Covering The Cost of Assisted Living in California: Assisted Living Waiver

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 lottery win.

Thankfully, there are more reliable sources of funding 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 The Assisted Living Waiver program allows participants to pay a reduced fee for assisted living housingprograms 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 Living Facility.

What are my options?

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 the Assisted Living Directory California 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 benefits.

What Happens 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.

Which Facilities 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.