If your family's income is too high for regular Medi-Cal, your child may still qualify on their own. California has Medi-Cal waivers that look only at your child's income, not yours. The most common is the HCBS-DD waiver, which you reach through your Regional Center. Here is how the waivers work, who they fit, and how to start.
This guide explains how California's Medi-Cal waivers for disabled children work. It is information, not legal or medical advice, and every child's situation is different. For your own case, it is worth confirming the details with your Regional Center, your county Medi-Cal office, or Disability Rights California.
Why your income usually doesn't count
For regular Medi-Cal, a child who lives at home is counted as part of the parents' household. Your income and savings decide whether your child qualifies, and many working families land just above the line.
The waivers change which income gets counted. The state looks at your child as if they lived in a care facility, where only the child's own income and resources matter. A child's own income is usually little or none, so your income stops being the thing that blocks Medi-Cal.
The rule that does this has a name: institutional deeming. It is worth knowing the term, because it is the exact thing to ask about if you are ever told your child earns too much. Institutional deeming is not a program you apply to on its own. It is the income rule that two different waivers use to set your income aside.
This is not a California quirk. Federal Medicaid rules let states set aside a parent's income for a child who needs an institutional level of care but lives at home, and California does this through the waivers below.
Two honest points to hold onto. First, this can mean Medi-Cal at no cost, or Medi-Cal with a share of cost, which is a monthly amount you pay toward care before Medi-Cal covers the rest. Which one depends on your child's own situation. Second, it does not erase every income rule. Your child's own income still counts. It is your income, as the parent, that is set aside.
The two waivers, and which one fits your child
Which waiver fits depends on your child's disability and the kind of care they need. For most families it comes down to one of three situations. You can be on only one of these waivers at a time, so the question is which one fits your child, not how to combine them.
If your child is a Regional Center client: the HCBS-DD waiver
The HCBS-DD waiver is California's Medi-Cal waiver for people with developmental disabilities. It is run by the Department of Developmental Services through your local Regional Center, and it is the largest waiver of its kind in the country.
It fits children who qualify for Regional Center services: those with a developmental disability such as autism, intellectual disability, cerebral palsy, or epilepsy that began before age 18 and substantially affects daily life. A diagnosis alone is not the test. What matters is how the disability affects your child day to day.
For a child on this waiver, institutional deeming applies, so your income is not counted. Two things are worth knowing going in. Your child has to need the level of care that a facility for people with developmental disabilities would provide, though they do not have to live in one. And the waiver runs on a set number of slots. So far there have been enough, and Regional Center services themselves are something your child is entitled to while the waiver side is worked out.
One detail on the income rule: for this purpose, a "child" means under 18, or under 21 if you still claim them as a tax dependent.
If your child isn't a Regional Center client yet: start with intake
This is the situation that confuses people most, so here is the plain version. There is no separate "deeming waiver." If your child is not a Regional Center client yet, the first step is not a waiver at all. It is intake.
Call the Regional Center for your county and ask to begin intake and request an eligibility assessment. The assessment is free. If your child is found eligible, the HCBS-DD waiver path above opens from there, and institutional deeming applies to the Medi-Cal piece.
Intake has its own timeline and steps. Our guide to starting the Regional Center process in California walks through what the first 90 days actually look like.
If your child isn't eligible for Regional Center: the HCBA waiver
Not every child with a serious disability qualifies for Regional Center. A child who is medically fragile or depends on medical technology, for example, may need a high level of care without having a developmental disability. For those children there is a second door: the HCBA waiver.
HCBA stands for Home and Community-Based Alternatives. It is run by the Department of Health Care Services, and it is for people who need a nursing-facility level of care but want to live at home. It has no Regional Center requirement, and it serves children. Like the other waiver, it uses institutional deeming, so your income is not counted.
One thing to be straight about: HCBA reached capacity and has had a waiting list since 2023. Children under 21 are a priority group when a spot opens, but a spot is not guaranteed. The realistic move is to apply, get on the list, and ask where your child stands.
Who qualifies
Here is the same thing side by side.
| Waiver | Who it fits | What happens to your income |
|---|---|---|
| HCBS-DD | Children who qualify for Regional Center services: a developmental disability that began before age 18 and substantially affects daily life, plus a need for a developmental-disability facility level of care. | Your income as the parent is not counted. Your child is assessed on their own income, which is usually little or none. |
| HCBA | Children who need a nursing-facility level of care but are not Regional Center eligible, such as children who are medically fragile or depend on medical technology. | Your income as the parent is not counted. Your child is assessed on their own income. There is a waiting list as of 2023. |
In both cases, your child still has to meet the medical level-of-care test for that waiver. That gate is real, and it is where good documentation matters most.
How to apply, step by step
What to do next depends on where you are starting from.
If your child already has a Regional Center
Talk to your service coordinator. Ask to add the home- and community-based services your child needs to their Individual Program Plan, and ask the Regional Center to set up Medi-Cal through institutional deeming. The Regional Center contacts your county, and the county decides whether your child qualifies for no-cost or share-of-cost Medi-Cal.
If your child doesn't have a Regional Center yet
Start intake. Find the Regional Center for your county at dds.ca.gov and call their intake line to request a free eligibility assessment. Write down the date you call, because some of the timelines that follow run from there. If your child is found eligible, you move into the steps above.
If your child isn't Regional Center eligible
Find the HCBA waiver agency for your county or ZIP code on the Department of Health Care Services HCBA page, and contact that agency to request an application. Your child also needs to have Medi-Cal or apply for it. Because of the waiting list, the sooner you apply, the sooner your child holds a place in line.
What the waiver pays for
Two things come with a waiver. The first is full-scope Medi-Cal, which covers your child's regular medical care: doctor visits, hospital care, prescriptions, and therapies. The second is a set of home- and community-based services meant to keep your child living at home instead of in a facility.
The exact services depend on the waiver and on your child's plan, but they commonly include:
- service coordination, so one person helps organize the pieces
- respite care, which gives family caregivers a break
- in-home care and skilled nursing for children who need it
- day programs and community-based supports
- supported living, and supported employment as your child gets older
Many families also rely on In-Home Supportive Services (IHSS) for in-home care hours. If you applied for IHSS and were denied, our guide on what to do when IHSS is denied in California covers your next steps.
Common reasons applications stall (and how to avoid them)
A few problems come up again and again. Knowing them ahead of time is how you get past them.
You are told your income is too high. This is the most common one, and it usually means regular Medi-Cal rules were applied instead of the waiver. Ask directly about institutional deeming and the waiver your child is pursuing. That rule is exactly what sets your income aside.
The care-level need isn't documented. Both waivers require showing that your child needs a facility level of care. Medical records, assessments, and letters from your child's doctors and therapists are what establish it. Gather them early, and be specific about what your child needs help with day to day.
The waiting list. For HCBA, a list is not a no. Apply to hold your place, and ask whether your child qualifies for priority, since children under 21 are prioritized when a spot opens.
A decision that doesn't sound right. Ask for it in writing. If it is about Medi-Cal eligibility, you have the right to request a Medi-Cal fair hearing. If it is a Regional Center decision, the Regional Center has its own appeal process. Disability Rights California publishes free, detailed guides on both, and can sometimes help directly.
You do not have to figure out which door is yours on your own. If you are not sure where your child fits, Access Navigator can help you find your next step, in plain language and at no cost.