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Two renewals happen every year. Only one of them needs you.
Waiver level-of-care recertification
Who: your regional center.
- CDER reviewed within 12 months
- DS 3770 recertification signed by regional center staff
- Recertification sent to DDS in SANDIS
- IPP reviewed at least every 12 months
You do not sign anything and there is no fee.
Medi-Cal annual renewal
Who: your county Medi-Cal office.
- May renew automatically — you get a letter
- Or a renewal form arrives in a yellow envelope
- You get at least 30 days to return it
- New for 2026: property is counted again
Ignore this envelope and coverage ends.
If coverage does end for a missed form: you have 90 days from the termination date to send it in without starting a new application.
If your child or the adult you support is a regional center client on the Medicaid waiver, you have probably wondered the same thing everyone else does around this time of year: does the waiver renew by itself, or is there something I am supposed to be doing? The short answer is that two separate renewals are happening, one of them is handled entirely by the regional center, and the other one will end coverage if you ignore the envelope.
This article walks through both, in the order they actually happen, and tells you exactly which one needs you. It is written for parents of minors first, because that is where most of the confusion sits, with a clearly marked section on what changes for adults and at age 18.
The word "waiver" is doing two jobs
When a service coordinator says “the waiver” and when a county eligibility worker says “the waiver,” they are often talking about different pieces of the same arrangement. Untangling them is most of the battle.
Who is responsible for what
| Yearly task | Who does it | Do you have to act? |
|---|---|---|
| Level-of-care reevaluation | Regional center, reviewed by DDS | No — but ask when it is due |
| CDER review | Regional center | No — but check it is accurate |
| DS 3770 recertification | Regional center (QIDP signs) | No |
| IPP review and SARF | Planning team, including you | Yes — attend the meeting |
| Medi-Cal annual renewal | County Medi-Cal office | Yes — if a form arrives |
| Property / asset reporting (new 2026) | County Medi-Cal office | Yes — at your first renewal after Jan 1, 2026 |
| Freedom of Choice form (DS 2200) | Regional center | Not annual — only at enrollment, re-enrollment, or turning 18 |
1. The HCBS waiver itself
California operates a Home and Community-Based Services waiver for people with developmental disabilities, administered by the Department of Developmental Services (DDS) through the 21 regional centers. It is the mechanism that lets the state draw federal Medicaid dollars for community services instead of paying for care in an intermediate care facility (ICF/DD) or a developmental center. To be on it, a person has to meet ICF/DD level of care.
2. Institutional deeming, often called “the medical waiver” or “the deeming waiver”
This is the Medi-Cal eligibility rule that most families are really asking about. Because the person qualifies for institutional level of care, Medi-Cal evaluates them as if they lived in an institution rather than with their family. For a minor, that means the parents’ income and property are not counted. For an adult, spousal impoverishment rules apply. The person becomes their own Medi-Cal Family Budget Unit — a household of one — and gets full-scope Medi-Cal under aid code 6V (no share of cost) or 6W (with a share of cost).
The two are linked, and that is why problems travel
Institutional deeming exists because the person meets waiver level of care. If waiver eligibility ends, the deeming rule that ignores parent or spouse income goes with it.
That is why a quiet problem on the regional center side can show up months later as a Medi-Cal notice you were not expecting.
What the regional center does every year — and why you do not file anything
Federal rules require that every person receiving waiver services be reevaluated at least once a year to confirm they still need institutional level of care (42 CFR 441.302(c)). In California, that reevaluation is regional center work. There is no annual application, no form for you to sign, and no renewal fee.
Inside the regional center, the annual cycle looks like this:
What the regional center produces each year
-
CDER
Client Development Evaluation Report
The assessment record that documents functional need. It is what DDS now reads when the recertification is submitted.
Reviewed within 12 months of the prior CDER -
DS 3770
Medicaid Waiver Eligibility Record
Carries the recertification date. Signed by a Qualified Intellectual Disabilities Professional — regional center staff, not you.
Within 12 months of the last certification -
SANDIS
Recertification transaction
The regional center transmits confirmation to DDS that the person still meets ICF/DD level of care.
Annually -
IPP + SARF
Plan review and annual review form
The planning team reviews and revises the plan based on a reassessment of functional need. This is the meeting you attend.
At least every 12 months
The Freedom of Choice form is not an annual document
Despite how often families are told otherwise, the DS 2200 is not signed every year. Under the DDS waiver monitoring protocol it is required in exactly three situations:
- When eligibility is first determined
- When someone is disenrolled and then re-enrolled
- When a minor turns 18
If you are asked to sign one every single year, that is a local practice, not a state requirement. Signing it does no harm — but do not assume the waiver lapses without it.
What you do every year — the county Medi-Cal renewal
This is the one that needs you. Medi-Cal eligibility has to be renewed at least every 12 months. Your county tries to renew it first without asking you anything, using information it already has. That is called an ex parte or automatic renewal, and when it works, you get a letter telling you coverage continues and you do nothing.
When the county cannot confirm eligibility from what it already has, it sends a renewal packet. DHCS describes it as a yellow envelope. Inside is a renewal form — the MC 210 RV, or the pre-populated MC 217 — and you have at least 30 days from the date on the form to respond.
Your renewal year, step by step
-
Any time — do this now
Find your renewal month
Log in at BenefitsCal.com, or call your county Medi-Cal office and ask. Confirm they have your current address, phone and email.
-
Ahead of your renewal month
The county tries to renew without you
If it can confirm eligibility from records it already has, you get a letter saying coverage continues. Nothing else is required.
-
If records are not enough
A renewal packet arrives
A yellow envelope with the MC 210 RV, or the pre-populated MC 217. Since 2026 it may also ask for property information on the MC 604 IPS.
-
At least 30 days from the form date
Return it
Online at BenefitsCal.com, by mail, by phone, or in person at the county office. Keep a copy and note the date you sent it.
-
If it was missed
You still have 90 days
Send the renewal form in within 90 days of the termination date and the county reconsiders without a new application.
A "Medi-Cal has ended" notice is usually fixable
If coverage was terminated because a renewal form or asset verification was not returned, you have 90 days from the date of termination to send it in. The county reconsiders eligibility without requiring a new application.
- Applies to a missed renewal form
- Applies to missing property verification under the 2026 asset rules
- Faster and simpler than filing an appeal — try this first
Do not wait out the 90 days hoping it resolves itself. Send the form, keep proof of the date, and call the county to confirm it was received.
Three things can land in your mailbox
- An auto-renewal letter. Coverage continues. Read it, confirm the names and dates are right, file it.
- A renewal form. Fill it out and return it by the due date, online at BenefitsCal.com, by mail, by phone, or in person at the county office.
- A notice that Medi-Cal has ended. Do not treat this as final. See the cure period below.
Find your renewal month before you need it
- Log in at BenefitsCal.com and look for your renewal due date.
- Or call your county Medi-Cal office and ask what month your case renews.
- Make sure the county has your current mailing address, phone, and email. A renewal packet sent to an old address still counts as sent.
- Report changes in address, income, household size, or living situation within 10 days.
The handoff that actually breaks
The state Medi-Cal Eligibility Procedures Manual instructs counties that at the yearly redetermination they “should check with IHO or the referring Regional Center … to verify that the waiver beneficiary is still medically eligible.” That sentence is the seam. The county has to hear from the regional center, and nothing in the process makes that confirmation land automatically on the right desk at the right time.
Two agencies, one confirmation, no automatic handoff
Counties should check with IHO or the referring Regional Center at the yearly determination to verify that the waiver beneficiary is still medically eligible. DHCS Medi-Cal Eligibility Procedures Manual, Letter 278
That sentence is the seam. The county has to hear from the regional center, and nothing in the process guarantees the confirmation lands on the right desk at the right time.
Your county may ask you for the regional center letter
In practice, some counties ask the family to supply a letter from the service coordinator confirming the person is still a regional center client receiving waiver-eligible services, rather than chasing the regional center themselves.
This is not written into state guidance as a family responsibility, but it is a common enough experience that it is worth being ready for.
If your county asks you for that letter, ask your service coordinator for it in writing — do not argue the point at the deadline.
Should you remind your service coordinator? Yes — and here is what to ask
Not because coordinators are careless. Regional center caseloads are large, recertifications are tracked in a database rather than by conversation, and the person most affected by a missed date is you. A short, specific, written check-in once a year costs nothing and creates a record.
The natural moment is your annual IPP meeting. Ask these four things and ask for the answers by email:
Four questions to ask at your annual IPP meeting
- When is my waiver recertification due?You are asking for the month the DS 3770 recertification date falls in.
- Is the CDER current and accurate?Since May 2026 DDS reads it directly. An out-of-date CDER can stall a recertification.
- When is my Medi-Cal renewal month?They may not know. Verify it yourself at BenefitsCal.com.
- Will you confirm to my county worker, or should I request a letter?Settle this in advance, not in the week the renewal is due.
Copy, paste, send — then keep the reply
Hi [coordinator name],
Ahead of [consumer name]'s annual review, could you confirm a few dates in writing?
1) The month the waiver recertification (DS 3770) is due.
2) When the CDER was last reviewed, and whether it reflects current support needs.
3) Whether your office sends confirmation of continued waiver eligibility to the county Medi-Cal
worker directly, or whether I should request a letter to send with our renewal.
Thank you — [your name], [phone]
Email beats a phone call, for one reason
If something goes wrong later and you appeal, a dated email showing you asked and what you were told is evidence.
A remembered phone call is not.
New for 2026: property counts again
California phased the property test out of non-MAGI Medi-Cal — raising the limit sharply in 2022, then removing it in 2024. It came back on January 1, 2026, under AB 116 and DHCS guidance in ACWDL 25-14, set at the 2022 levels:
- $130,000 in countable property for one person
- $65,000 for each additional household member, up to ten people (so $195,000 for two)
Effective January 1, 2026
Property counts again for non-MAGI Medi-Cal
- Applies to HCBS waiver aid codes 6V and 6W
- If you are already covered, the question arrives at your first annual renewal on or after January 1, 2026 — a December renewal month means December 2026
- Counties use the MC 604 IPS, "Additional Income and Property Information," alongside the renewal form
- Exempt: your principal residence, one vehicle, household goods and personal effects, burial plans and funds up to $1,500, and life insurance with a face value of $1,500 or less
This applies to the HCBS waiver aid codes — 6V and 6W are on the list of affected programs. If you were already covered, the asset question arrives at your first annual renewal on or after January 1, 2026, not before. Someone with a December renewal month does not report property until December 2026. Counties are using the MC 604 IPS, “Additional Income and Property Information,” alongside the renewal form while systems are updated.
Common exemptions include your principal residence, one vehicle, household goods and personal effects, burial plans and funds up to $1,500, and life insurance with a face value of $1,500 or less. Retirement accounts are treated differently depending on whose they are and how they are held — ask your county worker rather than assuming.
A property notice is not the end of it either
If coverage is discontinued for excess property or for failure to provide asset verification, the same 90-day cure period applies. You can submit the documentation and have eligibility restored without a gap.
Do not let a property notice sit.
New for 2026: DDS is now looking at the CDER
On March 27, 2026, DDS issued directive D-2026-Home and Community Based Services-001, “HCBS Waivers: Level of Care Final Determination.” Effective May 1, 2026, DDS reviews the information in a person’s CDER when the regional center submits an “Add” or “Recertification” transaction in SANDIS. If DDS cannot establish level of care from the CDER alone, it contacts the regional center for supporting documentation — which may include the DS 3770, the IPP, and other evaluations — through the Regional Center Portal.
For the purposes of these waivers, level of care means two or more “severe support needs” in one or more of three domains: self-help, social-emotional, or health. The directive currently applies to people age three and older.
Effective May 1, 2026
DDS now reviews the CDER behind every recertification
Level of care for these waivers means two or more "severe support needs" in one or more of three domains:
When the regional center submits an "Add" or "Recertification" transaction in SANDIS, DDS reads the CDER. If it cannot establish level of care from the CDER alone, it asks the regional center for supporting documentation — the DS 3770, the IPP, other evaluations. The process currently covers people age three and older.
Source: DDS Directive D-2026-Home and Community Based Services-001, March 27, 2026.
The eligibility standard has not changed
This directive is new and its practical effects are still unfolding as of August 2026.
It does not change who is eligible — the level of care standard is the same. It changes how closely the paperwork behind the annual recertification is examined.
What changes for adults, and at age 18
- The Freedom of Choice form (DS 2200) is required again when a minor turns 18. It is one of the three triggers in the DDS monitoring protocol. Expect it, and sign it.
- Deeming shifts from parents to spouse. For an adult, institutional deeming means spousal impoverishment rules apply. Parental income is already out of the picture at 18 for most Medi-Cal purposes.
- SSI may enter the picture. Many young adults become SSI-eligible at 18 because parental income stops being deemed to them. SSI recipients keep the SSI resource limits ($2,000 individual, $3,000 couple), which are far lower than the $130,000 non-MAGI limit. Which rule applies to you depends on which program your Medi-Cal runs through — ask.
- Adults have been waiver-eligible since 2000. Regional centers refer people 18 and over for DDS waiver eligibility determinations, with the same institutional deeming rules and no parental income counted.
If something goes wrong, the clocks are short
Two different agencies. Two different clocks.
A Medi-Cal notice (county)
To request a state fair hearing, from the date of the Notice of Action.
For benefits to continue while you wait: request by the effective date where a 10-day notice is required, or within 10 days of the notice date otherwise.
How to fileOnline, by mail to the county or CDSS State Hearings Division, by fax to (833) 281-0905, or by phone at (800) 743-8525 — TDD (800) 952-8349.
Try this firstIf coverage ended because a form was not returned, the 90-day cure period may fix it without a hearing.
A regional center notice
To appeal if you want services to continue while the appeal is decided (aid paid pending).
To file an appeal at all. Miss the 30-day window and you can still appeal — the service stops on the date in the notice.
How to fileDDS Office of Community Appeals and Resolutions — online through the DDS appeal form, email appealrequest@dds.ca.gov, fax (916) 654-3641, or mail 1215 O Street MS 8-20, Sacramento, CA 95814.
A Medi-Cal notice
- You have 90 days from the Notice of Action to request a state fair hearing.
- For benefits to continue while you wait (aid paid pending), request the hearing by the effective date on the notice where a 10-day notice is required, or within 10 days of the notice date otherwise.
- Request online, by mail to the county or the CDSS State Hearings Division, by fax at (833) 281-0905, or by phone at (800) 743-8525 (TDD (800) 952-8349).
- Separately: if coverage ended because a renewal form or asset verification was not returned, the 90-day cure period may fix it without a hearing at all. Try that first.
A regional center notice
- 30 days from the Notice of Action to appeal if you want services to continue while the appeal is decided.
- 60 days from the Notice of Action to file an appeal at all. Miss the 30-day window and you can still appeal — the service just stops on the date in the notice.
- File with the DDS Office of Community Appeals and Resolutions: online through the DDS appeal form, by email to appealrequest@dds.ca.gov, by fax to (916) 654-3641, or by mail to 1215 O Street, MS 8-20, Sacramento, CA 95814.
Free help exists and you do not have to pay for it
The Office of Clients' Rights Advocacy (OCRA), part of Disability Rights California, gives free legal information, advice, and representation to regional center clients in all 21 catchment areas.
1-800-390-7032 · TTY 877-669-6023
Keep these five things in one digital folder
Keep these five things in together
- Your most recent IPP and SARFThe plan and the annual review form behind it.
- A dated letter from the regional centerConfirming waiver enrollment and waiver-eligible services.
- Your Medi-Cal renewal noticePlus a note of your renewal month, checked at BenefitsCal.com.
- Every Notice of ActionFrom either agency, with the date you received it written on it.
- The email thread with your service coordinatorWhere you asked about recertification and got an answer in writing. If you ever appeal, this is evidence. A remembered phone call is not.
None of this is glamorous. But the failure mode in this system is almost never a dramatic denial — it is a date nobody watched, a confirmation that did not travel between two agencies, and a piece of mail that arrived at an old address. A folder and one annual email close most of that gap.
You do not have to sort this out alone
All of the help below is free. None of it requires a lawyer or a fee.
- Office of Clients' Rights Advocacy (OCRA)Free legal information, advice and representation for regional center clients in all 21 catchment areas. 1-800-390-7032 · TTY 877-669-6023
- Your county Medi-Cal officeThe only office that can tell you your renewal month or restore coverage. Check your due date first at BenefitsCal.com.
- Medi-Cal state hearings(800) 743-8525 · TDD (800) 952-8349 · fax (833) 281-0905
- DDS information line833-421-0061 for questions about waiver eligibility and the appeal process.
Sources
- DDS Directive D-2026-Home and Community Based Services-001, "HCBS Waivers: Level of Care Final Determination" (March 27, 2026) — the May 1, 2026 CDER review, the annual SANDIS Recertification transaction, the level of care definition, and the age-three-and-older scope.
- DDS Home and Community-Based Waivers Monitoring Protocol, Version 7.0 (rev. 1/2025) — the 12-month recertification and CDER review requirements, the annual IPP review and SARF, and the three triggers for the DS 2200.
- DDS Form DS 3770, Medicaid Waiver Eligibility Record — the recertification date field and the QIDP signature line.
- DDS Home and Community-Based Services Programs — the structure of California's 1915(c) waiver and the DDS contact line.
- 42 CFR 441.302 — State assurances — the federal requirement for level of care reevaluations at least annually.
- 42 CFR 435.916 — Periodic renewal of Medicaid eligibility — renewal at least every 12 months, ex parte renewal, the pre-populated form, 30 days to respond, and the 90-day reconsideration period.
- DHCS Medi-Cal Eligibility Procedures Manual, Letter No. 278 — the DHS 7096 referral, aid codes 6V and 6W, institutional deeming and the separate budget unit, and the yearly check with the referring regional center.
- DHCS ACWDL 25-14 — Reinstatement of the Asset Limit (June 30, 2025) — the $130,000 / $65,000 limits, inclusion of aid codes 6V and 6W, application at the next annual renewal, the MC 210 RV / MC 217 / MC 604 IPS forms, and the 90-day cure period.
- Health Consumer Alliance, "The Return of Medi-Cal Asset Limits" (Dec. 2025, updated March 2026) — the property exemptions and the AB 116 authority.
- CANHR, 2026 Asset Limit Reinstatement FAQs — confirmation of the January 1, 2026 effective date and the renewal-month example.
- DHCS — Keep Your Medi-Cal — the three renewal outcomes, the yellow envelope, BenefitsCal for your due date, and the 10-day change reporting rule.
- DHCS — Medi-Cal Fair Hearing — the 90-day hearing deadline, aid paid pending timing, and hearing request contacts.
- DDS — Lanterman Act Appeals Information Packet — the 30-day and 60-day windows and the Office of Community Appeals and Resolutions filing details.
- Disability Rights California — RULA § 10.1, appeal process and timeline — the appeal deadlines with statutory citations (W&I Code §§ 4707(c), 4710.5(a)).
- Disability Rights California — RULA § 11.12, family income too high for Medi-Cal — the plain-language explanation of institutional deeming.
- Disability Rights California — Office of Clients' Rights Advocacy — the free advocacy service and intake numbers.
- DHCS ACWDL 00-59 (Nov. 15, 2000) — extension of DDS waiver eligibility to people 18 and older under the same institutional deeming rules.
DDS is the primary authority on waiver level of care and regional center process; DHCS is the primary authority on Medi-Cal eligibility and renewal. Where a county policy handbook and state guidance differ, state guidance governs; where state guidance and federal regulation differ, the regulation governs.
About this article
IHSS Connect publishes this article for general information and education. It is not legal advice, and reading it does not create an attorney-client relationship. IHSS Connect is not a law firm and is not affiliated with the California Department of Developmental Services, the Department of Health Care Services, any regional center, or any county agency.
Benefit rules, dollar amounts, and deadlines change — sometimes mid-year. Only your county Medi-Cal office can decide what you are eligible for, and only your regional center can act on your waiver recertification.
If a decision on your case looks wrong, or you want advice about your own situation, talk to someone who can look at your file:
- Office of Clients' Rights Advocacy (regional center clients): 1-800-390-7032, TTY 877-669-6023
- Free and low-cost legal help: LawHelpCA.org
- DDS information line: 833-421-0061
- Medi-Cal state hearings: (800) 743-8525, TDD (800) 952-8349
Asset limits and program rules reflect California policy in effect as of August 2026. Verified August 2026.
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