California caregiver benefits guide
Last checked: May 18, 2026
California Medicaid is called Medi-Cal. Medi-Cal home and community-based services, often called HCBS, may help a person get care at home or in a community setting instead of a nursing home, hospital, or other institution.
The first call for many families is not a waiver office. It is often the county In-Home Supportive Services office, the local HCBA Waiver Agency, an MSSP provider, or a regional center. The right path depends on the person’s age, disability, Medi-Cal status, care needs, county, and whether there is a waitlist.
Quick answer
California has several Medi-Cal HCBS waiver paths. The main ones for families are the Home and Community-Based Alternatives Waiver, the Multipurpose Senior Services Program, the Assisted Living Waiver, and developmental disability waivers run through regional centers.
If the person needs hands-on help at home, also ask about In-Home Supportive Services. IHSS is often the most direct California path for paying a family member to provide approved care at home.
California warning
Rules can change. Counties, Medi-Cal managed care plans, waiver contractors, regional centers, and state agencies may use different names for the same kind of help. Always confirm the current rule with official California sources before you rely on it.
Main programs and where to start
| Program or route | Who it may help | Where to start |
|---|---|---|
| IHSS | People who are aged, blind, or disabled and need help to stay safely at home. | Call the county IHSS office. Ask for an IHSS application and the Health Care Certification form. |
| Home and Community-Based Alternatives Waiver | People at risk of nursing home or institutional placement who need care management and waiver services at home or in a family member’s home. | Contact the HCBA Waiver Agency for the person’s county or ZIP code. |
| Multipurpose Senior Services Program | Medi-Cal members age 60 or older who are certified or certifiable for skilled nursing facility care and need help staying at home. | Find the MSSP provider that serves the person’s county through the California Department of Aging. |
| Assisted Living Waiver | Medi-Cal members age 21 or older who need a nursing facility level of care and want to live in an approved assisted living setting or public subsidized housing in a covered county. | Contact an ALW Care Coordination Agency in a covered county. |
| HCBS-DD Waiver and Self-Determination Program | People with intellectual or developmental disabilities who are served by a California regional center and meet waiver rules. | Call the person’s regional center service coordinator. |
| California Paid Family Leave | Working caregivers who need short-term wage replacement while caring for a seriously ill family member. | Apply with the Employment Development Department. This is not Medi-Cal and does not pay for care hours. |
What an HCBS waiver is
HCBS means home and community-based services. In plain English, this means long-term care help outside an institution.
A Medicaid HCBS waiver lets a state pay for some services that help a person stay at home or in another community setting. Without that help, the person might need care in a nursing facility, hospital, intermediate care facility, or similar setting.
California Medicaid is called Medi-Cal. California’s Department of Health Care Services says HCBS waivers are for people who would otherwise require care in a nursing facility or hospital. The person must have full-scope Medi-Cal eligibility for HCBS waiver services.
A waiver is not automatic. The person must meet Medi-Cal rules, the program’s target group rules, and the level-of-care rule. The service must also be medically needed and fit the person’s care plan.
Main waivers in California
Home and Community-Based Alternatives Waiver
The Home and Community-Based Alternatives Waiver is often called the HCBA Waiver. It helps people who are at risk of nursing home or other institutional placement.
HCBA care is planned by a care management team. The team includes a nurse and social worker. The team can coordinate Medi-Cal state plan services, IHSS, behavioral health care, and other long-term services.
HCBA services may be provided in the person’s home, a leased home, or the home of a family member.
Important: DHCS says the HCBA Waiver reached maximum capacity and a waiting list started July 12, 2023. New applicants can still apply to get a place on the waiting list.
Multipurpose Senior Services Program
The Multipurpose Senior Services Program is called MSSP. It serves Medi-Cal members who are age 60 or older and disabled as an alternative to nursing facility placement.
MSSP gives social and health care management. It may also buy some needed services when other programs do not cover them. Many MSSP participants also receive IHSS.
MSSP services can include care management, adult day care, minor home repair, extra personal care or chore help, respite, transportation, meals, counseling, money management, and communication services.
Assisted Living Waiver
The Assisted Living Waiver is called ALW. It is for certain Medi-Cal members who need a nursing facility level of care and are willing and able to live safely in an assisted living setting or public subsidized housing.
ALW is not the same as in-home care in a private home. It is for approved residential settings. DHCS lists the counties where ALW is available. As of the last check, the list included Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma counties.
ALW participants must have full-scope Medi-Cal with zero share of cost. They also must have enough income to pay room and board, with some money left for personal needs.
Developmental disability waivers and regional centers
California also has HCBS programs for people with intellectual or developmental disabilities. These are run through the Department of Developmental Services and regional centers, with DHCS oversight as the state Medicaid agency.
The HCBS-DD Waiver is for regional center consumers who meet Medi-Cal and level-of-care rules. Services may include respite, home health aide services, supported living, transportation, home changes, family training, skilled nursing, and other supports.
The Self-Determination Program is also for eligible regional center consumers. If your family member is already connected to a regional center, ask the service coordinator about both the HCBS-DD Waiver and the Self-Determination Program.
Services that may help caregivers
Not every service is available in every program. The care plan controls what is approved. Still, these are the kinds of services caregivers should ask about:
- Personal care: help with bathing, dressing, toileting, transfers, eating, and safe movement.
- IHSS hours: county-approved in-home services for people who qualify.
- Respite: short-term relief so the main caregiver can rest, work, sleep, or handle other duties.
- Adult day care or day programs: daytime supervision, activities, meals, or health-related support.
- Home modifications: changes such as ramps, grab bars, or other access changes when the program covers them.
- Transportation: rides or travel help for medical care or program-approved needs.
- Care management: help from a nurse, social worker, or case manager to set up services and update the care plan.
- Caregiver training: training when the program approves it as part of the plan.
- Meals, chore help, and safety supports: these may be available through MSSP, IHSS, regional center services, or other local programs.
Ask for the service by the task, not just the program name. Say, “He cannot bathe safely,” “She wanders at night,” “He needs help transferring,” or “I need respite because I cannot leave her alone.”
Can family caregivers be paid through a waiver?
Sometimes. But in California, the answer depends on the program.
IHSS is often the main family caregiver pay route
IHSS can pay an approved provider to give approved care to an eligible person at home. CDSS says care providers may include family members, friends, neighbors, or providers through the public authority.
The person receiving care must qualify for IHSS. The county decides the tasks and hours. A doctor or other licensed health care professional must complete the Health Care Certification form before services can be approved.
Start with the county IHSS office if your main question is, “Can I get paid to help my family member at home?” You can also read our guides at Can I Get Paid to Be a Caregiver? and Can I Get Paid to Care for a Family Member? Quiz.
HCBA and Waiver Personal Care Services
Some HCBA Waiver members may also receive Waiver Personal Care Services, called WPCS. DHCS says WPCS is for HCBA Waiver members who also receive IHSS and have a doctor’s order showing that WPCS is needed to remain safely at home.
A WPCS provider must meet provider rules. DHCS says the person must first complete the IHSS provider enrollment process and be at least 18 years old. An IHSS provider can also be a WPCS provider.
Parent and spouse providers have special limits. DHCS policy says a parent of a minor HCBA Waiver member or a spouse may provide WPCS only under “extraordinary care” rules. That means the care must go beyond what the parent or spouse would ordinarily be expected to provide and must be needed for health and safety.
MSSP, ALW, and regional center programs
MSSP may buy services and arrange care, but it is not usually described as a direct paycheck program for a family caregiver. Ask the MSSP provider what paid services can be part of the person’s care plan.
ALW pays for approved assisted living services in approved settings. It is not a general program for paying a relative to provide care in a private home.
Regional center services and the Self-Determination Program may allow more choice in how some services are arranged. Do not assume a family member can be paid. Ask the regional center what the person’s Individual Program Plan allows and what provider, vendor, or financial management rules apply.
California Paid Family Leave is different. It may give short-term wage replacement to an eligible worker who takes time off to care for a seriously ill family member. It does not pay the caregiver as a home care provider, and it does not approve care hours.
Waitlists and priority
Some California HCBS programs have enrollment caps or limited slots. This means a person can meet the basic rules and still wait.
HCBA Waiver waitlist
DHCS says the HCBA Waiver reached maximum capacity and started a waiting list on July 12, 2023. New applicants should still apply with the assigned Waiver Agency to secure a place on the waiting list.
When a slot opens, applicants who meet reserve-capacity criteria get priority for intake processing. DHCS lists reserve-capacity criteria as applicants moving from similar HCBS waivers because their needs can no longer be met, applicants under age 21, or applicants who have lived in a health care facility for at least 60 days when the HCBA application is submitted.
ALW waitlist
DHCS posts an Assisted Living Waiver enrollment and waitlist dashboard. Because ALW is county-limited and slot-limited, families should confirm current waitlist status with an ALW Care Coordination Agency.
MSSP and regional center timing
MSSP has an enrollment cap and local providers. Ask the MSSP provider for your county if they are taking new referrals and what happens if there is no opening.
Regional center timelines depend on regional center eligibility, assessment, the Individual Program Plan, and the service requested. Ask for decisions in writing when services are denied, changed, or delayed.
How to apply
Step 1: Apply for Medi-Cal or confirm full-scope Medi-Cal
If the person does not have Medi-Cal, apply online through BenefitsCal, through Covered California, by phone with the county office, by mail, or in person. DHCS says the county office manages most Medi-Cal cases for DHCS.
If the person already has Medi-Cal, ask whether it is full-scope Medi-Cal and whether there is a share of cost. Some waiver routes require full-scope Medi-Cal. ALW requires full-scope Medi-Cal with zero share of cost.
For help with Medicaid cost and asset terms, see Medicaid Spend Down and Medicaid Look-Back Period.
Step 2: Call county IHSS if the person needs hands-on help at home
Call the county IHSS office and ask how to apply. The county social worker will assess the person’s need at home. The county will decide what tasks and hours can be approved.
Ask for the IHSS application and the Health Care Certification form. The Health Care Certification is often called SOC 873. Do not wait to gather medical proof.
Step 3: Call the HCBA Waiver Agency if care needs are high
If the person is at risk of nursing home or institutional placement, contact the HCBA Waiver Agency that serves the person’s county or ZIP code. DHCS says the application starts with the Waiver Agency.
Ask for the HCBA Waiver application, also known as DHCS 1320. If the person is already in a hospital, nursing facility, or other health care facility, tell the Waiver Agency how long the person has been there.
Step 4: Call MSSP if the person is 60 or older
If the person is 60 or older and needs nursing facility level care, contact the MSSP provider for the county. MSSP can assess the person and help arrange care management and services that may prevent or delay nursing home placement.
Step 5: Call the regional center for developmental disability services
If the person has an intellectual or developmental disability, call the regional center. Ask about regional center eligibility, the HCBS-DD Waiver, the Self-Determination Program, respite, supported living, home changes, and caregiver supports.
Phone script
“Hi, I help care for [name]. They have Medi-Cal or are applying. They need help with [bathing, dressing, toileting, meals, transfers, supervision, transportation, or medical care]. I need to know which program to apply for first: IHSS, HCBA Waiver, MSSP, ALW, or regional center services. Can you tell me the exact form, where to send it, and how to get a written decision?”
If the first answer is no, say: “Please tell me the reason in writing. Is there another Medi-Cal home care route, a waitlist, a grievance, or a state hearing right?”
Documents to gather
- Medi-Cal card or Benefits Identification Card, if the person has one.
- Medicare card, private insurance cards, and managed care plan letters.
- Photo ID, Social Security number, and proof of California address.
- Income and asset records requested by Medi-Cal or the county.
- Doctor names, diagnoses, medication list, and recent visit notes.
- Hospital, nursing facility, home health, or discharge papers.
- Proof of falls, wandering, unsafe transfers, feeding problems, or other safety risks.
- A daily care log showing what help is needed and how often.
- IHSS notices, waiver letters, waitlist letters, denials, and appeal papers.
- Power of attorney, conservatorship papers, authorized representative forms, or other permission forms if you help with applications.
If denied or waitlisted
Do not stop at a phone denial. Ask for the decision in writing. Written notices matter because they explain the reason and the appeal steps.
If Medi-Cal, IHSS, or services are denied
California hearing rules often use a 90-day deadline from the Notice of Action. CDSS says if you disagree with a county action, DHCS action, or Covered California eligibility decision, you have 90 days to request a state hearing. After 90 days, you must show good reason for being late.
For IHSS, the hearing rights notice says that if you ask for a hearing before an IHSS action takes place, services can continue until the hearing. If hours are being cut, act before the cut date on the notice.
Keep the envelope, notice, and all pages. Write down the date you received it. Ask for help fast if you do not understand the notice.
If the HCBA Waiver says waitlist
Ask the Waiver Agency to confirm that the application is complete and that the person is on the waiting list. Ask whether the person meets reserve-capacity criteria. Ask how to update the application if the person’s condition gets worse, enters a facility, or has a new discharge plan.
If a plan or agency says “we do not do that”
Ask which office does. In California, one family may deal with the county Medi-Cal office, county IHSS, a Medi-Cal managed care plan, an HCBA Waiver Agency, an MSSP site, a regional center, EDD, and local aging services.
Use clear words: “I am asking for long-term services and supports at home.” Also ask, “Can you screen for IHSS, HCBA, MSSP, ALW, regional center services, respite, and transportation?”
For more call wording, see caregiver phone scripts. For planning papers, see caregiver checklists. For respite help, see respite care for caregivers. To estimate care costs, see the care cost calculator.
FAQ
Is IHSS the same as an HCBS waiver?
No. IHSS is a California in-home care program, not the same as the HCBA Waiver or MSSP Waiver. But IHSS can work with waiver services. Many families should ask about IHSS first because it may approve in-home care hours and may allow a family member to become the paid provider.
Can a spouse be paid in California?
It depends on the program and task. IHSS has its own spouse-provider rules. For HCBA Waiver Personal Care Services, DHCS has special “extraordinary care” rules for spouse providers. Ask the county IHSS office or HCBA Waiver Agency to explain the current rule for your case.
Does the HCBA Waiver have a waitlist?
Yes. DHCS says the HCBA Waiver reached maximum capacity and a waiting list started July 12, 2023. New applicants are still encouraged to apply through the assigned Waiver Agency.
What if the person is already in a nursing facility?
Call the HCBA Waiver Agency and tell them the person is in a facility. Also ask the facility discharge planner about Medi-Cal long-term services and supports. DHCS lists reserve-capacity priority for some HCBA applicants who have lived in a health care facility for at least 60 days when the application is submitted.
Can VA benefits help too?
Possibly, if the person is an eligible veteran or surviving spouse. VA benefits are separate from Medi-Cal. Start with VA Aid and Attendance if the person needs help with daily care.
Are caregiver costs tax deductible?
Some care costs may affect taxes, but the rules are fact-specific. See caregiver tax deductions and talk with a qualified tax professional.
Resumen en español
En California, Medicaid se llama Medi-Cal. Algunos programas de Medi-Cal pueden ayudar a una persona a recibir cuidado en casa o en la comunidad en vez de vivir en un centro de cuidado.
Para ayuda en casa, muchas familias deben llamar primero a IHSS del condado. Si la persona tiene necesidades médicas altas o riesgo de cuidado en un asilo, pregunte por HCBA Waiver. Si tiene 60 años o más, pregunte también por MSSP. Si tiene una discapacidad del desarrollo, llame al centro regional.
Official sources used
- California Department of Health Care Services: 1915(c) Home and Community-Based Services Waivers
- California Department of Health Care Services: Home and Community-Based Alternatives Waiver
- California Department of Health Care Services: Waiver Personal Care Services
- California Department of Health Care Services: WPCS Frequently Asked Questions
- California Department of Health Care Services: HCBA Policy Letter 24-003, WPCS Parent and Spouse Providers
- California Department of Health Care Services: Assisted Living Waiver
- California Department of Aging: Multipurpose Senior Services Program
- California Department of Aging: MSSP Providers List
- California Department of Social Services: In-Home Supportive Services
- California Department of Social Services: County IHSS Offices
- California Department of Social Services: IHSS Provider Resources
- California Department of Health Care Services: Apply for Medi-Cal
- California Department of Health Care Services: Medi-Cal Fair Hearing
- California Department of Social Services: State Hearing Requests
- California Department of Developmental Services: Home and Community-Based Services Programs
- California Department of Developmental Services: Regional Centers
- California Department of Developmental Services: Self-Determination Program
- California Employment Development Department: Paid Family Leave
- California Employment Development Department: Paid Family Leave for Caregivers
- Medicaid.gov: Home & Community-Based Services 1915(c)
About this guide
This guide is for California caregivers who need a starting point for Medi-Cal home and community-based services. Program names, contractors, forms, and waitlist rules can change. Confirm details with DHCS, CDSS, CDA, DDS, EDD, the county, the waiver agency, the regional center, or the managed care plan before you act.
This is general information, not legal, tax, medical, or financial advice. For legal or tax questions, talk with a qualified professional in your state.
