Assembly BillVetoedWelfare and Institutions
AB 2081: Medi-Cal: Home and Community-Based Alternatives Waiver.
What AB 2081 does, verified September 21, 2026
This bill amends the Medi-Cal program to increase the number of Home and Community-Based Alternatives (HCBA) waiver slots by 10,000, starting in 2027. The department must increase the total number of slots, including any federally approved expansions, and ensure there is sufficient capacity to enroll eligible individuals. By March 1, 2027, the department must seek necessary amendments to the waiver to accommodate those on the waiting list. The department will continue to monitor capacity and expand it as needed.
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Last action: Vetoed by Governor. (2026-09-18)Alert me
Author and sponsors
Full contact details, staff, and committees with Connect, $15/moUnlockRecent actions24 total · showing 5
| Sep. 18, 2026 | Vetoed by Governor. |
| Sep. 08, 2026 | Enrolled and presented to the Governor at 3:30 p.m. |
| Aug. 28, 2026 | Senate amendments concurred in. To Engrossing and Enrolling. (Ayes 77. Noes 0. Page 6805.). |
| Aug. 27, 2026 | In Assembly. Concurrence in Senate amendments pending. |
| Aug. 27, 2026 | Read third time. Passed. Ordered to the Assembly. (Ayes 39. Noes 0.). |
Latest bill textEnrolled version, September 2, 2026 · 1,470 words
| Enrolled September 02, 2026 |
| Passed IN Senate August 27, 2026 |
| Passed IN Assembly August 28, 2026 |
| Amended IN Senate August 13, 2026 |
| Amended IN Assembly March 26, 2026 |
CALIFORNIA LEGISLATURE— 2025–2026 REGULAR SESSION
Assembly Bill
No. 2081
| Introduced by Assembly Member Stefani (Principal coauthor: Assembly Member Bonta) (Coauthors: Assembly Members Connolly, Elhawary, Kalra, Michelle Rodriguez, and Schiavo) |
February 18, 2026 |
An act to amend Section 14132.991 of the Welfare and Institutions Code, relating to Medi-Cal.
LEGISLATIVE COUNSEL'S DIGEST
AB 2081, Stefani. Medi-Cal: Home and Community-Based Alternatives Waiver.
Existing law establishes the Medi-Cal program, which is administered by the State Department of Health Care Services and under which qualified low-income individuals receive health care services. The Medi-Cal program is in part governed by, and funded pursuant to, federal Medicaid program provisions.
Under existing law, home- and community-based services (HCBS) approved by the United States Department of Health and Human Services are covered for eligible individuals to the extent that federal financial participation is available for those services under the state plan or waivers granted in accordance with certain federal provisions. Existing law authorizes the Director of Health Care Services to seek waivers for any or all approvable HCBS.
Existing law sets forth provisions for the implementation of the Nursing Facility/Acute Hospital Transition and Diversion Waiver, which is the predecessor of the Home and Community-Based Alternatives (HCBA) Waiver, for purposes of providing care management services to individuals who are at risk of nursing facility or institutional placement, subject to federal cost neutrality. Existing law authorizes the director to propose that the waiver provide for achievement of annual cost neutrality in the aggregate to allow enrollment and authorization of waiver services based on medical necessity, and to require care management contractors to enroll at least 60% of all total annual enrollments from certain health care settings or populations. Existing law additionally sets forth provisions authorizing the director to expand the number of waiver slots up to 5,000 additional slots.
This bill would recast the above-described waiver provisions to refer to the HCBA Waiver. The bill would authorize the director, beginning January 1, 2027, to semiannually evaluate the populations receiving the priority enrollment described above, and to designate additional populations to receive priority enrollment based on this evaluation, subject to applicable cost-neutrality requirements. The bill would delete the provision relating to the 5,000 slots. The bill would instead require the department, beginning in 2027, and for the HCBA Waiver period, to increase the total number of waiver slots by 5,000, in addition to any planned expansion of waiver slots federally approved as of January 1, 2026, as specified, consistent with the above-described requirements.
The people of the State of California do enact as follows:
SECTION 1.
Section 14132.991 of the Welfare and Institutions Code is amended to read:14132.991.
(a) When administering the Home and Community-Based Alternatives (HCBA) Waiver, as authorized by subdivision (t) of Section 14132, the director may take the following actions, among others:(1) Contract with one or more organizations, referred to as a care management contractor, qualified to provide or arrange for delivery of care management and waiver services, including, but not limited to, personal needs assessments, and arranging for services available through public and private agencies, including services available under the waiver, for the waiver participants and applicants. The contract with the care management contractor, the care management contract, may require the care management contractor or their subcontractor, or both, to do all of the following, among other things:
(A) Provide, arrange for, or subcontract with community-based providers for the provision of, waiver services to waiver participants.
(B) Recognize program and service linkages, coordinate service delivery mechanisms and promote prevention of avoidable institutional placement, emergency room visits or inpatient hospital stays, or both, and coordination between health, social, and long-term services and supports by person-centered care planning.
(C) Provide or arrange for, care management to each waiver participant to stabilize their health care, and provide access to home- and community-based services, including managing and anticipating episodes of medical crisis in which transitional care management is needed.
(D) Carry out the waiver’s person-centered model of care, pursuant to the requirements set forth in Sections 441.720, 441.725, and 441.540 of Title 42 of the Code of Federal Regulations.
(E) Submit all information and reports required by the department, including, but not limited to, annual financial statements in the timeframe specified by the department.
(F) Pay any providers of waiver services who are not directly employed by or contracted with the care management contractor no less than the rates specified in the waiver or the department’s fee schedule, whichever is less, for the provider type.
(G) Bill the department, at the rate established by the state, for all services the care management contractor provides to waiver participants, directly or through a subcontractor or other direct service provider.
(H) Comply with the requirements of the waiver, including any other requirements established by the department regarding waiver operations, including, but not limited to, requirements regarding care coordination. These requirements may be set forth in the care management contract, care management manual, all-county letters, plan letters, plan or provider bulletins or policy letters, or similar instructions.
(2) Propose that the waiver provide for achievement of annual cost neutrality in the aggregate to allow enrollment and authorization of waiver services based on the medical necessity of the waiver services on a case-by-case basis.
(3) Require care management contractors to enroll at least 60 percent of all total annual enrollments from either of the following:
(A) Hospital, nursing facility, or other institutional settings assisting members with transitions back to the home or community, or both, setting.
(B) Individuals who had been continuously receiving in home care services, of the type offered under the waiver, under the Early and Periodic Screening, Diagnosis, and Treatment State Plan benefit, California Children Services or Pediatric Palliative Care programs for children, for at least the prior three months but have at the time of transition exceeded the age limit for that benefit.
(4) If the director determines that the care management contractor is not fiscally solvent, or is in danger of becoming fiscally insolvent, the director has the option to immediately terminate the contract with the care management contractor.
(5) Terminate or refuse to renew, in whole or in part, a care management contract when the director determines that the action is necessary to protect the health of the beneficiaries or funds appropriated to the Medi-Cal program.
(6) Beginning January 1, 2027, semiannually evaluate the populations described in paragraph (3) based on the net impact of enrollment in the HCBA Waiver on health care utilization costs in order to maintain the aggregate cost neutrality described in paragraph (2). Based on this evaluation, the department may designate additional populations under paragraph (3) for whom enrollment in the HCBA Waiver would be cost neutral in order to respond to changes in the needs of the eligible population and available health care services over time.
(b) Beginning in 2027, and for the HCBA Waiver period, the department shall increase the total number of HCBA Waiver slots by 5,000, in addition to any planned expansion of waiver slots federally approved as of January 1, 2026. This subdivision does not require the department to enroll individuals in all waiver slots described in this subdivision if doing so would be inconsistent with achieving the aggregate annual cost neutrality described in paragraph (2) of subdivision (a) or with the most recent evaluation conducted pursuant to paragraph (6) of subdivision (a).
(c) In order to achieve maximum cost savings, the Legislature hereby determines that an expedited contract process for contracts under this section is necessary. Therefore, contracts entered into or amended pursuant to this section shall be exempt from Chapter 6 (commencing with Section 14825) of Part 5.5 of Division 3 of Title 2 of the Government Code, Section 19130 of the Government Code, and Part 2 (commencing with Section 10100) of Division 2 of the Public Contract Code and shall be exempt from the review or approval of any division of the Department of General Services.
(d) (1) The department shall implement this section only to the extent that it can demonstrate federal cost neutrality as required under the terms of the HCBA Waiver, and only to the extent that any necessary federal approvals are obtained and federal financial participation is available.
(2) The department may seek amendments to the HCBA Waiver or take other actions as necessary to implement this section.
(3) Notwithstanding Chapter 3.5 (commencing with Section 11340) of Part 1 of Division 3 of Title 2 of the Government Code, the department may implement, interpret, or make specific this section, in whole or in part, by means of letters or other similar instructions, without taking regulatory action.
Text of AB 2081 as enrolled, from the official record. Connect Plus keeps every version and highlights what changed.Compare versions