On February 16, 2024, the Centers for Medicare & Medicaid Services (CMS) approved the ALW renewal application. The waiver approval included many changes one of them being the Long-Term Care Ombudsman office may now submit a letter on behalf of a member to their Care Coordination Agency (CCA) requesting expedited release from the ALW Waitlist due to a need for imminent services.
Experiencing a Forced SNF or Hospital Discharge?
If you are experiencing a forced discharge before the state's required minimum 60-day hospital admission date, we encourage you to request to speak to an APS or Ombudsman caseworker to submit an Imminent Services Prioritization letter to our agency at once to ensure placement priority is received on our waitlist.
If you have a client who qualifies for Imminent Services Prioritization as documented by the Long-Term Care Ombudsman office please submit their waitlist request form along with supporting documentation to info@allhoursadultcare.com with the subject line ‘Waitlist Request (Ombudsman)’.
Are you experiencing a forced discharge or eviction from your current residence?
Contact Adult Protective Services (APS) and open a case for yourself or your loved one. Return a letter to our office on county letterhead to be placed on the APS waitlist.
Effective 9/3/2024, DHCS is immediately stopping the direct submission of new ALW applications from a SNF or Hospital that meet the ALW reserve capacity criteria for long-term care stays (SNF or Hospital stays of 60 or more days)
WHAT DOES THIS MEAN
All applications for institutional transfers must be submitted to the waitlist. Please continue to submit the required documentation with your SNF/Hospital referrals. Our office will be in contact with you when your referral has reached the top of the waitlist and is ready for an RN assessment.
*Open APS or Ombudsman cases are still prioritized with the DHCS
Assisted Living Waiver Program (ALWP)
The Assisted Living Waiver (ALW) is a Home and Community-Based Services (HCBS) waiver that was created by legislation directing the California Department of Health Care Services (DHCS) to develop and implement the program to test the usefulness of assisted living as a Medi-Cal benefit.
**Medi-Cal members who are enrolled in the Program of All-Inclusive Care for the Elderly, the PACE program, and Medi-Cal members who are enrolled in The Senior Action Network Health Plan (SCAN) are not eligible to enroll in ALW, or any of the 1915c Medi-Cal Waivers.• PACE and (SCAN) are both comprehensive care plans that cover all of an individual’s medically necessary needs, including home and community-based services.
Click an Option Below to
Apply for Assisted Living Waiver!
FAQ’s
All Hours Adult Care Coordinating Role
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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.
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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.
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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.
- Meeting Seniors’ Needs Hotline - http://msnhglobal.org
- Senior Care Advocates - https://seniorcareadvocate.com
- The Light for Seniors - https://www.lightsourceis.com/index.php/founder
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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.
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LTC Ombudsman
Time until assessment: 30 days
Adult Protective ServicesTime until assessment: Approximately 4-6 months
Community (Anywhere at home, with family of friends, apartment or shelter, RCFE or ARF)
Time until assessment: 12-24 months
Skilled Nursing Facility or Hospital (Rehab or Convalescent)
6 - 12 months
Eligible for discharge after 60 days. -
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
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Yes. The facility must be on the approved waiver list and confirmed they can accommodate the care level before admission.
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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
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Starting January 1, 2024, assets will no longer be counted to determine Medi-Cal eligibility!
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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.
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Apply from:
Adult Protective Services (APS)
Community
Skilled Nursing Facility or Hospital
• AHAC team assists applicants with the intake and processing required to receive a care assessment (performed by a Registered Nurse).
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Waitlist Process
• We ensure the application is complete before submitting to DHCS for approval.
• Our community waitlist is currently averaging 8-12 months.
• Once name is released, our team will contact you to schedule Initial Assessment.
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Assessment
• One of our RN Care Coordinator’s will conduct an in-person or virtual assessment to evaluate and thoroughly review all your care needs.
• We will submit complete assessment with signed Patients’ Rights form to DHCS for approval.
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DHCS Review
• Approval may take up to 45 days.
• We have 180-days from the initial assessment submission date to secure placement at an ALW approved facility.
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Housing Navigation to ALW Facility
• Our housing navigation team will work with you and your advocates to make sure we secure placement at an ALW approved facility that can accommodate and provide the care you need.
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Care Coordination
• We will continue to monitor and oversee participants’ care throughout their enrollment.
• An RN Care Coordinator or Social Worker will call and or visit on a monthly basis to check-in and ensure participants are receiving adequate care at the facility based on their ALW Individual Care Plan.
Need to Apply for Medi-Cal Membership?
Visit the DHCS Website or CMS
to begin the process.
NEW! View all ALW facilities on a map by clicking this link.
Must identify 3 cities or facilities on your waitlist request form.
Document Resources
Return documents if requested to info@allhoursadultcare.com
Advanced Healthcare Directive Form (must be signed by two NON-FAMILY witnesses) download and complete this form, and return it to our office with required ALW documents.
LIC602 A Physician’s Report (if completed, must be signed by the participant or legally authorized representative.)
LIC603 (ONLY needed from participants currently residing in an Assisted Living Facility)
If you have already had an assessment with another Care Coordinating Agency and would like to switch your services to our agency, please complete the CCA Change form linked below and send it to our office with the member’s Date of Birth and Medi-Cal number