Assisted Living Waiver
Losing independence is one of the biggest fears people have as they age. Most people would want to stay in their houses, but the reality is most of them need help with daily living activities.
Fortunately, there is a way you can get help but still stay at your house and be as independent as you can.
In California, this is possible with the Medi-Cal benefit of the Assisted Living Waiver.
What Is the Assisted Living Waiver Program?
The Assisted Living Waiver is a program under California Medicaid (Medi-Cal). Thanks to the Assisted Living Waiver, people with limited financial resources may receive nursing home care benefits.
ASWP can provide them with the same quality and level of care as those in an assisted living residence. If you are eligible, Medi-Cal can pay for nursing care at home if its cost is lower than when in a nursing home.
Medi-Cal does this thanks to the Home and Community-Based Services (HCBS) Waivers, also known as Waiver Funded Services.
Through the Assisted Living Waiver, the elderly and PWDs can receive the care assistance they badly need. The program is statewide, but not all counties have available providers. There are currently 15 counties where the waiver is available.
If you are not in a location where ALWP is available but want to be a participant, you can move to any county with a provider.
In addition, participants must contribute to their room and board costs. The Medi-Cal Assisted Living Waiver is not an entitlement program.
Applying to the program and meeting the eligibility requirements doesn’t guarantee that you’ll receive nursing care.
This is because ASWP has a limited number of slots for participants. Once the slots are full, the applicants will likely fall into a waitlist.
Eligibility
To qualify for the Assisted Living Waiver, you have to meet the requirements set by the California Department of Health and Human Services. These qualifications are:
Age
The ALW program is for persons with disability and the elderly. They must be between 21 and 64 years of age if the participant has a disability.
If not, they must be more than 65 years of age.
Residence
The Assisted Living Waiver is only for California residents. If you are an applicant living in a nursing home, you can qualify if you have been there for at least six months.
Applicants must also stay in a county with an assisted living residence. The counties where ALWP services are available are currently:
- Alameda
- Orange
- Los Angeles
- Riverside
- Contra Costa
- Kern
- Fresno
- Sacramento
- Sonoma
- Santa Clara
- San Mateo
- San Bernardino
- San Joaquin
- San Francisco
- San Diego
Financial
Eligibility to the ALWP also includes meeting the financial criteria. These criteria comprise the participant’s income, homeownership, and assets.
Income
The income limit for the applicant is equal to 138% of the Federal Poverty Level (FPL).
The FPL increases every year, which happens in April in California. Until March 2022, the monthly income limit of a single applicant is up to $1,481.
If the applicants are spouses, their income limit is $2,003 a month.
On the other hand, the income limit of the applicant (if only one spouse in a couple is an applicant) is $1, 481. There are a few more specifics to the income limit of the applicant, so it is vital to research more on the topic.
One of the things to keep in mind is that the cost of the participant’s room and board will be based on your income.
Homeownership
As your highest valued asset, you may be worried that Medicaid may take your home. Don’t worry because your home may be exempt if:
- You live in your home or intend to return to it, as indicated in writing.
- Your non-applicant spouse still lives in your home.
- You have a child below the age of 21 living in your home.
- You have a dependent relative living in your home.
Assets
As of 2022, a single applicant has an asset limit of $2,000. On the other hand, the asset limit for spouses who are both applicants is $3,000.
The asset limit applies to both applicant and non-applicant spouses, which is considered jointly owned. However, a bigger portion of the asset is given to the non-applicant spouse to avoid spousal impoverishment.
Functional Needs
Last but not least, you are eligible for an Assisted Living Waiver if you need a nursing facility level of care. This is determined using a specialized assessment tool that a registered nurse administers.
Your care needs are further defined to different tier levels, from one to five. One means minimal support, while five equals the highest amount of support the ALWP can provide.
Services Under the Assisted Living Waiver
A personal care plan is devised by a Medi-Cal social worker, which lists all the recommended services the participant needs.
The services and benefits that may be included in this care plan are any of the following:
- Assistance with daily living activities (bathing, eating, toileting, etc.)
- Assistance in administering medicine and transportation
- Skilled nursing
- Preparing meals
- Transitioning from nursing home to assisted living
- Housekeeping and laundry
- Recreational, therapeutic and social activities
How to Apply for ALWP?
Application to the Assisted Living Waiver Program starts by submitting an accomplished Medi-Cal application form to your county’s Department of Human Services.
Next, contact one of the coordinating agencies to request the ALWP.
Know that the application process for ALWP can take three to six months, especially if there is a waitlist.
Does Insurance Help Pay for Assisted Living?
Sadly, most traditional health insurance does not pay for long-term care, so most do not cover assisted living. There are some insurance plans with options for this but they are not comprehensive.
The best option is long-term care insurance, which provides benefits not covered by medical insurance or Medicare.
Long-term care insurance can cover some of the payments for assisted living. It may cover assisted living, nursing homes, hospice, adult day care, home health aides, and skilled nurses.
Having such insurance can help ease your burden, especially if partnered with an Assisted Living Waiver.
Conclusion
Assisted Living Waiver is one of the many programs in California that can help low-income families and PWDs.
Many California residents need assistance in their daily activities but understandably don’t want to leave their homes.
In that case, the Medi-Cal Assisted Living Waiver Program can help.