Medi-Cal (California Medicaid) Community-Based Adult Services (CBAS) Program

Last updated: March 26, 2024

 

Overview of Medi-Cal Community-Based Adult Services Program

California’s Community-Based Adult Services (CBAS) Program is an adult day health care program for seniors and adults who are disabled or have chronic medical, cognitive, or behavioral conditions. Intended to prevent and delay premature nursing home admissions, supportive services are provided in adult day health care centers that are certified as CBAS centers. This includes daytime supervision, nursing services, personal care assistance, and transportation to and from the CBAS center.

CBAS centers are not located in all CA counties. Currently, there are nearly 300 centers within 26 counties: Alameda, Butte, Contra Costa, Fresno, Humboldt, Imperial, Kern, Los Angeles, Merced, Monterey, Napa, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Shasta, Solano, Stanislaus, Ventura, and Yolo. If there is not a CBAS center in one’s county, they may be able to attend a CBAS center in a neighboring county if it is within an hour drive from their home.

While many home and community based services (HCBS) Medicaid programs allow program participants to self-direct their own care, specifically allowing them to hire their own caregiver, this is not an option through the CBAS Program. However, program participants have a say in which CBAS center they would like to attend.

Community-Based Adult Services are not an entitlement. This means applicants who meet eligibility requirements are not guaranteed immediate receipt of adult day health care. CBAS centers have limited capacity and when capacity is reached, a waitlist forms. CBAS centers are individually owned and operated, and therefore, any waitlist(s) that exist are CBAS center specific.

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The Community-Based Adult Services (CBAS) Program operates under an 1115 Medicaid Waiver called CalAIM (California Advancing and Innovating Medi-Cal). In 2012, CBAS replaced the Adult Day Health Care (ADHC) Program. CBAS is an available benefit for persons enrolled in CA’s State Plan Medicaid. In California, the Medicaid program is called Medi-Cal.

 Other Options: Seniors might also be interested in the Medi-Cal In-Home Supportive Services Program (IHSS Program). IHSS provides in-home personal care and homemaker services. Another option is California’s Home and Community Based Alternatives Waiver (HCBA Waiver), which provides a wide variety of long-term services and supports.

 

Benefits of Medi-Cal Community-Based Adult Services Program

Community-Based Adult Services are provided in adult day health centers that are certified as CBAS centers. The hours of operation vary based on the center. However, all centers must be open at least 5 days a week for a minimum of 6 hours / day. Centers cannot be open longer than 12 hours / day. While available benefits may include the following, an individual assessment determines the exact services and supports one receives.
– Care Coordination
– Meals
– Mental Health Services
– Personal Care Services
– Professional Nursing Services
– Registered Dietician Services (i.e., nutrition assessment, dietary education)
– Social Services
– Therapeutic Activities (individual or group)
– Therapies (physical, speech, occupational)
– Training / Support (for families and caregivers)
– Transportation (to / from home and CBAS center)

 

Eligibility Requirements for Medi-Cal Community-Based Adult Services Program

CBAS is for California residents who are aged 18 or older. Applicants must reside in a county in which there is a CBAS center or live within an hour drive from a CBAS center in a nearby county. Currently, there are CBAS centers located in the following California counties: Alameda, Butte, Contra Costa, Fresno, Humboldt, Imperial, Kern, Los Angeles, Merced, Monterey, Napa, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Shasta, Solano, Stanislaus, Ventura, and Yolo. Additional eligibility criteria for CBAS follows.

 

Financial Criteria: Income and Assets

Income
The applicant income limit is equivalent to 138% of the Federal Poverty Level (FPL), which increases annually in January. For Medi-Cal, however, the income limit increases in April. Effective 4/1/24, a single applicant can have a monthly income up to $1,732. When both spouses are applicants, the income limit is $2,352 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of their spouse. Only the applicant spouse’s income is considered, which is limited to $1,732 / month. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance. In 2024, the maximum amount that can be transferred is $3,854 / month. This is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. Non-applicant spouses who have their own income equal to or greater than this amount are not entitled to a Spousal Income Allowance.

Assets
There is no asset limit (effective 1/1/24). An applicant’s assets, regardless of value, are not considered in the eligibility process.

There is a Look-Back Period during which Medi-Cal scrutinizes past asset transfers of persons applying for Medicaid-funded nursing home care, but it is not applicable to persons applying for the Community-Based Adult Services Program. However, if one may require Nursing Home Medicaid in the near future, it may be applicable. With the elimination of the asset limit, assets transferred on or after 1/1/24 are not considered. Assets transferred prior to 1/1/24 are still being scrutinized, but the 30-month “look back” is being phased out month-by-month and will no longer exist by July of 2026.

While all assets are disregarded when determining Medi-Cal eligibility, one’s assets are not necessarily safe from the Medicaid Estate Recovery Program (MERP). Following the death of a long-term care Medicaid beneficiary, the state attempts reimbursement of long-term care costs for which it paid for that individual via their remaining estate. This may include one’s home. With the utilization of proper planning strategies, one can protect their home and other assets from being used as reimbursement and instead go to loved ones as inheritance. Contact an Experienced Medi-Cal Planner for assistance.

 

Medical Criteria: Functional Need

While an applicant can require a Nursing Facility Level of Care (NFLOC), this high of a level of care need is not necessary to be eligible for Community-Based Adult Services. Other eligibility categories include persons with Alzheimer’s disease or related dementias, persons with Traumatic Brain Injury, and persons with chronic mental illness. To determine if one is functionally eligible, the CBAS Eligibility Determination Tool (CEDT) is used.

While the exact functional eligibility criteria varies based on the eligibility category, an applicant’s ability to complete their Activities of Daily Living (ADLs) and Instrumental Activities of Daily Living (IADLs) is considered. Examples of ADLs and IADLs include bathing, mobility, dressing, medication management, meal preparation, and money management. Relevant to persons with Alzheimer’s disease or a related dementia, cognitive impairments, such as memory, decision making, and judgment, are also considered. A diagnosis of dementia in and of itself does not mean one is functionally eligible.

 Learn more about long-term care Medicaid in California.

 

Qualifying When Over the Limits

Having income over Medicaid’s limit does not mean an applicant cannot still qualify for Community-Based Adult Services. Medi-Cal has a Share of Cost Program, which may also be called a Medically Needy Program. With this program, an applicant with “excess” income has to pay towards the cost of their care services / medical expenses. This is their “share of cost” and is based on their monthly income. It can be thought of as a deductible and once it has been paid for the month, Medi-Cal will pay for Community-Based Adult Services. Professional Medicaid Planners can assist persons in lowering their “share of cost”. Find a Medicaid Planner.

 

How to Apply for Medi-Cal Community-Based Adult Services Program

Before You Apply

Prior to submitting an application for CBAS, applicants need to ensure they meet the Medi-Cal eligibility criteria. Applying when over the income limit can be cause for denial of benefits. The American Council on Aging offers a Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.

As part of the application process, applicants will need to gather documentation for submission. Examples include proof of income and copies of Social Security and Medicare cards. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.

Since CBAS is not an entitlement program, some CBAS centers may have a waitlist for program participation. In the case of a waitlist, each CBAS center determines how their waitlist operates and if certain persons are prioritized. Applicants can be on a waitlist at multiple CBAS centers.

 

Application Process

To apply for the CBAS Program, one must complete an Application for Health Insurance and be determined eligible for Medi-Cal
It should be indicated on the application that long-term home and community based care is needed. Persons who require assistance with completing the application can call Covered California’s Customer Service Center at 1-800-300-1506. Persons can also apply online for Medi-Cal at CoveredCA.com or over the phone / in person at one’s Department of Health Care Services county office. As part of the application process for CBAS, a functional needs assessment will be completed once it is determined one is eligible for Medi-Cal.

There are approximately 292 CBAS centers in CA. See a current list of centers or a service area map.

Learn more about the Community-Based Adult Services Program. Alternatively, persons can call the Senior Information Line at 800-510-2020.

The CBAS Program is administered by the California Department of Health Care Services (DHCS), the California Department of Aging (CDA), and the California Department of Public Health (CDPH). CBAS Centers must be licensed as Adult Day Health Care (ADHC) centers by CDPH. The CDA certifies ADHC centers as CBAS centers.

 

Approval Process & Timing

The Medi-Cal application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as waitlists may exist, approved applicants may spend many months waiting to receive benefits.

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