California Medicaid pays for in-home personal care and related services through 2 programs, including the Home and Community-Based Alternatives (HCBA) Waiver and the Home and Community-Based Services Waiver for the Developmentally Disabled (HCBS-DD). California has 1915(c) HCBS waivers administered by DHCS. Waiver Personal Care Services (WPCS) is offered for individuals with complex medical needs through the HCBA Waiver. Recipients must have full-scope Medi-Cal eligibility. The IHSS program (Welfare & Institutions Code §12300) is a separate state-plan personal care program rather than a 1915(c) waiver.
Which California waivers can a home care agency bill?
Each waiver below lists who it covers, the services it pays for, and how providers bill.
Home and Community-Based Alternatives (HCBA) Waiver
Population
Aged and disabled individuals of all ages who are at risk of nursing home or institutional placement and have full-scope Medi-Cal eligibility
Services covered
case management
community transition services
private duty nursing
family training
home health aide
habilitation services
waiver personal care services (WPCS)
Billing format
EVV via CalEVV (Sandata) or Alternate EVV system; submitted to Medi-Cal
To bill Medicaid for home care you need a state license, a Type 2 NPI, state Medicaid enrollment and screening, waiver or managed care contracts, EVV and authorizations.
Private pay means higher rates and fast payment; Medicaid means steady volume at state-set rates with authorizations and EVV. Compare rates, cash timing and admin before you mix them.
Track units remaining, the end date and the service code for every client, and check them before each schedule change. Hours over the cap are unbillable.
Four units equal one hour. How to convert units to hours, the common HCPCS codes, how states round partial units, and how to stay inside the authorization.
These free tools are made by the team behind Caregiver Scheduling,
caregiver scheduling software for home care agencies.
Simple pricing
From$199/month
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