As if the search for
the perfect Assisted Living facility for you or your loved one
isn’t difficult enough, researching all the available
options to pay for the facility can have you wishing for a quick
Thankfully, there are
more reliable sources of funding – it just takes a little
leg work to find them. Private pay or using private insurance
are two common options for paying for an Assisted Living Facility
but it is just as common to use Medicaid. In fact, 50%
of residents use some form of Medicaid to pay for nursing
home or assisted living care.
Many states have created
specific programs to assist with the costs of either Skilled
Nursing care or placement in an Assisted Living Facility. Along
with these programs, states often introduce pilot programs
to help defray Assisted Living costs (or, unfortunately, eliminate
them during times of budget difficulties).
Deciphering these programs
(the application requirements, the benefits of the program as
well as which homes and agencies accept the benefits) can be
difficult, confusing and frustrating but is worth it in order
to relieve financial concerns. Keep in mind contacting the local
Medicaid office for the most up-to-date information is essential
in these difficult financial times with state, federal and local
budgets in a constant state of flux.
Even with the current
economic climate, California provides a few options to those
looking for financial assistance to help pay for an Assisted
What are my
Within the Medicaid
system, there are several programs which may be of assistance.
For instance, the Assisted Living Waiver Program
allows the participant to pay a significantly reduced fee for
an Assisted Living facility. The ALW program began as a pilot
program in just a few counties but has now expanded to include
several other counties. Participating counties include Los Angeles,
Sacramento, San Joaquin, Riverside, Fresno and San Bernardino
with Sonoma County slated to join the program later this year.
Who is Eligible?
There are very specific
eligibility requirements for this program one of which is to
consult with an approved Care Coordinator in order to determine
eligibility in the program. Because the program is only available
in certain counties, residency in that county is required. In
addition, a stay in a Skilled Nursing Facility immediately prior
to placement in an Assisted Living Facility is also required.
The Care Coordinator will be able to guide you through the process
of matching you or your loved one with the right facility and
to ensure all eligibility requirements are met. The ALW program
can be extremely helpful in reducing the costs of an Assisted
Living Facility if a person is eligible.
Always Best Care is
one such Care Coordinator agency and can be contacted through
Living Directory California website. For more information
about the ALW program as well as a complete list of participating
facilities and Care Coordinators, please visit http://www.dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx
How Do I Apply?
First, contact the local
Social Security office either in person or visit their website
at www.ssa.gov to apply for Social Security benefits. The eligible
adult may also qualify for Supplemental Security Income (SSI)
or Social Security Disability Insurance (SSDI) but it is necessary
to start with the Social Security application. Getting SSI or
SSDI will help in getting benefits at the State and Local levels.
Once a person qualifies
for Supplemental Security Income, they may automatically be
eligible for Medicaid. Medicaid is administered by individual
states but funded jointly through the Federal and State governments.
It can be known under different names in different states but
in California, it is known as Medi-Cal. The Department of Health
Care Services (http://www.dhcs.ca.gov)
manages state health care services and administers the Medicaid
if I am Denied?
Social Security or Medi-Cal
Benefits are often denied. It is a long and complicated process
but mistakes are made and reversals can happen. Appealing a
denial is strongly encouraged. Following the rules of the initial
application as well as the appeals process is critical, particularly
since there are strict timelines in which to adhere.
Accept the ALW?
There is a good assortment
of facilities within the participating counties which accept
ALW. For instance, Sacramento County has at least seventeen
participating facilities and Los Angeles County has over forty
participating facilities. The smaller counties have fewer participating
facilities but the Care Coordinator will have the most up to
date information on facilities accepting ALW payment.
Searching through the
maze of agencies and eligibility requirements may seem like
a daunting task (and makes winning the lottery seem so much
easier) but the reward for your persistence will be getting
much needed help that you, as a Caregiver, need which will ultimately
benefit your loved one.
Join our Google+ Community & Discussion Group!
- Article by Trish
Hughes Kreis exclusively for Assisted Living Directory