Medi-Cal Assisted Living Waiver – ALW Program
Elder Options is the oldest and most experienced Care Coordinating Agency, supporting the ALW program with Credentialed Care Managers since the initiation of the waiver in 2006. Our knowledgeable and helpful staff is well versed in the program and provides support to clients, families, assisted living staff, and other community partners.
Administered by the CA Department Health Care Services (DHCS), the Medi-Cal Assisted Living Program provides placement in an approved Assisted Living community as alternative to skilled nursing home placement. It is available in specific counties throughout California. Elder Options, Inc. is an approved Care Coordination Agency (CCA) for Sacramento County Assisted Living communities.
Funded by federal funds from CMS and State of California, the ALWP began as a pilot project in 2006. Elder Options was one of the first CCAs to participate in this program and has been a part of this program ever since. Elder Options in its role as a CCA provide support to clients, families and Assisted Living Administrators in assuring quality care for each client by conducting in-takes, establishes preliminary eligibility, conducts initial R.N. assessments, assists families in finding appropriate placement and provides advocacy and monthly face-to-face care coordination for all approved clients.
The specific criteria for eligibility for ALWP is:
- Full scope Medi-Cal
- Source of Income (Social Security, Pesion, SSI)
- Medi-Cal with no Share of Cost (SOC)
- Meeting the ADL/IADL criteria (Activities of Daily Living/Instrumental Activities of Daily Living)
- Willingness to move from skilled nursing to an approved Assisted Living Facility – Sacramento county OR
- Living in the community with the desire/need to enter Assisted Living.
Note: The ALWP Program is currently on a wait list format. The approximate wait for an assessment for the ALW program can be extensive. However wait times are subject to change depending on availability of slots.
PAYMENT. Set fees and tier levels for each client are determined by degree of assistance needed for each individual and are paid to the Assisted Living community the client moves into. All fees are set by CA Department Health Care Services (DHCS) and must be complied with by all participating Assisted Living communities. Once an individual applies and is accepted into the ALWP, payment is as follows:
- Client’s retirement (Social Security/pension). A small allowance is retained by the client/family for monthly needs allowance but balance is paid to the Assisted Living community.
- The balance of the required amount is paid by Medi-Cal under the ALWP program. Monthly care coordination and client follow up is paid by ALWP to the contracting CCA.
REQUIRED INFORMATION & DOCUMENTS TO BEGIN THE APPLICATION PROCESS
- 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”.)
- No Share of Cost
- Address and telephone number
- Total monthly income and source i.e., Social Security
- Questionnaire regarding ability to complete activities of daily living (ADLs)
- Completed Physician’s Report (602a)
- Power of Attorney documents if individual is unable to act on own behalf.
- E-Tar and Face Sheet if individual currently resides in a skilled nursing facility (snf).
- Choice of two approved Assisted Living communities. (We strongly recommend you personally visit several facilities to choose the most appropriate one for the client.)
TO BEGIN THE PROCESS
Initial Call & Intake:
- An individual calls and is interested in the ALW Program. The current wait list status will need to be explained. If still interested, the ALW coordinator or C.M. of the Day will complete the intake.
- The family/client/POA will be e mailed the necessary information.
- If all necessary information is available for the intake process, an eligibility response is run on the Medi-Cal website to assure current eligibility.
- When this is completed, the wait list form is approved and forwarded to CA DHCS by Elder Options to be included on the wait list.
- A copy of the “Submission to the Wait list” letter will be forwarded to the family/client/POA.
- Elder Options’ staff will check Medi-Cal eligibility monthly and will keep in contact with family/client regularly to assure client’s continued interest in the ALW program.
- Elder Options will be notified once a month of number of slots available at which time E.O. will immediately notify the family/client/POA of the individuals at the top of the wait list to finalize the move into an approved Assisted Living Facility. This must be done within 60 days of notification.
Note: Currently wait list times are 6 months for individuals in skilled nursing facility (snf) and 12 months for individuals living in a community setting.