Get Ca Dhcs Home And Community-based Alternatives (hcba) Waiver Application 2019-2025

Filling out the CA DHCS Home And Community-Based Alternatives Waiver Application can seem daunting. This guide provides clear and structured steps to assist you in completing the application accurately and efficiently.

Follow the steps to complete the application successfully.

1. Click ‘Get Form’ button to access the HCBA Waiver Application form and open it in your preferred online document editor.
2. Begin by filling in the applicant’s name and contact information, including phone number, date of birth, and gender. Select the appropriate options regarding gender identification.
3. Provide details regarding the applicant’s residence, including the county of residence and type of housing, such as home, hospital, or nursing facility. Note relevant dates of admission and estimated discharge.
4. Input the applicant’s current mailing address and physical address if different. Include all necessary details such as street, apartment number, city, and zip code.
5. Indicate health care insurance information. Specify if the applicant has Medi-Cal and if applicable, provide the Medi-Cal number. Also, note any additional insurance such as Medicare and other insurance providers.
6. Describe the applicant’s current medical diagnosis clearly and concisely. Use additional spaces for further medical needs if necessary.
7. Check the boxes that reflect the applicant's current medical needs. Provide specific details about medical equipment or care needed, ensuring to utilize the back of the application for additional comments.
8. Identify the individual with legal authority to make healthcare decisions for the applicant, if applicable. Include their contact information.
9. List all current service providers related to the applicant’s care, detailing the hours of service received weekly and types of services provided.
10. Once all sections are completed, review the application for accuracy. Save your changes and download or print the form as required. Ensure you keep a copy for your records.

Start completing your CA DHCS HCBA Waiver Application online today!