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. The Assisted Living Waiver Pilot Project was initially approved in 2009 and was amended and approved for another 5 years in March of 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 Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma.
The California Department of Health and Human Services requires that participants in this waiver program contribute to their room and board costs. In 2021, the monthly “room and board rate” is either $1,079.37 or $1,099.37, depending on one’s income. For those who cannot afford this minimum monthly expense, they may be able to a find a spot in a publicly subsidized housing apartment.
To qualify, applicants must be a minimum of 21 years old who 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.
Financially, the Assisted Living Waiver has the same eligibility requirements as Aged and Disabled (A&D) Medi-Cal. The A&D requirement considers both the applicant’s income and his/her assets. As of December 2020, the state set the monthly income limit at $1,468 for a single applicant and at $1,984 for a married couple who are both applying for benefits. These income limits will increase in April of 2021 and will reflect 138% of the 2021 Federal Poverty Level figures. In dollars, this will be a monthly income limit of $1,481 for an individual and $2,003 for a married couple with both spouses as applicants.
To be clear, when only one spouse needs assisted living care, only income in his/her name will be counted towards 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 2021, this amount may be great as $3,259.50 / month. This is called a monthly maintenance needs allowance.
The asset limit, which includes most of the individual or couple’s total resources, cannot exceed $2,000 for an individual or $3,000 for a couple with both spouses as applicants. That said, there are several assets that are considered non-countable towards the asset limit. These include one’s home (given a non-applicant spouse lives in the home or the applicant expresses intent to return to the home), household furnishings, personal items, and a vehicle.
Unlike with income, if only one spouse of a married couple is applying for Medi-Cal, all assets are considered jointly owned by the couple. However, there is a spousal impoverishment rule in place for the non-applicant spouse called a Community Spouse Resource Allowance (CSRA). This rule allows the non-applicant spouse to keep up to $130,380 (as of 2021) of the couples assets. This protects him/her from having too little assets from which to live. Learn more about Medicaid and jointly owned assets here.
Individuals who are Medi-Cal eligible through share of cost are not eligible to take part in the Assisted Living Waiver.
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. 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 who 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.
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:
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.
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.