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 medical, cognitive, or behavioral conditions that are chronic. 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 available in all CA counties. Currently, they are located within 28 counties. This includes Alameda, Butte, Contra Costa, Fresno, Humboldt, Imperial, Kern, Los Angeles, Marin, Merced, Monterey, Napa, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, 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.
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.
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 per 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
– Mental Health Services
– Personal Care Services
– Professional Nursing Services
– Registered Dietitian Services
– Social Services
– Therapeutic Activities
– 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, Marin, Merced, Monterey, Napa, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Barbara, Santa Clara, Santa Cruz, Shasta, Solano, Stanislaus, Ventura, and Yolo.
Additional eligibility criteria for CBAS follows.
Financial Criteria: Income, Assets & Home Ownership
The applicant income limit is equivalent to 138% of the Federal Poverty Level (FPL), which increases on an annual basis. From April 2022 – March 2023, a single applicant can have a monthly income up to $1,564. When both spouses are applicants, the income limit is $2,106 / 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 $1,564 / 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.
The maximum amount that can be transferred is $3,435 / month (eff. 1/22 – 12/22). 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.
In 2022, the asset limit is $130,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is set at $195,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are still limited. This is because Medicaid considers the assets of a married couple to be jointly owned. In this case, the applicant spouse can have up to $130,000 in assets, while the non-applicant spouse is allocated a larger portion of the couple’s assets as a community spouse resource allowance to prevent spousal impoverishment. In 2022, the CSRA allows the non-applicant spouse to keep up to $137,400 in assets.
Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.
Medi-Cal has a look back rule in which assets should not be given away or sold under fair market value within 30-months of application. However, this “look back period” is only applicable to persons who apply for nursing home Medi-Cal.
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take their home. Fortunately, for Medi-Cal eligibility purposes, Medicaid considers the home exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has a written “intent” to return home. California is unique from other states in that there is no home equity interest limit. Home equity is the current value of the home minus any outstanding mortgage. Equity interest is the portion of the home’s equity value that is owned by the applicant.
– A non-applicant spouse lives in the home.
– The applicant has a dependent relative, such as a disabled child, living in the home.
– The applicant has a child under 21 years of age living in the home.
While the home is likely exempt while one is receiving Medi-Cal benefits, it may not be safe from Medicaid’s estate recovery program. To learn more about when Medicaid can and cannot take one’s home, click here.
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. Note that a diagnosis of dementia in and of itself does not mean one is functionally eligible.
For more information about long-term care Medicaid in California, click here.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit(s) does not mean an applicant cannot still qualify for Community-Based Adult Services. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.
Medi-Cal has a share of cost program, which may also be referred to as a medically needy program. With this program, an applicant with income over Medi-Cal’s income limit has to pay towards the cost of their care services / medical expenses, which is their “share of cost”. This can be thought of as a deductible and is based on one’s monthly income. Once one has paid their share of cost for the month, Medi-Cal will pay for Community-Based Adult Services. Learn more about the medically needy pathway to eligibility.
When persons have assets over the limits, Irrevocable Funeral Trusts (IFTs) are an option. They are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option, which turns countable assets into a stream of income, are annuities. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid planners are educated in the planning strategies available in California to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. Some of these planning strategies also serve to protect assets for family as inheritance. Unfortunately, these strategies often violate Medi-Cal’s 30-month look back rule. As persons might require Medi-Cal funded nursing home care in the future, these strategies should be implemented well in advance of the need for such potential care. There are, however, some workarounds, and Medicaid planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). 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 and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.
As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, previous bank statements, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, 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.
To apply for the CBAS Program, one must complete an application, and be determined eligible, for Medi-Cal. An application can be downloaded here. 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.
Throughout the state, there are approximately 278 CBAS centers. A current list of centers can be found here.
For additional information about the Community-Based Adult Services Program, click here. 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 Medicaid 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 even further. 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.