THE ASSISTED LIVING WAIVER (ALW) PROGRAM

The Assisted Living Waiver (ALW) is a Home and Community-Based Services (HCBS) waiver that was created by legislation that directed the California Department of Health Care Services (DHCS) to develop and implement the project to test the efficacy of assisted living as a Medi-Cal benefit.

The pilot program was determined to be successful during the first three years in a limited trial in three counties.  In March 2009, the Centers for Medicare and Medicaid Services approved a waiver renewal for an additional five years and expansion of the program into additional counties.  Today the ALW is operating in Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, San Mateo, Santa Clara, and Sonoma counties.  A five year waiver renewal was effective March 1, 2014. 

1. Facilitate a safe and timely transition of Medi-Cal eligible seniors and persons with disabilities from a nursing facility to a community home-like setting in a Residential Care Facility for the Elderly (RCFE) or public subsidized housing, utilizing ALW services
   
2. Offer eligible seniors and persons with disabilities, who reside in the community, but are at risk of being institutionalized, the option of utilizing ALW services to develop a program that will safely meet his/her care needs while continuing to reside in a RCFE or public subsidized housing.

• Making affordable housing with personal and health-related services available to seniors and individuals with disabilities
  
• Maximizing dignity, privacy, independence and autonomy
  
• Providing an alternative to long-term care placement in a nursing home

The ALWP is designed to assist Medi-Cal beneficiaries to remain in their community as an alternative to residing in a licensed health care facility. The program provides specified benefits to eligible seniors and persons with disabilities. Medi-Cal reimburses for the services provided to residents enrolled in the ALW, however, the resident is responsible to pay for their own room and board. For 2015, for those with SSI income of $1,145.00, room and board is $1,014.00 and those with income of $1,165.00 or greater, room and board is $1,034.00.

The ALW is an alternative to long-term placement in a nursing facility and is presently available in the following counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, San Mateo, Santa Clara, and Sonoma. The ALW is currently enrolling beneficiaries residing in skilled nursing facilities and in the community, into licensed Residential Care Facilities (RCF) and Public Subsidized Housing (PSH).

Assisted Living Waiver (ALW) eligible individuals are those who are enrolled in Medi-Cal and meet the level of care provided in a nursing facility due to their medical needs. Individuals with Medi-Cal benefits that include a share of cost may not be enrolled in the ALW. Please contact your local county office to obtain information about how to apply for Medi-Cal benefits. Please note: the state does not determine eligibility for Medi-Cal benefits. 

Determination of care needs is done by registered nurses (RN) employed by a Care Coordination Agency (CCA). Contact one of the CCAs in your county of residence to request an assessment. A pre-screening “assessment” will be done over the phone before an appointment is set up for the actual assessment. 

Services that are required by state statutes and regulations to be provided or coordinated must include, but are not limited to:

• 24-hour awake staff to provide oversight and meet the scheduled and unscheduled needs of residents (24-hour awake staff is not required in RCFEs with 6 beds or less)
• Provision and oversight personnel and supportive services (assistance with activities of daily living and instrumental activities of daily living)
• Health related services including skilled nursing (e.g., medication management services, treatments, wound care, etc.)
• Social services
• Recreational activities
• Meals
• Housekeeping and laundry
• Provide or arrange transportation

A resident has the right to make choices and receive services in a way that will promote the resident’s dignity, autonomy, independence, and quality of life. These services are disclosed and agreed to in the contract between the provider and resident. Assisted living does not generally provide ongoing, 24-hour skilled nursing. Assisted living units are private occupancy and shared only by the choice of residents (e.g., by spouses, partners or friends).

• Assistance in developing and updating ALWP participant's Individualized Service Plans (ISP) which details in part, the frequency and timing of assistance. Participants play active roles in the development process and must sign their ISP
• Providing personal care and assistance with ADLs and IADLs sufficient to meet both the washing, drying and folding laundry; scheduled and unscheduled needs of the residents
• Performing all necessary housekeeping tasks
• Maintaining the facility
• Providing three meals per day plus snacks. Food must meet minimum daily nutritional requirements and meet the resident's special dietary needs as prescribed by their PCP
• Providing intermittent skilled nursing services as required by residents
• In accordance with State law, providing assistance with the self-administration of medications, or administering medications by an RN or LVN;
• Providing or coordinating transportation
• Providing daily recreational activities
• Providing social services
• Providing a response system that enables waiver beneficiaries to summon assistance from personal care providers

Participants in the Assisted Living Waiver Program will have access to three waiver benefits

Assisted Living Services - These services are called the Assisted Living Services when they’re provided in an RCFE and Assisted Care when they’re provided by a licensed Home Health Agency and delivered to residents of publicly funded housing.

Care Coordination - These services include identifying, organizing, coordinating and monitoring services needed by a participant. Care Coordinators conduct assessments to assist in determining eligibility, develop Individualized Service Plans (ISPs), arrange for services, maintain contact with participants, and monitor service delivery on a monthly basis.

Nursing Facility Transition Care Coordination - This benefit helps to transition residents from nursing facilities to the community.

For additional information on the Assisted living Waver Program (ALWP) please visit the California Department of Health Care Services website: www.dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx  or contact your local county office which can be found at www.dhcs.ca.gov/services/medi-cal/Pages/CountyOffices.aspx

Assisted Living Waiver Program Participating Facilities