The Assisted Living Waiver (ALW) Program

An Alternative to Medi-Cal Financed Nursing Home Care

Until recently, an elderly individual who did not have the means to pay for 24/7 medical care, had to be placed into a skilled nursing facility. Assisted living facilities could not accept Medi-Cal as payment for their monthly bill.

Accordingly, children and spouses were forced to place their loved ones into an environment not ideally suited for their family member solely because of their financial situation.

The ALWP is designed to assist Medi-Cal beneficiaries to remain in their community as an alternative to residing in a nursing home. Medi-Cal reimburses for the services provided to residents enrolled in the ALW, however, the resident is responsible to pay for their own room and board. For 2015, for those with SSI income of $1,145.00, room and board is $1,014.00 and those with income of $1,165.00 or greater, room and board is $1,034.00.

The ALW is an alternative to long-term placement in a nursing facility and is presently available in 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 ALW is currently enrolling beneficiaries residing in skilled nursing facilities and in the community, into licensed Residential Care Facilities (RCF) and Public Subsidized Housing (PSH).

Assisted Living Waiver (ALW) eligible individuals are those who are enrolled in Medi-Cal and meet the level of care provided in a nursing facility due to their medical needs. Individuals with Medi-Cal benefits that include a share of cost may not be enrolled in the ALW.

San Diego currently has 12 facilities participating in the program.

Determination of care needs is done by registered nurses (RN) employed by a Care Coordination Agency (CCA).

More Information on this program can be found at:

http://www.dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx

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