Medi-Cal Waiver Program

For Consumers

Who w​​e are

The Medi-Cal Waiver Program (MCWP) provides comprehensive case management and direct care services to persons living with HIV (PLWH) as an alternative to nursing facility care or hospitalization. Case management is a participant centered, team approach consisting of a registered nurse and social work case manager. Case managers work with the participant and primary care provider(s), family, caregiver(s), and other service providers, to assess care needs to keep the participant in their home and community.

The goals of the MCWP are to: (1) provide home and community-based services for PLWH who may otherwise require institutional services; (2) assist participants with HIV health management; (3) improve access to social and behavioral health support and (4) coordinate service providers and eliminate duplication of services.

What we pro​vide

There are 17 MCWP providers located throughout California. MCWP providers served about 1,000 participants during 2022.

MCWP participant services include: attendant care, nurse and social work case management, home-delivered meals, homemaker services, minor physical adaptions to the home, non-emergency medical transportation, nutritional counseling, psychotherapy, skilled nursing (RN/LVN), specialized medical equipment/medical supplies, and nutritional supplements.

Who is eligible

Participants must have (1) a written diagnosis of HIV/AIDS, (2) a health status to make home care appropriate, (3) full-scope Medi-Cal eligibility, and (4) been certified to meet Nursing Facility Level of Care.

How to find a provider

To find a MCWP provider in your community,  please see the MCWP provider list​. 

For Providers

Centers for Medicare and Medicaid Services §1915(c) Home and Community-Based Services Waiver

​Current Waiver

On February 16, 2023, the Centers for Medicare and Medicaid Services (CMS) approved the renewal of the §1915(c) Home and Community-Based Services (HCBS) Waiver for the Medi-Cal Waiver Program (MCWP) for the period of January 1, 2023 to December 31, 2027. The MCWP Waiver is retroactively effective to January 1, 2023​. 

• MCWP Renewal Approved Letter (PDF)​​
• MCWP Waiver 2023–27 (PDF)​​
  

Approved Amendments​

On November 1, 2023, CMS approved an amendment to the §1915(c) HCBS MCWP Waiver to add telehealth as a permanent service delivery option for Psychotherapy, Case Management, and Nutritional Counseling, effective starting November 12, 2023.

• MCWP Telehealth Amendment Approval Letter (PDF)​​
  
• MCWP Telehealth Amendment 2023–27 (PDF)​​
  

​All Project Directors’ Letters 

• APDL 24-01: Guide for Operationalizing Telehealth as a Permanent Service Delivery Option for the Medi-Cal Waiver Program (PDF)​
  

• APDL 23-05: Full Scope Medi-Cal Eligibility Expansion for Older Adults (PDF)​
  

• APDL 23-04: Public Health Emergency Wind-Down (PDF)
  

• APDL 23-03: Waiver Agency Case Management Team to Participant Ratio (PDF)​
  

• APDL 23-02: Increase in MCWP Annual Individual Participant Cost Limit (PDF)​
  

• APDL 23-01: Key Changes to the 2023-2027 Medi-Cal Waiver Program Waiver (PDF)
  

• APDL 22-01: New Interim Procedure for Nursing Facility Level of Care Determination and Certification (PDF)
  

• APDL 17-03: Changes to Client Reassessment Timeframes and New Monthly Service Plan Monitoring Requirement (PDF)

• APDL 17-02: Increase in MCWP Annual Individual Client Cost Limit Amount (PDF)

• APDL 17-01: Increase in MCWP Reimbursement Rates for Homemaker and Attendant Care Service (PDF)

• APDL 16-03: Changes in MCWP Services in the AIDS Regional Information and Evaluation System (ARIES) (PDF)

• APDL 16-02: Comprehensive Service Plan – New Federal Requirements (PDF)
• APDL 16-01: Medi-Cal Waiver Program Protocols Update (PDF)
  

Scope of Work

• MCWP Scope of Work CY 2022–2025 (PDF)​
  

Electronic Visit Verification

Electronic Visit Verification (EVV) is a telephone and computer-based solution that electronically verifies in-home service visits occur. EVV solutions must verify: type of service performed, individual receiving the service, date of the service, location of service delivery, individual providing the services, and time the service begins and ends.

The implementation of EVV for personal care services (PCS) went live on January 1, 2022 and for Home Health Care Services (HHCS) on January 1, 2023. MCWP agencies and subcontractors subject to EVV requirements are required to comply with all EVV policies and procedures​.

MCWP services impacted by EVV:

• ​PCS:
• Services of home health/hospice aide in home health or hospice settings (G0156)
• Homemaker service (S5130)
• ​HHCS:
• Direct skilled nursing services of a registered nurse (RN) in the home health or hospice setting (G0299)
• Direct skilled nursing services of a licensed practical nurse (LPN) in the home health or hospice setting (G0300)

For more information on EVV, please see the California Department of Health Care Services Electronic Visit Verification Phase II website.​​

MCWP-Related Websites

• ​Medi-Cal Waiver Program Provider Manual​
  
• Medi-Cal Waiver Program Provider Bulletins​
  
• DHCS Medi-Cal Waivers​
  
• Medi-Cal Managed Care
  

MCWP HIPAA Notice of Privacy​ Practices

The MCWP is a program covered by the Health Insurance Portability and Accountability Act (HIPAA). The HIPAA Privacy Rule provides individuals the right to be informed of how their protected health information may be used and disclosed. The HIPAA MCWP Notice of Privacy Practices website has more information pertaining to this. For questions about the MCWP Notice of Privacy Practices please contact the CDPH Privacy Office at:

California Department of Public Health

Privacy Office, Office of Legal Services

Email: privacy@cdph.ca.gov

Telephone: (877) 421-9634 or

(877) 421-9634 (toll-free)

Contact Us​

Waiver participants and Waiver providers, please email your comments and questions regarding the MCWP Waiver to CDPHMCWP@cdph.ca.gov​ or call (916) 449-5900.