I/DD Waivers in California

All states: Medicaid disability services map

California I/DD services at a glance

Last verified against state sources: 2026-10-23.

Who runs I/DD services in California?

The Department of Developmental Services (DDS) runs I/DD services in California, working under the Department of Health Care Services (DHCS), the state Medicaid agency. California calls its Medicaid program Medi-Cal. DDS does not serve people directly. It oversees 21 nonprofit regional centers that plan, buy and coordinate services for people with developmental disabilities, and the regional center is both the front door and the case manager.

• DHCS: the single state Medicaid agency. DDS bills DHCS to claim the federal Medicaid match for waiver services.
• DDS: operates the state's federal I/DD programs (two 1915(c) waivers and a 1915(i) state plan option). It acts as the limited fiscal agent and the Organized Health Care Delivery System, which means it processes regional center payments to providers and invoices DHCS.
• Regional centers: DDS lists the 21 regional centers with a lookup by county. Each one decides eligibility, approves (vendors) providers, authorizes services and pays claims.
• Case management: regional center service coordinators provide case management and write each person's Individual Program Plan (IPP), the plan that lists the services a person will receive.
• The Lanterman Act: California funds I/DD services under the Lanterman Act, which DDS describes as an entitlement. Regional centers are the payer of last resort, so they pay only after generic services such as Medi-Cal, In-Home Supportive Services (IHSS) and schools. IHSS is run by the California Department of Social Services (CDSS) and counties, not DDS, and is not covered on this page.

What Medicaid waivers and programs serve people with I/DD in California?

California has two 1915(c) waivers for people with developmental disabilities: the HCBS Waiver for Californians with Developmental Disabilities (HCBS-DD Waiver) and the Self-Determination Program (SDP) Waiver. A 1915(c) waiver is a federal Medicaid option that lets a state pay for home and community services instead of institutional care. DDS also runs a 1915(i) state plan option, which covers similar services for people who do not need an institutional level of care. All three are used by regional centers to draw federal match on services the Lanterman Act already promises.

• HCBS-DD Waiver (1915(c), control number CA.0336.R05): serves regional center consumers of any age who have Medi-Cal, have a developmental disability under the Lanterman Act and meet the level of care for an intermediate care facility for people with developmental disabilities (ICF/DD, ICF/DD-H or ICF/DD-N). Children under 5 with significant functional limitations also qualify. The current five-year term began January 1, 2023, and the waiver can serve up to 179,000 people in the year ending December 31, 2027. There is no individual cost limit. Services include Community Living Arrangement Services (licensed residential and supported living), day services, prevocational services, supported employment, in-home and out-of-home respite, homemaker and chore, behavioral intervention, Community Based Adult Services, Coordinated Family Supports, participant-directed services with a Financial Management Service, therapies, nursing, transportation and home and vehicle adaptations. The current amendment, CA.0336.R05.28, added Remote Support Services.
• Self-Determination Program Waiver (1915(c), control number CA.1166.R02.00): serves regional center consumers of any age who choose self-determination, and has been open to all eligible regional center consumers since July 1, 2021. Participants get an individual budget and a spending plan, choose a Financial Management Services (FMS) provider and may use an independent facilitator. CMS renewed the waiver effective July 1, 2026 through June 30, 2031. See the DDS Self-Determination Program page.
• 1915(i) State Plan HCBS for the Developmentally Disabled (SPA 26-0009): serves Medi-Cal eligible regional center consumers with income up to 150 percent of the federal poverty level who meet needs-based criteria (people over age 5 need help in at least three areas of major life activity). Services include habilitation (community living, day and employment), enhanced habilitation, respite, Community Based Adult Services, home health aide, Financial Management Services and Remote Support Services. The renewal took effect October 1, 2026 for five years and projects 109,000 people in its first year.

Intermediate care facilities for the developmentally disabled (ICF/DD, ICF/DD-H for habilitative and ICF/DD-N for nursing) are a Medi-Cal institutional benefit, and they are the level of care the HCBS-DD waiver is an alternative to.

Does California pay for I/DD services through managed care?

No. California pays for I/DD waiver services fee-for-service through the regional centers. Medi-Cal managed care plans do not pay HCBS-DD waiver services, and regional center case management does not make the system managed care.

• Who pays claims: the regional center authorizes services in the IPP and pays the provider through the DDS Uniform Fiscal System. DDS then invoices DHCS for the federal share, according to the HCBS-DD waiver application.
• Billing Medi-Cal directly: the waiver also lets providers enroll with DHCS and bill Medi-Cal directly instead of going through the regional center.
• Who coordinates services: regional center service coordinators.

Is there a waiting list for I/DD services in California?

No. The HCBS-DD waiver states that every eligible person who expresses interest is enrolled, and that the state will amend the waiver if its approved capacity runs short. Waiver capacity is managed statewide, with no reserved slots and no limit on how many people can be enrolled at one time.

DDS contrasts California's entitlement with other states that keep waiting lists for services. We did not find a published count of people waiting for a particular service or provider. Families with a delay can ask their regional center service coordinator.

How do people apply for I/DD services in California, and how are budgets set?

People apply by contacting the regional center that serves the county where they live. The regional center does intake within 15 working days of a request and generally completes the assessment within 120 days. The diagnosis and eligibility assessment is free, and most services are free regardless of age or income. Services are then set out in the person's IPP.

• Lanterman Act eligibility: per the DDS eligibility page, a developmental disability (intellectual disability, cerebral palsy, epilepsy, autism or a closely related disabling condition) that begins before age 18, is expected to continue indefinitely and is a substantial disability. Children ages 3 and 4 may receive provisional eligibility.
• Young children: children under 3 enter through Early Start (BabyLine 800-515-2229).
• Waiver eligibility: the HCBS-DD waiver also requires Medi-Cal and an ICF level of care. A Qualified Intellectual Disability Professional at the regional center makes this decision using the Client Development Evaluation Report (CDER) and records it on the Medicaid Waiver Eligibility Record (DS 3770). The person must have at least two qualifying moderate or severe support needs.
• How services and budgets are set: the CDER is also used in developing the IPP, and the regional center authorizes services listed in the IPP. The HCBS-DD waiver has no individual cost limit. In the Self-Determination Program, the participant gets an individual budget and writes a spending plan. We did not find a published formula for how SDP budgets are calculated; ask the regional center.

What day and residential services can I/DD providers offer in California?

Providers can offer community-based day programs, therapeutic and mobility day services, prevocational and supported employment services, adult day health, and several kinds of residential support. Every provider is vendored by a regional center. Some day and residential settings also need a license from the California Department of Social Services (CDSS) Community Care Licensing. The research did not find published staff ratios or billing units for most day services; these are set in Title 17 regulations and rate models.

Day and employment services

• Community-based day services: Adult Development Centers, Activity Centers, Behavior Management Programs, Community Integration Training, Community Activities Support Services, Independent Living Programs and Social Recreation. They teach self-help, social and adaptive skills in a non-residential setting, generally four or more hours a day on a regular schedule, and may be delivered by telehealth. Transportation is billed separately. Adult Development Centers and Activity Centers must be licensed by CDSS Community Care Licensing, and all day providers are vendored under Title 17 CCR 54310 with a written program design. The research did not find a published ratio or billing unit.
• Activity-based/therapeutic and mobility day services: art, dance, music, recreation therapy, sports and Special Olympics, and training to use public transit or drive. These are paid mostly at usual and customary or median rates.
• Prevocational services (work activity programs): teach general work skills that lead to competitive integrated employment. Paid by rate model, with one-time incentive payments when a person gets and keeps a competitive integrated job.
• Supported employment: job coaching, job development and ongoing supports for people in paid community jobs or internships. The job coach works one to one at placement, and the ratio decreases as the job stabilizes. Incentive payments apply for placement and job retention.
• Community Based Adult Services (adult day health): health and social services at an Adult Day Health Care center, four or more hours a day, including therapies and transportation. Under the waiver and 1915(i), regional centers pay this as a continuation beyond the Medi-Cal CBAS benefit, up to 12 hours a day, at the DHCS fee schedule. Centers are licensed by the California Department of Public Health (CDPH) and certified by the California Department of Aging (CDA).

Residential services (Community Living Arrangement Services in the HCBS-DD waiver)

• Licensed residential facilities: Adult Residential Facilities (ARFs), ARFs for Persons with Special Health Care Needs, Residential Care Facilities for the Elderly (RCFEs), children's group homes and small family homes. Licensed by CDSS Community Care Licensing and vendored by a regional center. The waiver pays for services only, not room and board, using monthly rate model fee schedules or a specialized rate when needs exceed the model.
• Enhanced Behavioral Supports Homes (EBSH): licensed homes with enhanced behavioral staffing, licensed by CDSS as an ARF or group home and certified by DDS. Rates are set from provider budgets reviewed by the regional center and DDS.
• Supported Living Services: supports in a home the person owns or leases, such as daily living, finances, finding housemates and hiring attendants. No state license is required; the provider is vendored by a regional center. Paid by rate model, and subject to EVV (service code 896).
• Family Home Agency homes (Adult Family Homes and Family Teaching Homes): shared living in family homes that a Family Home Agency recruits, trains and monitors. No state license; the agency issues each home a Certificate of Approval under Title 17 CCR 56088.

How are I/DD provider rates set and how do agencies enroll in California?

Most regional center services are paid from rate models built in a 2019 rate study, with a separate fee schedule for each regional center. Since full implementation on January 1, 2025, providers receive a base rate of 90 percent of the rate model and can earn up to 10 percent more through the Quality Incentive Program (QIP). Agencies enroll by applying for vendorization with a regional center.

• Rate reform steps: per DDS's rate reform resources, rates rose by a quarter of the gap to the rate models on April 1, 2022, by half on January 1, 2023, and reached full implementation on January 1, 2025.
• Other rate methods: some services use usual and customary rates, statewide or regional center median rates for negotiated rates, or DHCS Medi-Cal fee schedules. Licensed residential rates are monthly.
• Updates: rate models are updated for state minimum wage and federal mileage rate changes. AB 2423 requires DDS to review the rate models every two years starting January 1, 2026, but changes take effect only if they are funded.
• Latest change: HCBS-DD waiver amendment CA.0336.R05.28, which DDS lists as effective March 1, 2026, made final rate reform adjustments (individual providers paid above the benchmark are set at the benchmark) and added excess mileage supplemental payments for in-home services.
• Vendorization: agencies apply through the DDS Provider Directory to the regional center for the area where the service or office is located. The regional center reviews minimum requirements within 15 days, checks the application is complete within 30 days and must decide within 45 days. Approval brings a vendor number and service code but does not guarantee referrals. See the DDS vendorization process page.
• EVV: per the DDS EVV page, electronic visit verification applies to regional center in-home personal care services (since January 1, 2022) and home health services (since January 1, 2023), such as supported living, in-home respite, homemaker, personal assistance and nursing. Providers use the free CalEVV system from Sandata or a certified alternate system. Live-in caregivers can be exempt by attestation. Day programs and licensed residential services are not covered.
• EVV and payment: CalEVV does not connect to regional center eBilling, so claims are not matched to EVV visits. But EVV compliance is an eligibility condition for the QIP rate component for fiscal year 2026-27, starting July 1, 2026.

What is changing next for I/DD services in California?

As of October 23, 2026, we did not find a confirmed change with a set date for California's I/DD services. DDS has proposed replacing its main assessment tool, but no implementation date has been set. Several renewals and amendments took effect in 2026 and are already in place.

• Proposed: new assessment and standard intake: a DDS fiscal year 2026-27 proposal would standardize intake eligibility assessments across regional centers and replace the CDER, which DDS says has not been meaningfully updated since 1977, with a validated strengths and needs evaluation. This is a proposal. We did not confirm whether it was enacted or when it would start; ask DDS or your regional center.
• HCBS-DD waiver renewal ahead: the waiver's five-year term began January 1, 2023, so its next renewal falls due for January 1, 2028. We did not find a renewal notice yet.

Already in place: the Self-Determination Program waiver renewal (effective July 1, 2026), the 1915(i) state plan renewal (effective October 1, 2026), HCBS-DD amendment R05.28 with Remote Support Services and final rate reform adjustments, and EVV as a QIP condition from July 1, 2026.

California I/DD sources

• DDS: Federal Programs, HCBS Waivers and 1915(i) State Plan
• DDS: HCBS-DD Waiver application CA.0336.R05 (as of January 1, 2025)
• DDS: HCBS-DD Waiver amendment CA.0336.R05.28 (approved)
• DDS: 1915(i) State Plan renewal SPA 26-0009
• DDS: Lanterman Act entitlement article
• DDS: Regional centers
• DDS: Eligibility
• DDS: Vendorization process
• DDS: Rate reform resources
• DDS: Electronic Visit Verification

Related reading

• California Self-Determination Program Spending Plans, Explained
• Disability Services and Independent Living Guide
• Essential Acronyms in Disability Services: A Quick Reference Guide
• Disability Services DayHab has a dilemma - how to solve it
• I/DD services in every state (map)
• California EVV requirements

Other states that report no I/DD waiting list

Hawaii, Minnesota, Nebraska, Wisconsin. See every state on the I/DD services map.

Page history

• October 23, 2026: Page rewritten and checked against state sources.

This page is a reference, not legal advice. State rules change, so confirm details with the state before you act on them.

Ankota provides software for I/DD provider agencies, including EVV, service documentation, goal tracking and billing. If you would like to talk through your program, contact Ankota or read more about Ankota's I/DD software.