To be eligible 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; **If you have a Share of Cost (SOC), contact your local Medi-Cal office or an outside agency for assistance.

• Have care needs equal to those of Medi-Cal-funded resident 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;

• Ability and willingness to pay the rental fee charged by ALW facility (through social security or another form of income)

• Willing to live in an assisted living setting located in one of the following 15 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

All Hours Adult Care services ALL 15 participating counties.

Yes, a social worker can submit the required paperwork to our office.

If the social worker will not be the point of contact after submission, an additional point of contact is required.

Yes. Your Share of Cost must be cleared BEFORE enrollment.

This can be done by purchasing additional insurance, paying a higher fee to the ALW facility, or working with a Medi-Cal helper to clear the Share of Cost.

**We do not endorse but recommend calling one of the following fee for service agencies or locating one of your choosing to assist you with your Medi-Cal membership application.

- Senior Care Advocates - https://seniorcareadvocate.com

- The Light for Seniors - https://www.lightsourceis.com/index.php/founder

Care coordination services for the waiver program are free of charge to the applicant or advocate assisting with the application. Participants are required to pay the ALW Room & Board Rate to Assisted Living Facility each month.

ALW Room & Board Rate as of January 2024 is $1,398.07 per month.

Room & Board cost is determined each year based on the federal Social Security Administration (SSA) published maximum SSI benefits available to beneficiaries in different living arrangements. Most ALW participants use their Social Security Income/State Supplementary Payment (SSI/SSP) to pay for rent.

LTC Ombudsman

Time until assessment: 30 to 60 days

Adult Protective Services

Time until assessment: Approximately 6-7 months

Community (Anywhere at home, with family of friends, apartment or shelter, RCFE or ARF)

Time until assessment: minimum 24 months

Skilled Nursing Facility or Hospital (Rehab or Convalescent)

minimum 7 months
Eligible for discharge after 60 days.

Voluntary Discharge:
If you voluntarily discharge from your facility before completing a 60 day admission, you will be placed on the 18 month minimum community waitlist

Involuntary or Premature Discharge:
If you feel your discharge planning is involuntary or premature, immediately request a visit from the Ombudsman at the facility and ask for an Imminent Services Prioritization Letter to the assisted living waiver program for a shorter wait time.

Do not discharge before calling our office for further instructions to complete the SNF / hospital intake forms that will reduce your time on the waitlist

Yes. The facility must be on the approved waiver list and confirmed they can accommodate the care level before admission.

Under California Code Regulations and Title 22, § 80091 clients who require health services and/or have a health condition including, but not limited to, those specified below shall not be admitted or retained in a Community Care Facility (CCF).

-Feeding Tube

-Active, communicable TB

-Conditions that require 24-hour nursing care and/or monitoring

-Stage 3 and 4 dermal ulcers

Any other condition or care requirements which would require the facility to be licensed as a health facility as defined by Sections 1202 and 1250 of the Health and Safety Code

​Starting January 1, 2024, assets will no longer be counted to determine Medi-Cal eligibility!​​​​​​​​​

Per DHCS: An ALW participant is presumed competent to sign documents/consent to services on their own behalf. There is no authority that permits anyone other than a legal representative, conservator, or power of attorney to sign the initial applicant documents and or the biannual assessment/individual service plan for a participant. However, nothing forbids another person from assisting the participant to sign the necessary documentation on their own behalf.