Medi-Cal Assisted Living Waiver – ALWP program
Administered by California Department Health Care Services (DHCS), the Medi-Cal Assisted Living Waiver Program provides placement in an approved assisted living community as an alternative to skilled nursing home placement under Medi-Cal. It is available in specific counties throughout California. Elder Options contracts with DHCS as a Care Coordination Agency (CCA) for approved assisted living communities in Sacramento County.
Elder Options conducts:
- Initial intakes
- Establishes preliminary eligibility
- Assists family in finding appropriate assisted living community
- Conducts initial assessment by RN
- Once person is approved and moved in, an Elder Options’ Care Coordinator provides monthly face-to-face visits to monitor care coordination
Eligibility criteria for Medi-Cal Assisted Living Waiver:
- A current Medi-Cal recipient (full scope with no share of cost)
- Must meet the needs criteria for Activities of Daily Living/Independent Activities of Daily Living i.e., feeding, walking, supervision, person care, falls risk, etc.
- Willingness to move into an approved Assisted Living facility (Sacramento County).
Elder Options has been a Care Coordination Agency since the program’s inception in 2006 and is well versed with the program. Elder Options’ Care managers and staff provide support to clients, families and administrators in assuring quality care for each client under Elder Options monthly visits to each client.
Payment. There are set fees and tier levels that indicate the degree of care needed and fees paid to the assisted living community. Fees are set by ALWP program and must be complied with by all participating assisted living communities. If an eligible client is approved for the ALWP program, payment is as follows:
- Client’s Social Security/pension – a small portion is retained by client/family for monthly needs allowance but balance is paid to assisted living community.
- Medi-Cal pays the balance due to the assisted living community under this program and pays the monthly care coordination to Elder Options, Inc.
Required Information and Documents to Begin an Application.
- Individual’s full name
- Date of birth
- Medi-Cal number and issue date – Medi-Cal has to be in place and cannot be “in process.”
- Address and telephone number
- Total monthly income and source
- Questionnaire regarding ability to complete activities/daily living
- Completed 601a (Physician’s Statement)
- Power of Attorney document (if individual is unable to act in own behalf)
- E-Tar and Face Sheet (if individual currently resides in a skilled nursing facility)
- Choice of two assisted living communities – we strongly recommend visiting sites in person
To Begin The Process
- Client/family/POA calls Elder Options to begin the ALWP process.
- Our staff does intake and completes questions regarding Activities of Daily Living, client needs, diagnosis, etc. Must include Medi-Cal number and issue date.
- Requests additional forms (see above) be forwarded to Elder Options, Inc. by fax or email.
- Visit assisted living communities. Let Administrator know that client is applying for Assisted Living Waiver Program. See if they have available bed available and if they’ll take client once approved.
- Call/email Elder Options and notify staff of choices for assisted living communities. If all other forms are in and packet is complete, our staff will notify RN to set up initial assessment.
- RN will call client/family and set up appointment for initial assessment at client’s home. If client is out of the area, assessment can take place at desired facility (with Administrator’s permission).
- RN completes assessment and forwards to our office for submission to CA DHCS for approval. Approval times are between 4-8 weeks.
- Once DHCS approves and pends client for the program, client/family is notified by our staff.
- Client/family notifies Elder Options about chosen assisted living community. Administrator to see if bed is available and choose a move-in date.
- Once client is moved in, family/POA notifies Elder OPtions staff so monthly monitoring by CCA can begin.