Medi-Cal: The Assisted Living Waiver Program for California, Explained

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Medi-Cal’s assisted living waiver

The Assisted Living Waiver allows Medi-Cal-eligible seniors to choose an assisted living community as an alternative to a nursing facility. California created this experimental waiver to test the efficacy of assisted living as a Medi-Cal benefit. The ALW is currently available through 2029, though it is being offered to a limited number of participants.[01]

The ALW allows seniors and persons with disabilities to live in their home or community for as long as possible. This waiver covers the costs of care for seniors who are eligible for a nursing facility but would prefer to receive services through an assisted living community or home health care agency.

Accepted applicants need to live in one of the communities covered by the waiver. These include a list of options classified as Residential Care Facilities (RCFs), Adult Residential Care Facilities (ARFs), and publicly subsidized housing options covered by the waiver. The state also authorizes Care Coordination Agencies (CCAs) to develop personalized care plans and coordinate care services. Eligible seniors may use a CCA to develop a care plan while living in their current RCF, ARF, or subsidized housing arrangement.[02]

 

Covered services

Care services covered by the ALW include:[02]

  • Assistance with activities of daily living
  • Meal services
  • Medication administration
  • Social activities
  • Housekeeping
  • Skilled nursing care, as needed

These services are administered by the community staff or by a licensed home health agency, based on the participant’s choice of a residential setting. Every six months, participants receive an assessment from a registered nurse to determine their required level of care.

Medi-Cal

Medi-Cal is the state of California’s Medicaid health care program. The program covers various medical services for children and adults with limited income and resources. Federal and state taxes support Medi-Cal, and program recipients can receive services for as long as they meet the eligibility requirements for Medicaid.

 

Eligibility for the Medi-Cal Assisted Living Waiver

To participate in the Assisted Living Waiver program, seniors must be eligible for Medi-Cal and meet all of the program’s criteria:[01]

  • Have full-scope Medi-Cal eligibility with zero share of the cost
  • Require the same level of care that a Medi-Cal-eligible resident living in a nursing facility would need
  • Be able to reside safely in an assisted living community or in public subsidized housing
  • Be able to pay for their room and board
  • Live in or be willing to move to one of 15 counties where ALW services are provided

Currently, the counties offering the ALW are:

  • Alameda
  • Contra Costa
  • Fresno
  • Kern
  • Los Angeles
  • Orange
  • Riverside
  • Sacramento
  • San Bernardino
  • San Diego
  • San Francisco
  • San Joaquin
  • San Mateo
  • Santa Clara
  • Sonoma

Seniors with Medi-Cal benefits that have partial Medicaid coverage and share in the cost of their care aren’t eligible to apply for the ALW program. It’s also important to note that Medi-Cal is a federally sponsored program, and that the state of California does not determine eligibility for Medi-Cal benefits.

Applying for the Assisted Living Waiver

To qualify for the Assisted Living Waiver, seniors must first apply for Medi-Cal coverage. To apply online, visit the Covered California website. Seniors can also apply through the mail with the Single Streamlined Application, or in-person at a county’s Social Services office. To qualify for residential habilitation, seniors must receive prior approval from a Department of Health Care Services’ nurse evaluator, who will decide which level of care best meets a given senior’s needs. From there, the senior can be added to a waiting list for an assisted living community covered by the ALW.[02]

To view the current providers or additional waitlist information, visit the Department of Health Care Services website.

Finding assisted living in California

Finding the right assisted living community can take time. For assisted living options tailored to your needs, location, and budget, consider reaching out to A Place for Mom’s Senior Living Advisors. They can help you navigate the complexities of finding senior living services and even help schedule community tours. Talk with one of our experts today to learn more about California’s assisted living and home care services.

This article originally appeared on APlaceForMom and was syndicated by MediaFeed.

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