A Guide to California's Assisted Living Waiver (ALW) Program

Are you or a loved one struggling with the high cost of assisted living in California? The fear that a nursing home is the only affordable option can be overwhelming, but there may be another path. California’s Assisted Living Waiver (ALW) program offers a critical lifeline, helping eligible seniors access the care they need in a more home-like setting.

The California Assisted Living Waiver (ALW) is a Medi-Cal program designed to help low-income seniors and adults with disabilities pay for care services in an assisted living facility or public housing. Its primary goal is to provide a safe and cost-effective alternative to long-term placement in a nursing home, allowing individuals to remain in their community and live with more independence.

What is the California Assisted Living Waiver (ALW) Program?

The ALW is a specific type of Home and Community-Based Services (HCBS) waiver. In simple terms, it "waives" the requirement for certain individuals to be in an institutional setting (like a nursing home) to receive Medi-Cal funded long-term care. Instead, it allows those funds to be used for care services in an approved Residential Care Facility for the Elderly (RCFE) or in some cases, public housing.

Administered by the California Department of Health Care Services (DHCS), the program is designed for individuals who meet the level of care required for a nursing facility but can have their needs safely and adequately met in an assisted living environment. It empowers participants to choose a setting that enhances their quality of life while receiving essential support.

Who is Eligible for the Assisted Living Waiver in California?

Eligibility for the ALW is twofold, requiring applicants to meet both financial and functional criteria. This is often the most complex part of the process, so understanding the requirements is key.

Financial Eligibility

Because the ALW is a Medi-Cal program, applicants must first be eligible for Medi-Cal. This involves meeting specific income and asset limits, which are updated annually.

• Income Limits: As of 2024, California has expanded Medi-Cal eligibility, and the income limits are generally higher than in the past. An individual’s income must typically fall at or below 138% of the Federal Poverty Level (FPL).

• Asset Limits: The asset limit for Medi-Cal has also been significantly increased. While specific rules apply, most applicants will find the asset requirements more lenient than before. However, it's crucial to verify the current limits as they can change.

It's important to note that even if an individual's income is slightly above the limit, they may still qualify with a "share of cost." This works like a deductible, where they pay a certain amount of their monthly income towards medical expenses before Medi-Cal begins to pay.

Functional (Level of Care) Eligibility

Beyond finances, an applicant must be assessed and certified as needing a Nursing Facility Level of Care (NF-A or NF-B). This assessment is conducted by a Care Coordination Agency (CCA) and determines if the individual requires assistance with daily activities to a degree that would typically warrant nursing home placement. The applicant must:

• Be 21 years of age or older.

• Be able to reside safely in an assisted living or public housing setting.

• Be willing to live in an ALW-participating facility in one of the approved counties.

The waiver is currently 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, and Sonoma.

What Services Does the ALW Cover?

A common point of confusion is what the waiver actually pays for. The ALW is designed to cover the cost of services and care, not room and board. Participants are responsible for paying a portion of their income (such as their Social Security) to the facility for their rent and meals.

The waiver itself covers a comprehensive package of services, including:

• Assisted Living Services: Personal care (bathing, dressing, grooming), medication management, and assistance with daily activities.

• Care Coordination: A dedicated Care Coordinator who develops a personalized care plan and arranges services.

• Skilled Nursing Services: Intermittent nursing care as needed.

• Housekeeping and Laundry: Basic assistance to maintain a clean living environment.

• Meals and Snacks: Providing nutritious meals throughout the day.

• Transportation: Assistance with medical appointments.

• Social and Recreational Activities: Programs to encourage engagement and well-being.

How to Apply for the Assisted Living Waiver in California

Navigating the application process can seem daunting, but breaking it down into steps makes it manageable.

1. Confirm Medi-Cal Eligibility: The first step is to be enrolled in Medi-Cal with no share of cost, or a share of cost you are able to pay. If you aren't enrolled, you must apply through your county's social services agency. 2. Contact a Care Coordination Agency (CCA): Find a designated CCA in your county. These agencies are contracted by the state to manage ALW applications and enrollments. They will be your primary point of contact. 3. Get on the Waitlist: Due to high demand, there is a significant waitlist for the ALW in most counties. The CCA will help you complete the necessary forms to be placed on the waitlist. It is crucial to get on the list as early as possible. 4. Undergo Assessments: Once a slot becomes available, the CCA will schedule a comprehensive assessment to confirm you meet the Nursing Facility Level of Care criteria. 5. Choose a Facility: If approved, your Care Coordinator will provide a list of ALW-participating RCFEs in your area. You must find and move into one of these facilities to begin receiving waiver services.

Key Takeaways for ALW Applicants

Applying for the Assisted Living Waiver requires patience and persistence. Here is a checklist to help guide you through the process:

• Verify Eligibility First: Before starting, confirm you meet both the financial (Medi-Cal) and functional (level of care) requirements.

• Check County Availability: Ensure the waiver is offered in the county where you plan to live.

• Act Quickly: The waitlists can be long. Contact a Care Coordination Agency to secure your spot as soon as you think you might need the benefit.

• Understand the Costs: Remember that the waiver covers services, but you are still responsible for the room and board portion of the bill.

• Work with Your Coordinator: Your Care Coordinator is your best resource. They will help you navigate the assessments and find a suitable facility.

• Advocate for Quality Care: Once placed, remember that resources like the California Long-Term Care Ombudsman Program exist to protect residents' rights and address any concerns about care quality.

Connecting ALW to Your Overall Senior Care Plan

The Assisted Living Waiver is a powerful tool for financing long-term care, but it's just one piece of a much larger puzzle. Understanding all your options—from in-home care to skilled nursing—is essential for making informed decisions. The ALW fits into a comprehensive strategy for aging well, a topic we cover extensively in our Senior Care Guide.

Next Steps

If you believe the Assisted Living Waiver is the right choice for you or your loved one, your immediate next step should be to contact your local Care Coordination Agency. For broader questions about senior services and programs in your area, your local Area Agency on Aging is an excellent starting point. Residents can find information from state-level resources like the California Department of Aging or more local ones such as the Los Angeles County Area Agency on Aging.

By taking proactive steps and utilizing available resources, you can navigate the path to affordable, quality care and find peace of mind for the future.