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Long Term Care
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California's Assisted Living Waiver
In March 2006, Medi-Cal began paying for assisted living care for qualified aged and disabled residents of Los Angeles, Sacramento and San Joaquin counties under the Assisted Living Waiver (ALW). A key goal of the program was to enable low-income, Medi-Cal eligible seniors and persons with disabilities, who would otherwise require nursing facility services, to remain in or relocate to a community setting in a Residential Care Facility for the Elderly (RCFE) or public subsidized housing . The program was converted into a five-year federal waiver program as of March 1, 2009. Pending final approval, the waiver program will be renewed through February 28, 2019.
Scope of Program
The ALW is currently operating in the counties of Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, San Mateo, Santa Clara and Sonoma. However, some of the counties in which the ALW program is operating do not currently have any RCFEs participating in the program. For a list of participating RCFEs, see http://www.dhcs.ca.gov/services/ltc/Documents/ListofRCFEfacilities.pdf.
Participants in the ALW have access to the following services:
Participants must be eligible for full-scope, n o share-of-cost Medi-Cal benefits and require a nursing facility level of care. The latter requirement is key to eligibility because the program is designed to serve people who would otherwise need nursing home care. Contracted Care Coordination Agencies use a standardized assessment tool to determine the clients need for nursing home level of care. The project serves people age 21 and older.
People living in other counties can receive services if they are otherwise qualified, willing to relocate to one of the participating counties, and work with an enrolled care coordination agency.
Using the standardized assessment tool, care coordination agencies will determine the level of care and services necessary for each participant.
Care coordinators will establish individualized service plans for each participant, including services that are covered by Medi-Cal and services funded by other sources. Participating RCFEs must develop a care plan to implement the service plan for each resident.
A licensed, Medi-Cal certified home health agency will implement care plans for participants who live at public housing sites. In this setting, the services provided are called Assisted Care.
Participants pay for their room and board, and Medi-Cal pays for their care and services. In 2017, for participants with monthly SSI income of $1,158.37, the room and board rate is $1,026.37. For participants with income of $1,178.37 or greater, the room and board rate is $1,046.37. Medi-Cal pays the RCFEs and home health agencies for five levels of care and services, with daily rates ranging from $52 per day for tier 1 to $200 per day for tier 5. RCFEs and home health agencies cannot negotiate the services to be delivered or the payment rate.
Choosing a Facility
Participants select the facility or provider of their choice. Care coordination agencies will inform participants about available facilities and providers. RCFEs are allowed to reject a participant. However, once a facility admits someone, it must provide necessary services and adapt services as the person’s needs change. All providers are expected to deliver all four levels (tiers) of care.
How to Apply
To begin the application process, contact the Care Coordination Agency in your county: http://www.dhcs.ca.gov/services/ltc/Documents/CareCoordinationAgencies.pdf
For more information about the ALW program, contact:
Page Last Modified: January 10, 2017