ASsisted living waiver program

 Funded by federal funds from CMS and State of California, the ALWP began as a pilot project in 2006. 

Administered by the Department Health Care Services (CA-DHCS), the Medi-Cal Assisted Living Program provides placement in an approved Assisted Living community as an alternative to skilled nursing home placement.  It is available in Fifteen (15) counties throughout California.  Care Republic CCA is an approved Care Coordination Agency (CCA) for San Bernardino, Riverside, 

San Diego and Kern counties Assisted Living communities.

The specific criteria for eligibility for ALWP are:

• Full scope Medi-Cal
• Source of Income (Social Security, Pension, 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.
• Living in the community with the desire/need to enter Assisted Living.

Payment

Set fees and tier levels for each client are determined by the 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:

1. 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.
2. 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.

 Note:  The ALWP Program is currently on a waitlist 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. 

• Must be 21 years old 
• 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 the ability to complete activities of daily living (ADLs)
• Completed Physician’s Report (602a)
• Power of Attorney documents if the individual is unable to act on own behalf.
• E-Tar and Face Sheet if an 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.)

Initial Call & Intake:

• An individual calls and is interested in the ALW Program. The current waitlist 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 emailed 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 waitlist form is approved and forwarded to CA DHCS by Care Republic to be included on the waitlist.
• A copy of the “Submission to the Waitlist” letter will be forwarded to the family/client/POA.
• Care Republic staff will check Medi-Cal eligibility monthly and will keep in contact with family/client regularly to assure the client’s continued interest in the ALW program.
• Care Republic will be notified once a month of the number of slots available at which time E.O. will immediately notify the family/client/POA of the individuals at the top of the waitlist to finalize the move into an approved Assisted Living Facility. This must be done within 60 days of notification.

Note:  Currently waitlist times are 6 months for individuals in a skilled nursing facility (SNF) and 12 months for individuals living in a community setting.