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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 who need long term care for their personal care and household tasks. 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 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 2018, the “room and board rate” is approximately $1030 per month or $1050 per month, 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 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 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 2018, the state set the monthly income limit at $1,235 for a single applicant and at $1,664 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 for an individual or $3,000 for a couple. When only one spouse needs assisted living care, only income in their name will be counted towards the individual income limit.
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 of 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.
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 on the care coordinating agencies listed on the state website. The full process can take between 3 to 6 months.
This is pilot program is currently available in the following 14 California counties. Again, it should be emphasized that program participants are not required to currently reside in these counties, only to move to an assisted living residence that is located within one of these counties.