CA AIDS Medi-Cal Waiver Program

The AIDS Medi-Cal Waiver Program (MCWP) is designed to provide an alternative to nursing facility care or hospitalization for individuals who meet specific criteria. In this article, we cover the MCWP, how it works, and how it can benefit you and your caregivers.

Overview of the AIDS Medi-Cal Waiver Program

The MCWP is a Medicaid waiver program established in 1987 and renewed in 2023 for a five-year period. The purpose of the MCWP is to improve the quality of life and health outcomes of individuals living with HIV or AIDS who are at risk of institutionalization or need assistance with activities of daily living (ADLs) or instrumental activities of daily living (IADLs). The MCWP serves individuals eligible for full-scope Medi-Cal benefits diagnosed with HIV or AIDS, who have a physician’s certification of the need for skilled nursing facility level of care, and who meet other clinical and financial criteria. The MCWP is administered by the California Department of Public Health (CDPH), Office of AIDS, in collaboration with the Department of Health Care Services (DHCS) and local agencies that provide case management and service coordination.

Eligibility requirements

To qualify for the MCWP, you must meet the following eligibility requirements:

• Be a resident of California.
• Be eligible for full-scope Medi-Cal benefits.
• Have a diagnosis of HIV or AIDS.
• Have a physician’s certification of need for skilled nursing facility level of care.
• Have a CD4 count of less than 200 cells/mm3 or an opportunistic infection within the past 12 months.
• Have an unmet need for at least one MCWP service.
• Have a monthly income of less than 300% of the Supplemental Security Income (SSI) federal benefit rate.
• Have countable resources of less than $2,000 for an individual or $3,000 for a couple

Services and supports

The MCWP offers a range of services and supports that are tailored to your individual needs and preferences. These services and supports include:

• Case management: A service coordinator will help you assess your needs, develop a care plan, arrange and monitor services, and provide referrals and advocacy.
• Skilled nursing: A registered nurse or licensed vocational nurse will provide skilled nursing care in your home or other setting.
• Home health aide: A certified home health aide will assist you with personal care, such as bathing, dressing, grooming, toileting, and transferring.
• Personal care services: A personal care attendant will help you with ADLs and IADLs, such as meal preparation, housekeeping, laundry, shopping, and transportation.
• Hospice: A hospice team will provide palliative care and support to you and your family if you have a terminal illness with a life expectancy of six months or less.
• Minor home modifications: A contractor will make minor changes to your home to improve your safety and accessibility, such as installing grab bars, ramps, or handrails.
• Durable medical equipment: A provider will supply you with medically necessary equipment, such as wheelchairs, walkers, oxygen tanks, or hospital beds.
• Medical supplies: A provider will provide necessary supplies, such as bandages, catheters, gloves, or syringes.
• Nutritional supplements: A provider will supply you with medically essential dietary supplements, such as Ensure or Boost.
• Mental health counseling: A licensed mental health professional will provide individual or group counseling to help you cope with emotional issues related to your condition.
• Substance use counseling: A certified substance use counselor will provide individual or group counseling to help you address substance use issues that affect your health.
• Family/caregiver training: A trainer will teach your family members or caregivers how to care for you at home.

Compensation for caregivers

One of the benefits of the MCWP is that it allows you to self-direct your personal care services, meaning that you can choose who provides your personal care services, including hiring a family member as a caregiver. You can also decide how much to pay your caregiver within the limits set by the program. The MCWP pays your caregiver directly through an intermediary service organization (ISO) that handles payroll, taxes, insurance, and background checks. The ISO also provides training and support to your caregiver. By self-directing your personal care services, you can have more control over your care and reward your family members for their work.

A note from Givers

If you want to learn more about the MCWP or other programs that might compensate family caregivers, please fill out this form, and we will contact you soon. We are here to help you find the best options for your situation and advocate for your rights as a caregiver.