Assisted Living Waiver Program in California

Assisted Living waiver programs, which bring Medicaid reimbursement to the Assisted Living model, are common place in the majority of the states in the US.  Over the last ten years, California has been working towards implementing their own Medicaid program for Assisted Living facilities.

What Is an Assisted Living Waiver?

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 facilities 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 expanded the program into additional counties.  A five-year waiver renewal was effective March 1, 2014.

Who Is Eligible for An Assisted Living Waiver?

To be eligibleto receive services as an ALW Participant, an individual must meet all of the following ALW eligibility criteria:

  • Age 21 or older;
  • Have full-scope Medi-Cal eligibility with zero share of cost;
  • Have care needs equal to those of Medi-Cal-funded residents living and receiving care in Nursing Facilities;
  • Willing to live in an Assisted Living setting as an alternative to a Nursing Facility;
  • Able to reside safely in an Assisted Living facility or public subsidized housing;
  • Willing to live in an Assisted Living setting located in one of the following counties providing ALW services: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma counties.

What Is the Goal of The Assisted Living Waiver?

1) Facilitate a safe and timely transition of Medi-Cal eligible seniors and persons with disabilities from a Skilled Nursing Facility (SNF) to a community home-like setting in a Residential Care Facility for the Elderly (RCFE), an Adult Residential Care Facility (ARF), or public subsidized housing, utilizing ALW services; and

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, ARF, or public subsidized housing.

Under the California ALWP, residents are able to combine their supplement security income with the Medi-Cal benefits creating the rates sited below. The CA system has a 4-tier system depending on the residents’ acuity level.

Here is an example of the 2017-tiered system in California:

Tier Level         Monthly ALWP Rate     Monthly SSI Rate           Total Monthly Reimbursement

1                                  $1,673                         $1,102                         $2,775

2                                  $2,008                         $1,102                         $3,009

3                                  $2,281                         $1,102                         $3,383

4                                  $2,646                         $1,102                         $3,748

In general Medicaid waiver programs represent a large savings for the state, given the same care provided in a Skilled Nursing setting will likely be twice as much as that provided in an Assisted Living setting. While the majority of Assisted Living operators will remain in the private pay model, this program is an excellent source of residents and income for facilities in less affluent areas and those with older physical plants. Overall this is a great program for Assisted Living Facilities in California.

Stay Informed with The JCH Group

The JCH Senior Housing Investment Brokerage serves as a premiere brokerage in the senior housing industry. We have designed, negotiated and closed hundreds of transactions. From independent living facilities to skilled nursing facilities, we are your experts for the perfect senior housing investment.

For your free valuation or for more information, speak to a JCH investment specialist today!

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