Assisted Living•Costs and Affordability
California’s Assisted Living Waiver (ALW) Program: How Medi-Cal Can Help Pay for Assisted Living
Assisted Living•Costs and Affordability
California’s Assisted Living Waiver (ALW) Program: How Medi-Cal Can Help Pay for Assisted Living
What Is the Assisted Living Waiver (ALW)?
The Assisted Living Waiver (ALW) is a Medi-Cal Home and Community-Based Services (HCBS) program administered by the California Department of Health Care Services (DHCS). Its purpose is to help seniors and adults with disabilities receive the care they need in a licensed assisted living community rather than in a skilled nursing facility.
The program helps eligible individuals remain in a more home-like environment while receiving assistance with daily activities such as:
· Bathing and dressing
· Medication management
· Personal care
· Housekeeping
· Meals
· Care coordination
· Limited skilled nursing services when needed
· Social and recreational activities
What Does the ALW Program Pay For?
One of the biggest misconceptions is that Medi-Cal pays the entire assisted living bill.
It doesn’t.
The ALW program pays for the care services provided in participating assisted living communities. Residents are still responsible for paying their room and board, although many use their Social Security, SSI, or other income to cover those housing costs.
Who Is Eligible?
To qualify for the Assisted Living Waiver, applicants generally must:
· Be 21 years of age or older
· Have full-scope Medi-Cal with no Share of Cost
· Require a nursing-facility level of care
· Be able to live safely in an assisted living community
· Be willing to live in a participating assisted living community located in a county that offers the ALW program
A registered nurse will perform an assessment to determine whether the applicant meets the required level of care.
Which California Counties Participate?
Currently, the Assisted Living Waiver is available in 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
· Sonoma
Even if you don’t currently live in one of these counties, you may qualify by moving into a participating assisted living community located there.
How to Apply for the ALW Program
Applying for the Assisted Living Waiver is different from applying for Medi-Cal.
Step 1: Apply for Medi-Cal
If you are not already enrolled, you’ll first need to qualify for full-scope Medi-Cal.
Applications can be submitted:
· Online through BenefitsCal
· Through your County Social Services office
· By phone
· In person at your local Medi-Cal office
Step 2: Contact an ALW Care Coordination Agency
Once Medi-Cal eligibility has been established, contact an approved Assisted Living Waiver Care Coordination Agency.
The agency will:
· Review eligibility
· Schedule a nursing assessment
· Develop a care plan
· Help locate participating assisted living communities
· Assist throughout the enrollment process
Step 3: Complete the Assessment
A nurse will determine whether your care needs meet the nursing-facility level of care required by the program.
If approved, you’ll be matched with a participating assisted living community that has an available ALW opening.
Is There a Waiting List?
Unfortunately, yes.
The Assisted Living Waiver is not an entitlement program, meaning there is a limited number of available enrollment slots. Many applicants are placed on a waiting list before services become available, and wait times can vary by county and participating care coordination agency.
Because of these waitlists, it’s often best to begin the application process as early as possible.
Why Families Choose the ALW Program
The Assisted Living Waiver allows seniors to receive personalized care in a residential setting while maintaining greater independence than they might in a nursing facility.
For many families, the program offers:
· Lower out-of-pocket care costs
· A more comfortable home-like environment
· Personalized assistance with daily activities
· Increased independence
· Improved quality of life
Purple Door Finders Can Help
Understanding Medi-Cal and the Assisted Living Waiver can feel overwhelming.
At Purple Door Finders, we help families navigate senior living options, identify communities that participate in the Assisted Living Waiver Program, and understand the steps needed to qualify. We can steer you in the right direction for the assistance you need. Our guidance is always free for families, and we’re here to make the process easier.
Need help finding an ALW-approved assisted living community? Contact Purple Door Finders today and let one of our counselors help you. We offer this service as a courtesy to seniors seeking a community and to communities that accept ALW waivers. No charge to either.