Medi-Cal: Home and Community-Based Alternatives Waiver.

The required annual increase in HCBA Waiver slots was reduced from 10,000 per year (Assembly version) to 5,000 per year (Senate version), in addition to federally approved expansions as of January 1, 2026.

A new paragraph (6) requires the department to semiannually evaluate priority enrollment populations starting January 1, 2027, based on the net impact of waiver enrollment on health care utilization costs, and allows designation of additional populations for priority enrollment if cost neutral.

The Assembly version's requirement for an annual report to the Legislature (covering waiver slot numbers, waiting list comparisons, demographic breakdowns by age/race/ethnicity/language, and departmental efforts to reduce the waiting list) was entirely deleted in the Senate version.

The Assembly version would have removed the federal cost neutrality criterion as a condition for implementing the waiver. The Senate version retains the requirement that the department implement the section only to the extent it can demonstrate federal cost neutrality under the waiver terms.

New language clarifies that the department is not required to enroll individuals in all authorized waiver slots if doing so would be inconsistent with achieving aggregate annual cost neutrality or with the most recent semiannual population evaluation.

Removed the director's discretionary authority to expand waiver slots by up to 5,000 additional slots (former subdivision (a)(3)), which required federal approval and Department of Finance sign-off.

Subdivision (b) now explicitly states that the annual increase of not fewer than 10,000 waiver slots is 'in addition to any planned expansion of waiver slots federally approved as of January 1, 2026,' clarifying that the new mandate stacks on top of existing approved capacity rather than replacing it.

Added the phrase 'and for the HCBA Waiver period' to subdivision (b), confirming the 10,000-per-year expansion obligation continues for the full duration of the waiver, not just an initial period.

Removed the reference to the predecessor 'Nursing Facility/Acute Hospital Transition and Diversion' waiver name from subdivision (a), simplifying the language to refer only to the HCBA Waiver.

Restructured subdivisions (d), (e), and (f): the expedited contracting provision moved from (e) to (d); the federal cost neutrality and approval conditions were consolidated into new subdivision (e); and the federal approvals/financial participation condition was renumbered as (f). No substantive change to the cost neutrality requirement itself.