Written by a parent, not a doctor. Nothing here is medical advice.

Childhood Cancer Lantern
Search Saved

Get ready to apply

California Department of Health Care Services

Home and Community-Based Alternatives Waiver

What you get

Care and services at home or in the community as an alternative to care in an institution. There is a waitlist right now. Ask to be added.

Who starts it
You, with their part of the form from your doctor
How it’s sent
PDF form, sent the way they ask
Your time
An hour or so, plus waiting for the form
Last checked
Aug 27, 2026

  1. Ask your doctor for their part of the formStart here. This is the part that takes the longest.

    California Department of Health Care Services needs their part of the form from your doctor. Copy this message, or say it in person at the next visit.

    Hi [doctor’s name],

We’d like to apply to California Department of Health Care Services’s Home and Community-Based Alternatives Waiver. They offer care and services at home or in the community as an alternative to care in an institution, and there is a waitlist.

They need their part of the form from you. Their form and instructions are here: https://www.dhcs.ca.gov/services/Pages/default.aspx

Could you do that when you have a chance? I’ll bring the printed form to our next visit, or I can email it. Thank you for everything you do for us.

[your name] · [phone]
    Copying is the only thing this page does with your text. Nothing is saved.

  2. Fill in their formPrint it, or fill it in on screen if the PDF allows.

    Open the application PDF ↗ Checked Aug 27, 2026

    What the form asks for

    DHCS 1320 HCBA application
    Applicant’s NamePhone NumberDate of BirthAgeMarriedGenderDate of Application SubmissionCounty of ResidenceType of Residence (type of housing)Residence facility name, city, admission/discharge dates, and consecutive days if applicableApplicant’s Current Mailing AddressApplicant’s Current Physical Address (if different from mailing address)Medi-CalMedi-Cal number / Client Index Number (CIN)Medicare and applicable partsOther Insurance? If yes, name of insuranceApplicant’s Current Medical DiagnosisAdditional Medical Need(s) — select all current needs and enter requested frequencies/hoursNumber and location of wounds or contractures, if applicableBriefly explain mobility and help needed with care needsBriefly explain special equipment needsOther medical needs or additional commentsIs this application being submitted for the applicantWho has legal authority to make the applicant’s health care decisionsLegal representative full name, relationship, and telephone numberDoes the applicant have signed legal representative or Durable Power of Attorney documentationWas the applicant or representative notified the application was submittedName, title, and telephone number of person completing the applicationHome Health Agency name, weekly hours, and types of servicesNumber of IHSS hours authorized per monthRegional Center name and service coordinatorAdult or Pediatric Day Health Center days per week and hours per dayDoes the school provide medical care services at schoolDoes the school provide a non-medical attendant during school hoursOther current service providers (CCS, MSSP, Hospice, PACE, SCAN)

    Have ready

    • Signed legal-representative or durable-power-of-attorney documentation, if applicable.

  3. Send it the way they ask

    • Submit the completed application to the Waiver Agency that serves the applicant’s county or ZIP code, following that agency’s current instructions.

After you send

Confirm receipt with the Waiver Agency and ask about its waitlist and next screening step. If you have not heard back in two weeks, write and ask whether it arrived.

Full record, as published