California Medi-Cal Long-Term Care

California's version of Medicaid, Medi-Cal, moved its long-term-care benefit fully into managed care under the CalAIM initiative. Skilled nursing facility care became a statewide Medi-Cal managed-care responsibility on January 1, 2023, and ICF/DD placements plus specified adult and pediatric subacute care followed a year later on January 1, 2024 — though ICF/DD-Continuous Nursing Care was left out of that carve-in (DHCS, CalAIM Long-Term Care Carve-In).

For care delivered outside an institution, the Department of Health Care Services lists several 1915(c) waiver options: the Assisted Living Waiver, the Home and Community-Based Alternatives Waiver, the Multipurpose Senior Services Program, California Community Transitions, and the Medi-Cal Waiver Program. Each requires full-scope Medi-Cal enrollment, a medical-necessity finding, and the relevant nursing-facility or acute-hospital level of care (DHCS, 1915(c) HCBS Waivers).