Medi-Cal (California Medicaid) Assisted Living Waiver (ALW)
What are Medicaid Waivers?
Medicaid pays for long term care services in nursing homes. For nursing home qualified persons that choose to live at home or in a residential community, Medicaid will pay for those services if they can be obtained at a lower cost. These are called Home and Community Based Services, Waiver Funded Services, Medicaid Waivers or simply Waivers.
Assisted Living Waiver Overview
The Assisted Living Waiver targets 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 to that of 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 is funded through 2014.
Qualifications for the Assisted Living Waiver
There are 3 types of eligibility requirements for the Assisted Living Waiver; functional, financial and geographic. 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 Medi-Cal; which considers both the applicant's income and their assets. In 2013, the Medi-Cal income limit is $1,138 for a single applicant and $1,536 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 income or assets are greater than the allowable limits can still qualify for this waiver in one of two ways. Medi-Cal has a spend down program which 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 Medi-Cal planner
who will help them re-structure their financial resources so that they qualify.
Finally, applicants must live in one of the geographic areas of the state where the pilot waiver is being tested.
Services Provided under the Assisted Living Waiver
During enrollment in this program, a personalized care plan is developed for each participant. The care plan determines for which services they are eligible and can include any of the following:
-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
-Housekeeping and laundry
How to Apply / Program Availability
This is pilot program that is currently available in the following 7 counties. To apply, interested individuals should contact their local Area Agency on Aging
to discuss availability and determine if there is a waiting list.
Use our Locator Tool to Find Other Options for which You're Eligible
Page Reviewed / Updated - Jan. 2013