Preparing your teen for life after high school involves collaboration between your child’s school district and a variety of public agencies such as Regional Center, the Department of Rehabilitation, Social Security, and more. Here, we’ll go over what services are available to your teen as they prepare to turn 18 and transition to adult services through various public benefits programs.
Some Regional Centers will transfer a child to a new transition-focused service coordinator when they turn 14 in preparation for the transition to adulthood. Regional Centers do not usually pay for transition services that are otherwise provided by the school district, but Regional Centers can participate in transition planning. You may ask the school to invite your service coordinator to be part of your child’s IEP team to help with transition planning. (You may also invite the Department of Rehabilitation to discuss vocational options.)
If your child used to be a Regional Center client but hasn’t received services recently, the transition to adulthood is a good time to reopen their case, as explained by Dr. Richard L. Rosenberg, a board member of the California Transition Alliance:
The Regional Center can support your young adult in developing their IEP transition goals and selecting services to help them reach those goals. The services can be community experiences, job development, and other goals for life as an adult. Your young adult can get training in daily living skills and an evaluation to see what their strengths and abilities are (called a functional vocational evaluation). Note that Regional Center can typically provide adult services only after your child leaves the school district at age 22 (or earlier if they obtain a standard high school diploma).
Regional Center can provide or coordinate independent living skills training, personal assistance, supportive housing, adult day programs, work opportunities, tailored day services, and more.
Here are some commonly funded Regional Center services for young adults:
The possibilities for how recipients can use Regional Center resources have grown with the Self-Determination Program. Note that adult day programs can accept SDP funding if they choose to and understand the billing process. Families interested in this pathway may need to educate and advocate with programs to make it work. Many families and participants choose to use their SDP budget for Tailored Day Services instead of traditional day programs because the rate is higher and it offers more flexibility.
People who choose to live in their own homes will often need information about affordable housing options, sources of financial support such as Supplemental Security Income (SSI), and how to stretch a limited budget to meet living expenses. These are ordinary challenges that are inseparable from a truly self-directed life in the community.
Independent Living Services (ILS) are designed to support adults with disabilities while they are still living at home with their families. Typically, recipients of ILS already possess basic self-help skills (or employ personal care aides to assist with these skills), and they need functional training for activities such as household chores, laundry, budgeting, cooking, and grocery shopping. ILS are vendored and monitored by Regional Center and are generally not provided long-term; the hope is that once a person acquires the skills to live independently, the services can be faded out. The law says clients have the right to get ILS for as long as they need and benefit from such services.
Supported Living Services (SLS) are provided to Regional Center clients who are ready to move into their own home or shared living situation, and these services are specific to each person’s individual and ongoing support needs. SLS can help with activities of daily living, including social and behavioral training, maintaining a home, choosing roommates and personal and/or health aides, purchasing furniture and other necessities, and managing finances, to name a few. These services are designed to support an individual’s progress toward long-range personal goals and foster a meaningful place in their community. Because these are often life-long endeavors, SLS are offered for as long and as often as needed, with the flexibility required to meet a person’s changing needs over time and without looking solely at the level of disability.
Some Regional Centers offer roommate-matching opportunities and referrals to affordable housing options. In some areas, you will also find residential housing programs, although these are fewer and typically quite competitive to get into as they tend to remain at capacity. Undivided families have shared that it’s advisable to start getting on residential program waiting lists as soon as you think you may want one for your child. For more information about housing options and services, see our full article Supports for Independent Living.
Before your young adult leaves high school, make sure to talk to your Regional Center service coordinator about what programs are available so that you can prepare for them in your transition plan.
If your child received Medi-Cal coverage before age 18, shifting from childhood to adulthood funding systems can be a big adjustment, with various agencies and rules to navigate. Here’s what you need to know.
When your child reaches 18, Medi-Cal waivers, such as the Home and Community-Based Services for the Developmentally Disabled (HCBS-DD) waiver and the Home and Community-Based Alternatives (HCBA) waiver, don’t suddenly vanish or undergo major changes. HCBS-DD depends on the person’s living situation and whether they get on SSI, and with the HCBA waiver, nothing should change at 18.
The HCBA waiver
In 2018, the HCBA waiver program changed how it handles its budget. Before that, each person in the program had to prove that their in-home care wouldn’t cost more than what it would cost the state to care for them in a facility. That was called "individual cost neutrality." The problem? Unless your child had really intensive medical needs (like a ventilator or trach), the state would say, “It’s cheaper to care for them in a group home or institution,” and they’d cut off or limit services, especially when the child turned 21.
In 2018, the rules changed to a more flexible system called “program-based cost neutrality.” Now, the state looks at the overall costs of the whole program, not just each person’s situation. That means your child isn’t penalized if their care costs more than the institutional average — as long as the program as a whole stays within budget. This is a huge factor in why the program has expanded so much — under the old individual cost neutrality rules, no one with a level of care less than subacute (trachs or vents) met program standards for cost neutrality.
Since the HCBA waiver program has been full since July 2023, planning ahead is key. Currently, priority goes to kids under 21 and those moving from healthcare facilities or other HCBS programs.
Private duty nursing after age 21
For children aged 0-21, Medi-Cal pays for private duty nursing care through the EPSDT benefit, even for children enrolled on the HCBA waiver. This means that children with Medi-Cal coverage don’t usually have to enroll in any special programs like the HCBA waiver to access nursing care at home. But how does this work before and after age 18?
Member on the Medi-Cal Members Advisory Committee Jennifer McLelland tells us, “If a child who needs private duty nursing is enrolled in the HCBA waiver prior to age 18, the child is enrolled in the HCBA waiver but HCBA waiver only provides "case management," it doesn't authorize or fund nursing. From age 18-21, nursing hours are approved/paid for by Medi-Cal EPSDT through the same process as they were when the person was a child. After the 21st birthday, nursing hours are approved by the HCBA Waiver Agency and paid for by the HCBA waiver directly. Nothing is supposed to change for the recipient, it's just a different pot of money.” Note that this is the least common scenario; most kids who are getting private duty nursing through Medi-Cal EPSDT are NOT enrolled in HCBA as children.
What’s the most common scenario? McLelland tells us, “If a child who needs private duty nursing is not enrolled in the HCBA waiver prior to 18 because they're getting Medi-Cal through another pathway (SSI, family income, HCBS-DDDD waiver, etc.), then their nursing is approved/paid for by Medi-Cal EPSDT through age 21 without HCBA involvement. They should apply for the HCBA waiver at age 18 with enough time to be enrolled by their 21st birthday. After the 21st birthday, nursing hours are approved by the HCBA Waiver Agency and paid for by the HCBA waiver directly. Nothing is supposed to change for the recipient, it's just a different pot of money.
The HCBA waiver is the only Medi-Cal program that pays for private duty nursing for adults over age 21. Private duty nursing is not a covered benefit for adult Medi-Cal beneficiaries who are not enrolled in the HCBA waiver. Although adults can enroll on the HCBA waiver, there is usually an extensive waitlist, and priority goes to children under age 21, people waiting to move from medical facilities into the community, and people waiting to transition from other HCBS waivers because their needs are no longer being met. If a young adult living in the community is not fully enrolled in the HCBA waiver by six months after their twenty-first birthday, they will lose priority status on the waitlist, and until they are enrolled there is no funding source to pay for home nursing care.
Can Regional Center help?
In some cases, the Regional Center system has authorized payments for private duty nursing services for young adults on the HCBA waiver waitlist. If your young adult is a Regional Center client and is still on the HCBA waiver waitlist as their twenty-first birthday approaches, ask for an emergency IPP meeting with the Regional Center. A young adult who has been receiving home nursing care and suddenly loses access to that care is at extreme risk for institutionalization. The Regional Center has the ability to authorize payments for private duty nursing if the service is necessary to keep a client safe at home.
For young adults who have medically intensive disabilities, who turn 21 while still on the HCBA waiver waitlist, and who are not eligible for Regional Center services, there are no easy solutions. Before age 21, Medi-Cal can cover medically-necessary private duty nursing through EPSDT. However, once the young adult turns 21, continued access to that care typically requires enrollment in the HCBA waiver. If the young adult is enrolled in Enhanced Case Management with a Medi-Cal Managed Care Plan (MCO), contact the case manager and request help. Medi-Cal MCOs have no legal obligation to cover private duty nursing care for adults, but if you make a case that the only alternative is placement in a nursing facility, they might be willing to authorize care on a time-limited basis to avoid paying for institutional care until a waiver slot becomes available.
The HCBS-DD waiver
Growing up can change how Medi-Cal coverage works, but in some cases child-based funding can still continue after age 18. If they’re still in school and living at home, young adults with disabilities are often able to stay on the HCBS-DD waiver for several years. Undivided Public Benefits Specialist Lisa Concoff Kronbeck explains that if an individual is still in the household with their parents and still in school and being claimed as a dependent, they might be considered a child under Medi-Cal up to age 21. Concoff Kronbeck, explains, “They’ll still be considered a child by Medi-Cal for the purpose of determining household income, and so they’ll still need institutional deeming if they’re living at home with their parents and are still in school.” This means they’d remain eligible for the HCBS-DD waiver for that time.
In order to qualify for the HCBS-DD institutional deeming waiver as an adult, an individual has to show that they require a Medi-Cal service that isn’t available through regular Medi-Cal. After age 21, your young adult is likely to qualify for Medi-Cal based on their income without requiring a waiver. If they qualify for Supplemental Security Income (SSI), they will automatically be eligible for Medi-Cal.
California Children’s Services (CCS) is a state program that provides and funds diagnostic and treatment services to children under age 21 with CCS-eligible medical conditions.
Concoff Kronbeck explains that CCS services generally end at age 21. However, there’s an important exception for children receiving CCS through their school district. She further explains that, according to the “SERR (Special Education Rights and Responsibilities) manual from DRC Disabilities Rights California, if they’re receiving their CCS services through the school district, through their IEP, through the medical therapy unit, then that would continue until they’re out of special education, because it’s based on the age requirements of special education.”
So, while the typical cutoff for CCS is age 21, children receiving services through their school might continue to do so until they exit special education — which in California is typically at age 22. The key is how their IEP and medical therapy needs align with CCS services, which might give families extra time before transitioning out of CCS.
According to Concoff Kronbeck, IHSS hours will look mostly the same for a recipient who is 17 years old compared to 18 years old. There are a few categories where an 18-year-old can receive hours that minors are not eligible for, such as domestic services and yard abatement. Some parents wish to reassess their child at age 18 to see if they will receive these additional hours. However, there will likely only be 6-10 more hours in these categories per month, so parents may just want to wait until their next annual assessment rather than scheduling a reassessment at age 18. This hourly task guidelines chart from IHSS shows how many hours an adult recipient can expect to receive per week in various categories based on the level of support they require.
If a child suddenly qualifies for IHSS at age 18 but didn’t at age 17, it’s because they qualified for SSI and thus became eligible for Medi-Cal, which is a requirement for IHSS.
Another thing to note is if you are your child's IHSS provider, then once your child turns 18, you can only keep signing your own timesheets if you are the recipient’s legal representative, such as if you are their conservator.
Once a person turns 18, they can apply online for Supplemental Security Income benefits (SSI) through the Social Security Administration. Qualifying for SSI is based on Social Security’s definition of disability and financial eligibility, and it automatically includes Medi-Cal coverage.
When a person with a disability is 18 or over, only their own income and assets are taken into account, not their parents’. For this reason, most 18-year-olds will qualify for monthly benefits, which can be used to help pay for daily expenses like food and housing (including paying their portion of rent). See our article on Supplemental Security Income to learn more about preparing to set this up for your child when they turn 18, how much they could receive, and common pitfalls to avoid.
The criteria for most public benefits programs is different for minors than for adults, so once your child turns 18, they may be eligible for more (or different) services.
Individuals who do not qualify for SSI may still be eligible for Medi-Cal and other public benefits programs like CalFresh (food stamps). It’s a good idea to stay on top of what public benefits are available, as guidelines for allowable income requirements and various Return to Work and incentive programs are regularly updated. You might find it helpful to take advantage of resources like Disability Benefits 101 or a disability benefits planner. The Department of Rehabilitation offers benefits counseling if your young adult receives DOR services.
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