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.

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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 

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