Medi-Cal Assisted Living Waiver Program

Page Reviewed / Updated - Jan. 2016

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 assisted living at a lower cost. The Assisted Living Waiver Program (ALWP) serves seniors that either reside in or are qualified for nursing home care but who are not living in a facility. 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.

The California Department of Health and Human Services requires that participants in this waiver program contribute to their room and board costs. In 2016, the state asks program recipients to pay $1014 / month or $1034 / month, depending on their income, towards their assisted living expenses.

 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

To qualify, applicants must demonstrate they need 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 to be met by the facility.

Financially, the Assisted Living Waiver has the same eligibility requirements as Aged and Disabled Medi-Cal. (Please note that these requirements differ from regular Medi-Cal requirements.) The Aged and Disabled requirement considers both the applicant's income and their assets. In 2016, policymakers set the monthly gross income limit at $1,211 for a single applicant 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 share of cost, are not eligible to participate 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. However, certain regular 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.

Benefits and Services

A Medi-Cal social worker 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

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

Interested individuals should contact the Area Agencies on Aging for these counties 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.

This is pilot program is currently available in these 14 California counties:

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