An act to amend Section 14132.991 of, and to add Section 14132.992 to, the Welfare and Institutions Code, relating to Medi-Cal.
AB 315 would revise California’s Medi-Cal Home and Community-Based Alternatives (HCBA) Waiver rules to emphasize full enrollment of eligible applicants and to address long-standing concerns about provider capacity and reimbursement rates. The bill recasts existing statutory references from the older Nursing Facility/Acute Hospital Transition and Diversion Waiver to the HCBA Waiver, and it removes language that allowed the department to expand waiver slots by up to 5,000. In its place, the bill requires the Department of Health Care Services to enroll all eligible individuals who apply, and to seek any waiver amendments needed to ensure that people on the waiting list can be served and that no one is placed on a waiting list going forward.
The bill also requires the department, by March 1, 2026, to submit a rate study to the Legislature on the sustainability, quality, and transparency of HCBA Waiver rates. That study must examine whether current payment methods provide enough providers and workforce capacity, whether rates keep pace with inflation, how alternative rate methodologies would affect state costs, regional cost differences, and options for future rate increases, including possible links to skilled nursing facility rates or consumer price indices. The bill’s findings state that HCBA rates have been stagnant since 2007, contributing to provider shortages and service access problems, and that better reimbursement is needed before certain HCBS services are transitioned into Medi-Cal managed care plans.
AB 315 would affect Welfare and Institutions Code Section 14132.991 and add new Section 14132.992. It would preserve the department’s authority to contract with care management contractors, require person-centered care coordination, and allow implementation through departmental guidance rather than formal regulation. It also keeps the bill contingent on federal approval, federal cost neutrality, and federal financial participation, reflecting the fact that the HCBA Waiver operates within federal Medicaid requirements.
The general sentiment reflected in the bill text and vote history is supportive of expanding access to home- and community-based care. The bill passed the Assembly Appropriations Committee unanimously on a 14-0 vote, suggesting broad committee support at that stage. The findings frame the measure as a way to prevent unnecessary institutionalization, improve independence and quality of life, and strengthen the provider network serving disabled older adults and people with disabilities.
The main points of contention are likely fiscal and operational rather than philosophical. The bill would require universal enrollment of eligible applicants, which could increase state obligations if federal waiver amendments are approved, and it directs the department to monitor capacity and expand it before waiting lists form. It also raises the issue of rate adequacy, with the bill explicitly criticizing stagnant reimbursement and calling for a study that could support future rate increases. Another potential issue is the interaction with the state’s planned move to integrate some HCBS services into Medi-Cal managed care by 2028, since the bill is intended to shore up the waiver system before that transition.
AB 315 would amend the Medi-Cal statutory framework governing the HCBA Waiver by replacing references to the older transition/diversion waiver structure, requiring enrollment of all eligible HCBA applicants, and mandating proactive waiver amendments to eliminate waiting lists. It would also add a new reporting requirement for a legislative rate study, which could influence future reimbursement policy for HCBA services and related home- and community-based care programs. The bill would not itself appropriate funds, but it could have significant fiscal implications depending on federal approval, waiver amendments, and any future rate changes that follow from the required study.
The available voting record indicates strong support, with the bill passing the Assembly Appropriations Committee 14-0. The bill’s findings and structure show a clear policy preference for expanding access to home-based care, stabilizing provider participation, and preventing institutional placement. No committee transcript is available, but the introduced text suggests the measure is framed as a response to provider shortages, waiting lists, and stagnant rates rather than as a controversial program redesign.
The likely areas of disagreement are cost, implementation, and federal approval. Requiring enrollment of all eligible applicants and eliminating waiting lists could increase service demand and state exposure, while the bill conditions implementation on federal cost neutrality and federal Medicaid approval. The rate study requirement signals concern that current HCBA reimbursement is too low, which may prompt debate over how much to raise rates, how to pay for increases, and whether to tie future increases to inflation or other benchmarks. There may also be concern about how this bill interacts with the Department of Health Care Services’ planned transition of some HCBS services into managed care by 2028.