What is the Assisted Living Waiver Program (ALWP)?
The ALWP is designed to assist Medi-Cal beneficiaries to remain in their community as an alternative to receiving care in a Skilled Nursing Home (SNF). The program provides specified benefits to eligible seniors and persons with disabilities. A key goal of the program was to enable low-income, Medi-Cal eligible seniors and persons with disabilities, to remain in or relocate to a community setting in a Residential Care Facility for the Elderly (RCFE) or public subsidized housing.
This program is open to residents statewide. However, not every county has providers. Participants must be willing to live in an assisted living residence located in one of the following counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, San Mateo, Santa Clara, and Sonoma.
Who qualifies for the Assisted?
Participants must be eligible for full-scope,no-share-of-cost Medi-Cal benefits and require a nursing facility level of care. The latter requirement is key to eligibility because the program is designed to serve people who would otherwise need nursing home care. Contracted Care Coordination Agencies use a standardized assessment tool to determine the client's need for a nursing home level of care. The ALWP serves people age 21 and older.
How much will the Assisted Living Waiver cost me?
As a Waiver recipient, you will be required to pay room and board to the facility, but the ALWP covers your personal and health care costs. In 2019, for participants with monthly SSI income of $1,173.37, the room and board rate is $1,039.37. For participants with an income of $1,193.37or greater, the room and board rate is $1,059.37.
What are the Financial Requirements for ALWP?
The Assisted Living Waiver has the same eligibility requirements as Aged and Disabled Medi-Cal which is different from regular Medi-Cal requirements. The Aged and Disabled requirement considers both the applicant's income and assets. The monthly gross income limit is $1,200 for a single individual and at $1,638 for a couple who are both applying together. The asset limit, which includes the individual or couple's total resources except for the home and vehicle, cannot exceed $2,000 or $3,000, respectively.
Individuals who are Medi-Cal eligible through a share of cost are NOT eligible to participate in the Assisted Living Waiver. Persons who have income or assets slightly higher than the allowable income limits can still qualify for this waiver. There are some expenses that can be deducted from the applicant's income to enable them to qualify without having a Share of Cost.
What type of care and services are provided through ALWP?
A state-contracted social worker works with each participant, and sometimes their family, to draft a personalized care plan. The plan makes recommendations services on individuals needs. The following is a list of all of the available services and supports included in this waiver:
Assisting in developing and updating an individualized care plan for each resident
Personal care and assistance with activities of daily living
Laundry
Housekeeping
Maintenance of the facility
Providing intermittent skilled nursing care
Meals and snacks
Providing assistance with self-administration of medications
Providing or coordinating transportation
Providing recreational activities
Providing social services
Care Coordination: These services include identifying, organizing, coordinating and monitoring services needed by participants.
Nursing Facility Transition Care Coordination: These services help transition participants from a nursing home to the community.
How long does it take to get into the ALWP?
Currently, the waiting list for ALWP is about 3-6 months for individuals residing at Skilled Nursing Facility, and about 12-18 months for individuals living in the community. Individuals are nevertheless encouraged to submit a Waitlist Request Form to hold a spot on the list and to demonstrate to the State that there is a strong demand for this program and a need for expansion.
Do these facilities have private rooms?
Yes. Privacy and independence are critical features of the Assisted Living Waiver program. Facilities must be able to offer participants private, single-occupancy apartments, with a private bathroom and space for socialization.
Can I bring my furniture?
Each facility has different requirements. Some provide furniture, and some do not. You will need to discuss this with the facility before moving in. If you are moving from a nursing home into an assisted living facility, the Assisted Living Waiver provides a service called Community Transition Assistance. This service offers limited financial assistance to help you buy essential household furnishings and other items you might have given up when you moved into the nursing facility. The Care Coordinator will let you know if you qualify for this program.
How to Apply
To begin the application process, contact the Care Coordination Agency in your county:http://www.dhcs.ca.gov/services/ltc/Documents/Care-Coordination-Agencies-2018.pdf.
For more information about the ALW program,
contact: www.dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx
Assisted Living WaiverDepartment of Health Care ServicesLong-Term Care Division
1501 Capitol Avenue, MS 4503
PO Box 997437 Sacramento, CA 95899-743
ALW Hotline –916-552-9322
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