HCBA Waiver Agency

The HCBA Waiver provides care management services to persons at risk for nursing home or institutional placement. The care management services are provided by a multidisciplinary care team comprised of a nurse and social worker. The care management team coordinates the HCBA Waiver and State Plan services (e.g., medical, behavioral health, In-Home Supportive Services, etc.), and arranges for other available long-term services and supports available in the local community. Care management and HCBA Waiver services are provided in the Participant’s community-based residence. This residence can be privately owned, secured through a tenant lease arrangement, or the residence of a Participant’s family member. See the links below to download the HCBA Waiver Form in English or Spanish.

Download the HCBA Waiver Form

Download the HCBA Waiver Form (Español)


When complete, mail this application to the following address: 5805 Sepulveda Boulevard, Suite 605, Sherman Oaks, CA 91411 


Or submit the application by secure FAX: (818) 788-7824 

List of HCBA Providers (CHLF, HHA & PCA):

Congregate Living Health Facilities:       PDF          XLS

Home Health Agencies:                           PDF          XLS

Personal Care Agencies:                          PDF          XLS

Independent Nurse Practitioner:             PDF          XLS