Medicaid waivers are offered in order to provide additional services in very specific situations. For example, waivers are offered to certain groups of people, within a specific geographic location, or to people who are not eligible for Medicaid for various reasons. There are waiver programs that provide home and community-based medical services, family planning services, managed care and specialty mental health services, just to name a few. There are also waivers for services aimed at the elderly or developmentally disabled. Here, our Medi-Cal planning attorneys will discuss one particular type – the assisted living waiver.
California’s Medi-Cal program
The state of California’s Medicaid program is called “Medi-Cal” and it pays for eligible medical services for eligible individuals with limited income and resources. Like most other states, Medi-Cal offers certain waivers for additional services that are not typically available under the standard Medi-Cal program. An Assisted Living Waiver is one of those specific waivers.
The need for Assisted Living services
If they have a choice, most seniors would prefer to live out their days at home where they are most familiar and feel comfortable. The unfortunate reality is that staying at home is not always a realistic choice for everyone. As we age, regardless of the status of our health, daily activities typically become more difficult, including preparing meals, paying bills, toileting and grooming. If staying at home is an important goal, then Assisted Living may be a great option.
Assisted living services provide seniors the opportunity to live in a home-like setting while still receiving the personal support services they require. This is considered a great alternative to nursing home care for many reasons. First, is usually less expensive and second, it gives seniors more independence.
The Assisted Living Medicaid Waiver program
For seniors who choose assisted living services, but who are at risk of needing nursing home services, the waiver program may be the solution. Medi-Cal planning attorneys can explain the qualifications in more detail, but basically, individuals need to meet certain financial and physical eligibility requirements. Obviously, seniors must be living in an assisted living facility in order to apply for an Assisted Living Medicaid Waiver
Seniors who are chosen to participate in the waiver program will be assigned a caseworker. That person will establish a unique care plan for the senior which might include various services. Assisted living services often include grooming and bathing, preparing meals, cleaning, health services, transportation, medication administration, and social activities.
Qualifying for the Medi-Cal Assisted Living Waiver program
Just as every state has its own Medicaid program, they also have their own waiver programs. For that reason, the qualifications necessary for the waiver programs differ depending on where you live. Let our Medi-Cal planning attorneys explain the necessary qualifications or contact your local Medi-Cal agency. In California, there are certain basic eligibility criteria which include being 21 years of age or older, having full-scope Medi-Cal eligibility with zero share of cost (SOC), having care needs equal to those of Medi-Cal-funded residents living and receiving care in a nursing home or other nursing facility, and being able to life safely in an assisted living facility or public subsidized housing.
Specifics regarding California Assisted Living Waiver programs
The first pilot program lasted three years and was limited to three trial counties. In March 2009, after that pilot was successful, the Centers for Medicare and Medicaid Services approved a waiver renewal for five more years and expansion of the program into several additional counties. As of March 1, 2014, the five-year waiver renewal became effective.
In California, the following counties provide Assisted Living Waiver 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.
How to obtain Medicaid waiver services
For certain Medi-Cal waiver programs, the first step in receiving benefits is simply to contact your local social services office. For other programs, an initial assessment must be completed, which is coordinated through that particular program’s administrator, in order to determine whether or not you are eligible for the services. In order to participate in any waiver program, you will be required to demonstrate you are eligible for Medi-Cal benefits. Both determinations can be made simultaneously.
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