ASSISTED LIVING WAIVER (ALW) Program
Provider Enrollment in California
Application and Documents Assistance
What is California's Assisted Living Waiver (ALW) program?
In March 2006, Medi-Cal (California's version of state Medicaid assistance) began paying for assisted living care for qualified aged and disabled residents under the Assisted Living Waiver (ALW). The ulitmate goal of the program was and still is to enable low-income, Medi-Cal seniors, who would otherwise require nursing facility services to remain in or relocate to a community setting in a Residential Care Facility for the Elderly (RCFE). The program has been so successful that it was converted into a federal waiver program as of 2009 and continues to be renewed and grow each year.
All providers must be licensed by California Department of Social Services and approved through Medi-Cal enrollment portal. Navigating the multiple applications and the maze that is Medi-Cal provider enrollment can be extremely confusing and time consuming. Any mistakes can cause costly delays.
Who qualifies to be a provider in the ALW program?
Almost all RCFEs will qualify, including 6 beds. The following is a list of services that must be provided to ALW residents (your facility already likely provides most if not all these services):
Personal Care and assistance with activities of daily living
Maintenance of the facility
Meals and snacks
Providing assistance with self administration of medications
Providing OR coordinating transportation
Providing recreational activities
Providing social services
Assist in developing and updating an individual care plan for each resident (care coordinators will more or less take care of this for your facility)
Care Planning for the ALW program:
Using a standardized assessment tool, care coordination agencies will determine the level of care (tier level) and services necessary for each participant. The care coordinators will establish indivualized service plans for each participant,including the services covered by Medi-Cal and services funded by any other source(s). Participating RCFEs must implement (coordinate) the service plan for each resident. The care coordination agency will arrange for the nurse assessment and monthly visits from a qualified social worker.
How we help:
The ability to thoroughly and accurately complete multiple applications is essential for the successful and timely access of enrolling your RCFE into California's Assisted Living Waiver program.
The level of literacy skills required to successfully navigate complex forms and applications is beyond the abilities of many people, or perhaps it is just not worth the time and effort.
The process of applying for the ALW program has several stages and each requires the completion of many pages of forms with timed deadlines to each response. An accurate and complete application with the correct documentation attached may substantially reduce the time required before acceptance into the program is hopefully awarded, a wait time that often, otherwise, may be years.
Get ALW provides training to RCFE Providers in preparation for any interviews with state agencies, both to help understand the meaning behind potential questions but also how to appropriately respond to questions on forms and applications.
Get ALW offers care coordination and life care planning experts that work in the field directly with the ALW program.
Get ALW has helped dozens of Assisted Living Facilities get enrolled in the ALW program and start accepting ALW residents.
Once approved as a provide for the ALW program, your facility will be guaranteed to be paid by a combination of the resident’s social security income and a direct payment from Medi-Cal. Several facilities already enrolled in the program report the piece of mind of knowing they the rent payment will be there at the end of the month, without worry.
The amount that the state will pays the RCFE facility is based on the different Tier Levels (levels of care).
ALW providers will receive a monthly payment from the Waiver Participant Social Security Income which ranges between $1069.37 -$1089.37 (room and board) AND a monthly payment for care paid directly by Medi-Cal based on the
Tier Levels below:
Tier 1 $71.00 per participant per day
Tier 2 $85.00 per participant per day
Tier 3 $97.00 per participant per day
Tier 4 $112.00 per participant per day
Tier 5 $200.00 per participant per day
Effective rates as of January 1, 2020
Who is eligible?
In short, any RCFE with good standards with DSS and located on the counties** of Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara and Sonoma.
A few other rules may apply.
**However, some of the counties in which the ALW program is operating do not currently have any RCFEs participating in the program.