What is the Assisted Living Waiver

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The Assisted Living Waiver (ALW) program is a Medicaid-funded initiative that allows eligible individuals to receive care in assisted living facilities rather than nursing homes. The program aims to provide more home-like, less institutional environments for seniors and individuals with disabilities, promoting greater independence and quality of life. It typically covers services such as personal care, housekeeping, medication management, and transportation. Eligibility requirements and covered services can vary by state.

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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 an assisted living residence at a lower cost. The Assisted Living Waiver Program (ALWP) serves seniors who need long term care assistance with personal care and household tasks. Most seniors and their families prefer an assisted living environment rather than a nursing home facility. This creates a win-win scenario for the state and for families.

 

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

• Sonom

 

The California Department of Health and Human Services requires that participants in this waiver program contribute to their room and board costs. For those who cannot afford this minimum monthly expense, they may be able to a find a spot in a publicly subsidized housing apartment.

 

General Requirements To qualify

 

Applicants must be a minimum of 65 years old, or a minimum of 21 years old if disabled. Applicants must also 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 can be met by the facility.

 

Income Limits

 

As of April 2022, the state set the monthly income limit at $1,564 for a single applicant and at $2,106 for a married couple who are both applying for benefits. These income limits will increase in April of 2023 and will reflect 138% of the 2023 Federal Poverty Level figures. To be clear, when only one spouse needs assisted living care, only income in his/her name will be counted toward the individual income limit. Furthermore, the applicant spouse may be able to transfer monthly income in his / her name to the non-applicant spouse to prevent spousal impoverishment. As of 2022, the maximum amount that is allowed to be transferred is $3,435 / month. This is called a monthly maintenance needs allowance.

 

How to Apply / Learn More

 

To learn more about the Assisted Living Waiver, which is administered by the California Department of Health Care Services (DHCS), click here. 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 one of the care coordinating agencies listed here. The full process can take between 3 to 6 months.

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CLICK HERE FOR:  (ALW) Program Participating Facilities

CLICK HERE FOR: Participating Care Coordination Agencies

CLICK HERE FOR: Reimbursement Rates

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