Medi-Cal Assisted Living Waiver Program

Page Reviewed / Updated - Mar. 2015

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

The Assisted Living Waiver Program (ALWP) serves seniors that currently reside in or are qualified for nursing home care. The state of California recognizes that individuals qualified for nursing home care can often receive the same level and quality of care in assisted living at a lower cost to the state. Most seniors and their families prefer the assisted living environment over a nursing facility, thus creating a win-win scenario for the state and for families. The Assisted Living Waiver Pilot Project was approved in 2009 and has been funded until 2019.

This program is open to residents statewide. However, there are not providers available in every county. 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.

Medi-Cal requires that participants in this waiver program contribute to their room and board costs. In 2015, this figure is set by the state at $1014 or 1034, depending on their income.

 Did You Know?
In California, the cost of assisted living can vary by 50% even in the same city.  Free assistance is available to help seniors find assisted living within their means.  Get help here.

 

Eligibility Guidelines

There are requirements of both the applicant's functional ability and financial status.  Functionally, individuals must be qualified for nursing facility care, but not require so much care that it becomes prohibitively expensive to receive that care in an assisted living environment.

Financially, the Assisted Living Waiver has the same eligibility requirements as Aged and Disabled Medi-Cal (this differs from regular Medi-Cal requirements).  The Aged and Disabled requirement considers both the applicant's income and their assets. In 2015 sets the monthly income limit at $1,313 for a single applicant and $1,770 for a couple. 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.

Persons who have income or assets greater than the allowable limits can still qualify for this waiver in one of two ways. Medi-Cal has a spend down program that considers the applicant's medical costs and their income. This program allows them to spend-down their income on their care costs until they meet the eligibility limit. Alternatively, they can work with a Medi-Cal planner who will help them re-structure their financial resources so that they qualify.

Benefits and Services

A Medi-Cal benefits adviser works with each participant, and sometimes their family, to draft a personalized care plan. The plan makes recommendations for which services they are best suited. The following is a list of all of the available services and supports included in this waiver:

  • Assistance with activities of daily living such as bathing, grooming
  • Assistance with the instrumental activities of daily living such as transportation and medication administration
  • Health related services including skilled nursing if necessary
  • Social and recreational activities
  • Prepared meals
  • Housekeeping and laundry
  • Nursing home transition care

 

How to Apply / Learn More

This is pilot program is currently available in the following 14 California counties. To apply, interested individuals should contact the Area Agencies on Aging for these counties to discuss availability and determine if there is a waiting list and learn of participating residences. 

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