Does Medi-cal pay for assisted living in california?
California has a limited Medi-Cal waiver program called the Assisted Living Waiver (ALW) which allows Medi-Cal to pay for residential care facilities for the elderly (RCFEs).
ALW allows qualified individuals in California in certain counties to use Medi-Cal funding to receive care in ALW approved Residential Board and Care, Assisted Living and publicly subsidized housing sites.
Eligible patients are anyone 21 years of age or older who is eligible for medi-cal without a share of cost and who has been determined to need a "skilled nursing" level of care.
ALW has significant liabilities:
1) Most RCFEs do not want to participate with the program (see below).
2) There are long waitlists.
3) The program requires private rooms but in most cases does not pay sufficiently for a private room in the marketplace.
4) Requiring private rooms (as opposed to shared rooms) costs twice as many Medi-Cal dollars and promotes the woodwork effect (family who support private paid residents in shared rooms can upgrade their relatives to private rooms when they participate with ALW).
5) It was not designed with small 4-6 bed RCFEs in mind even though these settings have high staff to resident ratios.
6) Most ALW participants go to large RCFEs that frequently have 1 staff to 20-30 residents during the day and 1 staff to 30-40 residents at night.
7) Requires RCFE owners pay out of pocket without reimbursement for care services required by some ALW participants (e.g. paying for an outside nurse to administer insulin shots).
8) Does not accommodate skilled nursing facility diversion at point of hospital discharge.
9) Forces relocation of rollover patients (current private paid RCFE residents who run of money). Since ALW priority is given to SNF patients on long-term Medi-Cal rollover residents must leave the RCFE, transfer to a SNF to become eligible (after three months) for long term Medi-Cal, apply for ALW and then try to find an available ALW slot.
10) When used in conjunction with the California Coordinated Care Initiative ALW disrupts the continuity of care by requiring CCI participants disenroll from CCI in order to participate with ALW.
For more on ALW see our Shaky Foundation ALW article.
By county: ALW providers/Total RCFEs (as of Feb 2015):
Los Angeles: 78/1,340
San Bernardino: 12/236
San Diego: 12/641
San Joaquin: 17/86