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 state of California recognizes that individuals qualified for nursing home care can often receive the same level and quality of care in an assisted living residence at a lower cost. The Assisted Living Waiver Program (ALWP) serves seniors who need long term care assistance with personal care and household tasks. Most seniors and their families prefer an assisted living environment rather than a nursing home facility. This creates a win-win scenario for the state and for families.
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 Francisco
- San Joaquin
- San Mateo
- Santa Clara
- Sonoma
The California Department of Health and Human Services requires that participants in this waiver program contribute to their room and board costs. For those who cannot afford this minimum monthly expense, they may be able to a find a spot in a publicly subsidized housing apartment.
Eligibility Guidelines
General Requirements
To qualify, applicants must be a minimum of 65 years old, or a minimum of 21 years old if disabled. Applicants must also have a need for both a specific level and type of care and meet the financial restrictions. 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. Ultimately, the state and the assisted living residence will determine whether the resident’s care needs can be met by the facility.
Financial Requirements
Income Limits
As of April 2024, the monthly income limit is set at $1,732 for a single applicant and at $2,351 for a married couple who are both applying for benefits. These income limits will increase in April of 2025 and will reflect 138% of the Federal Poverty Level figures.
To be clear, when only one spouse needs assisted living care, only income in his/her name will be counted toward the individual income limit. Furthermore, the applicant spouse may be able to transfer monthly income in his / her name to the non-applicant spouse to prevent spousal impoverishment. As of 2024, the maximum amount that is allowed to be transferred is $3,853.50 a month. This is called a monthly maintenance needs allowance. If the non-applicant spouse already has monthly income equal to or above this figure, a transfer of income is not permitted from the applicant spouse.
Asset Limits
As of January 2024, there are no longer any asset limits.
Individuals who are Medi-Cal eligible through share of cost are not eligible to take part in the Assisted Living Waiver.
Over the Financial Limits?
Persons who have income or assets slightly greater than the allowable income limits can still qualify for this waiver. Unfortunately, individuals who qualify for Medi-Cal through the Share of Cost option are not allowed to participate in the Assisted Living Waiver program. Certain consistent medical expenses can be deducted from the applicant’s income to allow them to qualify without having a Share of Cost.
Families interested in learning more about whether this option would work for them should contact an adviser that is familiar with the Assisted Living Waiver requirements. Such a benefits expert may be able to help them prepare their financial resources so that they qualify.
Benefits and Services
A Medi-Cal social worker works with each participant, and sometimes their family, to draft a personalized care plan. The plan recommends services they need. The following is a list of all the available services and supports included in this waiver:
- Assistance with activities of daily living, such as bathing, grooming, toileting, eating, and mobility
- 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
The Assisted Living Waiver does not cover room and board costs. However, for low income Californians, state Supplemental Security Income may provide additional funds towards room and board.
How to Apply / Learn More
To learn more about the Assisted Living Waiver, which is administered by the California Department of Health Care Services (DHCS), click here. Interested individuals should contact the Area Agencies on Aging for the counties listed below to discuss availability and determine whether there is a waiting list. If you have a particular residence already in mind, then check whether they are participating in the assisted living waiver.
To apply, the first step is to submit a Medi-Cal application to your county Department of Human Services. Once enrolled in Medi-Cal, the next step is to request the Assisted Living Waiver by contacting one of the care coordinating agencies listed here. The full process can take between 3 to 6 months.
The Assisted Living Waiver Program is currently available in the following 15 California counties. Again, it should be emphasized that program participants are not required to currently reside in these counties. They only have to move to an assisted living residence that is located within one of these counties.
- Alameda
- Contra Costa
- Fresno
- Kern
- Los Angeles
- Orange
- Riverside
- Sacramento
- San Bernardino
- San Diego
- San Francisco
- San Joaquin
- San Mateo
- Santa Clara
- Sonoma