California HCBS Waiver and Self-Determination Program for Individuals with Developmental Disabilities

How Do I Get Started?

To determine your eligibility for the Participant-Directed Program or Self-Determination Program, reach out to your local regional center. To find the regional center nearest to your place of residence, please go to: https://www.dds.ca.gov/rc/listings/

Know Your Rights

Under the Lanterman Act, California is the only state in which the right of individuals with intellectual and developmental disabilities to be supported in the least restrictive environment is construed as a civil right and an individual entitlement – not merely a right to “take a number and wait in line” until sufficient state resources become available.

Eligibility does not depend on immigration status; even undocumented residents are entitled to receive benefits under the Lanterman Act.

Not on the HCBS Waiver or SDP Waiver?

If there is not a spot available on a Waiver or your local regional center chooses to not put you on a Waiver, you are still entitled to receive Participant-Directed or Self-Determination services under the Lanterman Act.

How to Enroll

To enroll in the Participant-Directed Program or Self-Determination Program, an individual must first qualify for Lanterman Act Services. To do so, you will need to go through a review process with your local regional center.

An applicant is developmentally disabled under California law if (s)he developed a disability:

- Before turning 18
- That continues, or can be expected to continue, indefinitely
- That constitutes a substantial disability
- That includes an intellectual disability, cerebral palsy, epilepsy, autism and/or a disabling condition that is closely related to intellectual disability or requires treatment similar to that required for individuals with an intellectual disability

The process to qualify for Participant-Directed or Self-Determination services consists of at least five steps:

1. The individual must be found eligible for services under the Lanterman Act
2. The regional center must confirm that the individual meets the community residence requirement
3. The individual must enroll in federally-funded Medi-Cal through a county department of social services
4. The individual must receive at least one purchase of service (POS) from his/her regional center (RC) that qualifies for federal reimbursement
5. A determination may be made regarding whether the individual’s disability is sufficiently severe to qualify him/her for an institutional level of care. If this determination takes place and the individual meets the applicant standard, (s)he may consent to enroll in the HCBS Waiver consent. If the fifth step does not take place or the individual does not meet the requirement, (s)he may still consent to enroll in the In-Home Support Services State Plan Amendment (1915(i) SPA)

How to Prepare for Your Meeting with the Regional Center

Each regional center has its own application process. They all start out by asking for your home address to make sure you are applying to the right center. Then, they ask you for other personal information and give you an appointment to meet with someone at the regional center.

For your first meeting, we recommend you have every document that you think helps prove your diagnosis or condition, or describes your abilities and your needs, including:

- School records (including Individual Education Plans or psychological evaluations), medical records, work history, Social Security Records
- Evaluations and assessments
  - All psychological evaluations that show your conditions and diagnosis
  - The results of any adaptive skills (daily living skills) testing
- Other documents that describe you and/or your skills, like your work skills, the way you do things at home, and any other skills that show your condition.
- Letters from family members and neighbors that describe their observations of you
- Any other information that correctly describes your abilities and your disabilities

The regional center will photocopy – or ask for a photocopy – of your documents. They will also ask for your written permission to contact your doctors, schools, employers and others who may have information about you. They cannot get copies of your records without your permission.

Important! You should take notes during each step of this process. Write down the date of your first contact and the date of your first meeting with the staff (this is called the intake meeting). The regional center must tell you if you are eligible within 120 days of your first appointment (or 60 days for more urgent cases).

What Happens After You Qualify for Self-Determination?

Once you qualify for the Self-Determination Program, there will be another series of steps to ensure that you are receiving the services and support that you need.

This flow chart outlines the process:

Participant-Directed or Self-Determination Services: Which is Right For Me?

Participant-Directed Program

The Participant-Directed Program is an option for individuals of all ages who qualify for the Home and Community Based Services (HCBS) Waiver for Californians with Developmental Disabilities, and have the desire to self-direct Family Support Services, Community Based Training Services, Skilled Nursing, Respite Care, Financial Management Services, and non-Medical Transportation. Under this Program, participants have employer authority to hire, fire, schedule, and train their caregivers. While it offers a great deal of flexibility for participants, it does not offer as much freedom to control services and budget as the Self-Determination Program.

Important Notice: Due to the state’s temporary executive order, through June 28, 2020, people on the HCBS Waiver can temporarily self-direct additional services: Personal Assistance, Independent Living Skills and Supportive Employment.

Additional Participant-Directed Services Under the State’s Temporary Executive Order

In order for participants and families to temporarily access the additional Participant-Directed services, the following steps should be followed:

- The participant and/or family member identifies a person/people they want to provide the service(s). The person:
  - Must have the ability to perform the work as verified by the participant/family
  - Must be 18 years or older
  - Cannot be the participant’s spouse or parent for personal assistance or independent living skills
- The participant and/or family must use a Financial Management Service (FMS) provider to handle payroll, taxes, reporting, etc.:
  - Regional center assists in identifying available FMS providers
  - Regional center explains the types of FMS (Fiscal Agent vs Co-Employer) to help the participant/family determine the best type for their situation
  - The participant/family chooses which FMS provider they will use
- Worker submits required paperwork to the chosen FMS provider
  - Verification of age
  - Employment and federal disclosure information
- The individual can begin working as soon as all required paperwork is received by the FMS
- A separate vendorization of the participant or individual providing the service is not required
- Regional center creates authorization with FMS provider using sub-codes below in combination with either service code 490 or 491:
  - PA – Personal Assistance
  - ILS – Independent Living Services
  - SEP – Supported Employment Programs
- The rate paid to the FMS is $22.80 per hour and includes the following:
  - Employee wage of no less than $16.26 per hour
  - Mandated employer costs (estimated at 22% of the employee wage)
  - FMS cost (estimated at 15% of the total wage and employer costs)

About the HCBS Waiver for Californians with Developmental Disabilities

California’s HCBS Waiver offers community-based services not otherwise available through a participant’s Medicaid Program. The purpose of the HCBS Waiver is to serve participants in their own homes and communities as an alternative to placing Medicaid-eligible individuals in intermediate care facilities for persons with developmental disabilities. The HCBS Waiver program recognizes that many individuals at risk of being placed in these facilities can be cared for in their homes and communities, preserving their independence and ties to family and friends at a cost no higher than that of institution care.

Community-based services for individuals with developmental disabilities are provided through a statewide system of 21 private, non-profit corporations known as regional centers. Regional centers, as established by the Lanterman Developmental Disabilities Service Act, provide fixed points of contact in the community for persons with developmental disabilities and their families. Regional centers coordinate and/or provide community-based services to eligible individuals. The Regional centers are community-based nonprofit corporations governed by volunteer Boards of Directors that include individuals with developmental disabilities, their families, a representative of the vendor community, and other defined community representatives.

Regional centers are funded through contracts with the State Department of Developmental Services (DDS). They are responsible for the provision of outreach; intake, assessment, evaluation and diagnostic services; and case management/service coordination for persons with developmental disabilities and persons who are at risk of becoming developmentally disabled. In addition, regional centers are responsible for developing, maintaining, monitoring and funding a wide range of services and supports to implement the plans of care – known as Individual Program Plans (IPP) – for participants. The IPPs are developed using a person-centered planning approach. Regional centers also conduct quality assurance activities in the community, and maintain and monitor a wide array of qualified service providers.

Regional centers are responsible for ensuring that eligible participants who want to participate on the Waiver are enrolled, service providers meet the qualifications for providing Waiver services, IPPs are developed and monitored, participant health and welfare is addressed and monitored, and financial accountability is assured.

DDS ensures, under the oversight of the Department of Health Care Services, the State Medicaid agency, that the HCBS Waiver is implemented by regional center in accordance with Medicaid law and the State’s approved Waiver application. The HCBS Waiver affords Californians the flexibility to develop and implement creative, community alternatives to institutions. Californians HCBS Waiver services are available to regional center participants who are Medicaid (Medi-Cal in California) eligible and meet the level of care requirements for an intermediate care facility serving individuals with developmental disabilities.

California’s first Home and Community Based Services Waiver for Californians with developmental disabilities was approved effective July 1982 with a total enrollment cap of 3,360. This Waiver amendment application seeks to enroll up to 150,000 individuals by December 31, 2022.

Self-Determination

The Self-Determination Program is an option for Californians who qualify for services under the California Self-Determination Program Waiver for Individuals with Developmental Disabilities. This program offers individuals the freedom to self-direct all services that they qualify to receive. Under this Program, participants have employer authority and budget authority.

This program is currently in pre-launch, with 2,500 individuals qualified to receive services, and a waitlist of 7,500+ individuals. The program opens state-wide in June 2021.

To be added to the waitlist, so that you can start receiving services should a spot open up or upon the program’s June 2021 launch, contact your local regional center. To find the regional center nearest to your place of residence, please go to: https://www.dds.ca.gov/rc/listings/.

About the California Self-Determination Program Waiver for Individuals with Developmental Disabilities

California’s Self Determination Program (SDP) Waiver for Individuals with Developmental Disabilities offers home and community-based services not otherwise available through a participant’s Medicaid program. The purpose of the SDP Waiver is to serve participants in their own homes and communities as an alternative to receiving services in an intermediate care facility for persons with developmental disabilities. The SDP Waiver allows participants the opportunity to accept greater control and responsibility regarding the delivery of needed services. With the receipt of appropriate supports and information, participants will be able to manage their service mix within an individual budget amount to achieve the goals and objectives of their individual program plans.

In California, community-based services for individuals with developmental disabilities are provided through a statewide system of 21 private, non-profit corporations known as regional centers. Regional centers, as established by the Lanterman Developmental Disabilities Service Act, provide fixed points of contact in the community for persons with developmental disabilities and their families. Regional centers coordinate and/or provide community-based services to eligible individuals. The regional centers are community-based nonprofit corporations governed by volunteer Boards of Directors that include individuals with developmental disabilities, their families, a representative of the vendor community, and other defined community representatives.

Regional centers are funded through contracts with the State Department of Developmental Services (DDS). They are responsible for the provision of outreach; intake, assessment, evaluation and diagnostic services; and case management/service coordination for persons with developmental disabilities and persons who are at risk of becoming developmentally disabled. In addition, regional centers are responsible for developing, maintaining, monitoring and funding a wide range of services and supports to implement the plans of care [or individual program plans (IPP)] for participants. The IPPs are developed using a person-centered planning approach.

DDS ensures, under the oversight of the Department of Health Care Services (DHCS), the State Medicaid Agency, that the SDP Waiver is implemented by regional centers in accordance with Medicaid law and the State’s approved Waiver application.