By Nannette Green, RN, MHA, CCM
As case managers, we continuously seek information to be knowledgeable about programs that can be of great value and assist our patients, families, caregivers, and associated medical teams. One such program is the Assisted Living Waiver Program.
Background
The Assisted Living Waiver Program (ALWP) is designed to assist Medicaid beneficiaries (Medi-Cal in California) and seniors who need long-term care assistance with personal care and household tasks to have a choice to reside in an assisted living setting versus placement short or long-term in a skilled nursing facility.
In March 2006, Medi-Cal began paying for assisted living care for qualified aged and disabled residents of Los Angeles, Sacramento, and San Joaquin counties under the Assisted Living Waiver Program (ALWP). The primary goal of the ALWP is to enable low-income, Medi-Cal-eligible seniors and persons with disabilities who would otherwise require nursing facility assistance to remain in or relocate to a community setting in a Residential Care Facility for the Elderly (RCFE) or publicly subsidized housing.
As of March 1, 2009, the ALWP was converted into a five-year federal waiver program and expanded to 5,744 participants. In 2022, the ALWP's success allowed for another expansion and was approved to add 7,000 additional spaces. The most current five-year waiver is effective March 1, 2019, through February 29, 2024. The expected plan is to expand for another five years, effective March 1, 2024.
Key Points:
- Medicaid/Medi-Cal members who have a share of the cost are not eligible to be enrolled in the ALWP.
- To qualify, applicants must be a minimum of 21 years old if disabled or 65 years of age.
- Applicants must also need a specific level and type of care and meet the financial restrictions. Individuals must be qualified for nursing facility level of care but not require so much care that it becomes prohibitively expensive to receive that care in an assisted living environment.
- There are personal asset limits.
- The room and board payment is the resident's responsibility.
- Room and board are the candidates' responsibility and are based on income or Supplemental Security Income (SSI). The candidates must pay 90%, and they keep 10% of their funds.
- Candidates with income or assets above the allowable income limits may still qualify for this waiver.
- There are limited Medicaid/MediCal participant enrollment slots. New candidates waiting to participate are entered on a waitlist, which can extend for months to years.
- The eligibility process is very long. Some facilities start the process on admission so that by the end of 60 – 90 days, the patient eligibility requirements have been completed and approved. (California Dept of Health Care Service or HCS)
Best Outcome:
There has been an increase in the number of facilities available to accept patients under the ALWP. In speaking with acute care Case Managers based in emergency rooms, the use of the ALWP and assigned facilities that participate has been positive in that patients are transferred, without delay, directly to the appropriate levels of care versus being housed in an acute level of care bed.
Following up directly with one facility provider administrator, the administrator shared that the facility has successfully placed twelve (12) patients using ALWP. (October 25, 2023)
Link: ALWP – Publicly Subsidized Housing (PSH)
Eligibility: Application and processing for ALWP - a Registered Nurse at the Care Coordination Agency (CCA) processes submitted requests. There are specific CCAs for each county.
Initial program §1915(c) Home and Community-Based Services Waiver became effective 1/1/2018 and is set to expire on February 29, 2024. The Department of Health Care Services (DHCS) intends to renew the waiver for another five-year waiver term beginning on March 1, 2024.
Outcome:
The program has demonstrated success in hospital and emergency room discharge assistance in getting a patient to the appropriate level of care. Case Managers are often the key to unlocking essential services for vulnerable patients. What programs do you keep up your case management sleeve? Sharing resources and collaboration strengthens the practice of case management.
Link: California Care Coordination Agencies
https://www.dhcs.ca.gov/services/ltc/Documents/Care-Coordination-Agencies.pdf
Save the Date! Case Management Week 2024 is October 13-19! But case managers, what do YOU think?! Should CMSA celebrate you and your invaluable contributions to healthcare ALL month long? Case managers deserve appreciation, recognition, and celebration. Every. Single. Day. Stay tuned for exciting events, educational opportunities, prizes and more!
Bio: Nannette E. Green RN, MHS, CCM relocated from New York in October 1980. In nursing for 40+ years - Areas of experience: Med/Surg, ICU, Acute Rehabilitation, Case Manager 9 yrs, Case Manager Leadership 10 yrs), and a member of CMSA national/local since 2015. Retired in 2022 from Blue Shield of California as Sr. Manager for Case Management (Commercial). Previous President of local chapter CMSA Sacramento 2016 – 2018, Immediate Past President 2019 – 2020, Secretary 2021 – 2022.