As people age, the thought of losing independence often weighs heavily on their minds. While many wish to remain in their homes, the reality is that most require assistance with daily living tasks.

Fortunately, there is an opportunity for you to receive help while maintaining your independence at home.

California’s Assisted Living Waiver (ALW), a Medi-Cal program, supports low-income seniors and individuals with disabilities in accessing assisted living services at lower costs.

What Is the Assisted Living Waiver Program?

The Assisted Living Waiver is part of California’s Medicaid (Medi-Cal) system. Thanks to the waiver, individuals with limited financial means can receive nursing home care benefits.

The ASWP is designed to offer the same quality and level of care that residents would receive in assisted living facilities. If eligible, Medi-Cal may cover nursing care at home, provided that the costs are lower than those in a nursing home.

This is made possible through the Home and Community-Based Services (HCBS) Waivers, also referred to as Waiver Funded Services.

Through the Assisted Living Waiver, elders and individuals with disabilities can receive essential assistance for their care needs. While the program is available statewide, some counties may not have providers ready for service. Currently, 15 counties are offering the waiver.

If you live outside an area where ALWP is available but wish to participate, you can relocate to any county that has a provider.

Moreover, participants are required to contribute to their room and board expenses. It is essential to note that the Medi-Cal Assisted Living Waiver is not an entitlement program.

Applying for this program and meeting the eligibility criteria does not ensure you will receive nursing care.

This is due to the ASWP having a limited number of participant slots. Once these slots are filled, additional applicants may end up on a waitlist.

What Sets the Assisted Living Waiver Apart from Traditional Assisted Living?

The Assisted Living Waiver (ALW) presents several distinctions from standard assisted living services:

For those who cannot afford private assisted living, the Assisted Living Waiver (ALW) serves as a cost-effective solution. However, availability is limited due to county restrictions and the potential for waitlists.

Eligibility

To qualify for the Assisted Living Waiver, applicants must adhere to the guidelines established by the California Department of Health and Human Services. The qualifications include:

Age

The ALW program is intended for individuals with disabilities as well as seniors. They must be between 21 and 64 years old if they have a disability.

Conversely, they must be over 65 years of age if no disability is present.

Residence

The Assisted Living Waiver exclusively serves residents of California. If you reside in a nursing home, you may still qualify if you’ve been there for at least six months.

Applicants must be living in one of the 15 California counties where ALW services are provided. The counties currently available for ALWP are:

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

Financial

Another component of eligibility for the ALWP is meeting the financial criteria, which includes examining the applicant’s income, homeownership, and assets.

Income

The income limit for applicants is set at 138% of the Federal Poverty Level (FPL).

This limit changes annually in April in California. As of March 2022, a single applicant’s monthly income limit is $1,481.

If there are spouses, their combined income limit is $2,003 a month.

If only one spouse applies, the income limit for that applicant is $1,481. There are further specifics regarding these income limits, so it’s important to do thorough research.

It’s crucial to remember that the costs for room and board will also be influenced by your income level.

Homeownership

As your most significant asset, you might be concerned about Medicaid potentially seizing your home. Don’t worry; your home may be exempt if:

• You live in your home or plan to return there, substantiated in writing.
• Your non-applicant spouse resides in your home.
• You have a child under 21 living with you.
• You have a dependent relative living at home.

Assets

As of 2022, a single applicant is limited to assets totaling $2,000. On the other hand, the…

The asset limit for couples applying together is capped at $3,000.

This limit pertains to both applicant and non-applicant spouses and is treated as jointly owned. To safeguard against spousal impoverishment, the non-applicant spouse receives a larger share of this asset.

Functional Needs

Lastly, eligibility for an Assisted Living Waiver requires that you need a nursing facility level of care. This necessity is assessed through a specialized evaluation conducted by a registered nurse.

Your care requirements are categorized into various tiers, ranging from one to five. Here, one signifies minimal assistance, whereas five corresponds to the highest degree of support offered by the ALWP.

What Is the Duration of the Waiting List for ALW?

The Assisted Living Waiver (ALW) operates with a limited number of placements, resulting in wait times across many counties.

• Waiting periods differ by county, contingent on the availability of participating providers.
• Counties with higher demand (like Los Angeles, San Francisco, San Diego) typically experience lengthier waiting times.
• Some individuals may wait six months to over a year for a slot to open up.

To inquire about waitlist status:

1. Reach out to a Medi-Cal Coordinating Agency in your locality.
2. Inquire if waitlist priority is applicable for urgent cases (e.g., upon hospital discharge).
3. Explore alternative Medi-Cal home care programs while you wait.

For the latest waitlist information, visit California’s Department of Health Care Services (DHCS) website:
https://www.dhcs.ca.gov/

Services Provided Under the Assisted Living Waiver

A Medi-Cal social worker creates a personalized care plan, detailing all the recommended services required by the participant.

This care plan may encompass a variety of services and benefits, including:

• Support with daily living activities (bathing, eating, toileting, etc.)
• Help with medication management and transportation
• Skilled nursing care
• Meal preparation
• Assistance transitioning from a nursing home to assisted living
• Housekeeping and laundry services
• Engagement in recreational, therapeutic, and social activities

What Are Some Alternatives to the Assisted Living Waiver?

If you do not qualify for ALW or reside in a county where it is unavailable, consider these alternatives:

1. In-Home Supportive Services (IHSS)

   • Offers caregiver assistance in the home for Medi-Cal beneficiaries.
   • Accessible statewide without county limitations.

2. Community-Based Adult Services (CBAS)

   • Day programs that offer health monitoring, meals, and social engagement.
   • Available to Medi-Cal enrollees with medical needs.

3. PACE (Program of All-Inclusive Care for the Elderly)

   • Covers medical services, home care, and transportation for seniors.
   • Available in selected counties throughout California.

For a comprehensive list of Medi-Cal home and community-based programs, visit:
https://www.dhcs.ca.gov/services/

How to Apply for the ALWP?

To begin the application for the Assisted Living Waiver Program, complete a Medi-Cal application form and submit it to your local Department of Human Services.

Following this, reach out to one of the coordinating agencies to request access to the ALWP.

Keep in mind that the application process for ALWP may take anywhere from three to six months, particularly if you are facing a waitlist.

Does Insurance Assist with Assisted Living Costs?

Unfortunately, most conventional health insurance does not cover long-term care and thus does not typically include assisted living. Some insurance plans do offer limited options, but they are usually not comprehensive.

The most suitable choice is long-term care insurance, which supplies benefits not provided by standard medical insurance or Medicare.

This type of insurance can help cover a portion of the costs associated with assisted living and may extend to care in assisted living facilities, nursing homes, hospice, adult day care, home health services, and skilled nursing care.

Having this insurance can significantly alleviate financial pressures, especially when paired with an Assisted Living Waiver.

Can VA Benefits Be Used for Assisted Living?

Veterans may be eligible for financial aid for assisted living through the following:

• Aid & Attendance (A&A) Pension – Monthly payments for veterans requiring assistance with daily tasks.
• VA Homemaker and Home Health Aide Services – Offers in-home support for qualifying veterans.
• State Veterans Homes – Facilities providing assisted living and nursing care to eligible veterans.

To apply for VA long-term care benefits, visit:
https://www.va.gov/geriatrics/

Conclusion

The Assisted Living Waiver represents one of several programs available in California aimed at assisting low-income families and people with disabilities.

Many individuals in California require help with everyday activities yet prefer to remain in their homes.

In such scenarios, the Medi-Cal Assisted Living Waiver Program can provide the needed support.