HCBA

San Ysidro Health has been assigned by the Department of Health Care Services (DHCS) to provide administrative services and Comprehensive Care Management services, under the Medi-Cal HCBA to San Diego County participants.

How to contact us:
Toll free number: 1-833-503-5910
e-mail: caremanagement@syhealth.org

What is HCBA Waiver Program?
The Home and Community-Based Waiver program offers Medi-Cal services to a limited number of people with disabilities and/or chronic health conditions to help them live at home instead of in a nursing facility or other Medi-Cal funded institution. People are eligible as long as they would qualify for admission to: a nursing facility (including an intermediate care facility), a subacute facility, or an acute care hospital.

The HCBA Waiver Program was implemented by DHCS (California Department of Health Care Services) to “waive” Medicaid eligibility criteria to provide services to individuals with disabilities and/or chronic health conditions. Those who would qualify under the Waiver Program are those who otherwise would not be able to reside in the comfort of their own home.

How patients qualify to be on the HCBA Waiver?
To ensure minimum eligibility criteria have been met, the patient MUST require the provision of at least one Waiver service, at least once a month, and meet either of the following eligibility criteria:

  1. The individual has been in an institutional setting for at least 90 days, and will remain there if not for the provision of HCBA Waiver services in the home or community setting; or
  2. The individual must be a current Medi-cal member who will turn 21 years of age during the current calendar year and has been receiving, or has been authorized to receive, private duty nursing services for at least 6 months prior to his/her 21st birthday; or
  3. The patient is residing in the community and is at a high risk of institutionalization. 

Once the patient has been deemed eligible for HCBA Waiver enrollment, the Care Management Team will assess the HCBA application and determine if the patient meets priority enrollment or if the patient needs to be placed on a waiting list

What does the HCBA Waiver Do?
The HCBA Waiver allows Medi-Cal beneficiaries with high- level care needs to continue to live at home or in the community by identifying and ensuring applicants receive services that will sustain their health care needs and safety outside of an institution. Some of the services that may be provided to support Waiver participants in the community include but are not limited to:

– In-home nursing services
– Waiver personal care services
– Family/caregiver training
– Home or facility respite
– Habilitation services
– Community transition services
– Environmental accessibility adaptation
– Medical equipment operating expenses
– Personal Emergency Response System (PERS) installation, testing, and operation

Hours of operation
Monday to Friday,   8:00 am to 5:00 pm
Contact us for any question about HCBA Waiver program at:
Toll free number: 1-833-503-5910
e-mail: caremanagement@syhealth.org

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