The federal and state governments fund Medicaid to help low-income people, including the elderly and disabled, pay for a wide variety of professional services, such as medical equipment, ongoing care, emergency care, dental and transportation. The state-run Medicaid program in California is called Medi-Cal.
Medicaid programs generally don’t directly cover expenses related to assisted living. However, most states realize that assisted living is much more affordable than a nursing home and have implemented programs that can help residents pay for this level of care. The waiver program for assisted living in California is detailed in the section below.
Successful applicants for Medi-Cal receive full- or partial-scope coverage depending on eligibility, and in other cases there may be a share of cost (SOC) for this service. However, low-income seniors automatically qualify for full-scope Medi-Cal coverage with no share of cost if they receive Supplemental Security Income payments. This plan is sometimes referred to as SSI-Linked Medi-Cal.
Californians aged 65 or over and the disabled who don’t qualify for SSI may be able to secure full-scope coverage with no share of cost through the Aged & Disabled Federal Poverty Level program. To qualify for the A&D FPL program, applicants must own less than $2,000 for individuals or $3,000 for married couples in countable assets and have a monthly income below $1,242 for individuals or $1,682 for married couples.
There is no income limit for applicants aged 65 or over to receive institutional or nursing home Medicaid, although the $2,000 countable-asset limit still applies. This is partial-scope coverage and is only appropriate for those who require a nursing home level of care. No waivers will be granted at this level of Medi-Cal coverage.
Applications for Medi-Cal can be made online, in person or by calling (800) 300-1506. Visit the Covered California website for more information and to begin the application process. Free assistance is available from certified enrollers for in-person support.
Medi-Cal Assisted Living Waiver Program (ALW)
Individual states are permitted to run their own Medicaid programs at the state level, such as Medi-Cal for California, but there are federal regulations in place that forbid payments going toward assisted living. This restriction may be lifted by a waiver program which allows payments for assisted living.
Seniors in California who require daily help and supervision but don’t wish to live in a nursing home can apply for the Assisted Living waiver program. Applicants must be on a full-scope Medi-Cal plan with no share of cost and require a nursing home level of care.
This program is relatively new and slowly spreading across the state, and it’s not currently active in Tulare County. However, seniors in Visalia and Tulare County as a whole can still enroll in this program if they’re willing to move to an assisted living facility in an area that participates in the ALW. The up-to-date list of participating counties can be found on the DHCS website.
Applications for the ALW cannot be made online or by phone, and the individual must be assessed by a registered nurse at a Care Coordination Agency. To begin the process, contact a nearby CCA and request an assessment.