Assembly Member Bonta's proposal to overhaul California's Home and Community-Based Alternatives (HCBA) Waiver program mandates enrollment for all eligible applicants and requires a comprehensive evaluation of provider reimbursement rates. The legislation eliminates existing enrollment caps and directs the Department of Health Care Services to expand waiver capacity to accommodate all qualified individuals currently on waiting lists by March 2026.

The bill establishes new requirements for a detailed rate study, due by March 2026, examining the sustainability and effectiveness of current HCBA Waiver payment methods. This study must assess provider supply adequacy, workforce sustainability, regional cost variations, and options for future rate adjustments. The department must consult stakeholders while evaluating factors such as participant choice, service accessibility, and the fiscal impact of alternative payment approaches.

To expedite implementation, the legislation streamlines contracting processes for care management organizations while maintaining oversight provisions. These contractors must meet specific obligations regarding service delivery, financial reporting, and person-centered care models. The department retains authority to terminate contracts based on fiscal insolvency or to protect beneficiary health and program funds. All changes remain contingent on securing necessary federal approvals and maintaining federal financial participation.