and notices, plus the names and dates of every call to Medi-Cal.
Watch the deadlines on notices. A denial or cut can be appealed through a fair hearing, and a timely request can keep services going meanwhile.
Report changes in income, assets, address or living situation to Medi-Cal when they happen.
Plan for renewals. Medicaid and the care assessment are both renewed, usually once a year. See Renewals.
Protect a spouse at home. Spousal protections must be claimed; a certified Medicaid planner or legal aid office can explain them for your family.

Common questions

Is HCBA only for older adults? No. It serves people of any age with a qualifying level of care.

Can HCBA pay for nursing at home? Yes. Private-duty nursing is one of its main services.

Can I receive IHSS and HCBA together? Yes. HCBA is designed to work alongside IHSS.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.