WILL MEDI-CAL PAY
FOR ASSISTED LIVING?
Assisted living is a program for the elderly and the disabled that provides services of a nursing facility but in a more home-like atmosphere. Nursing homes are generally focused on providing medical care, sometimes 24 hours a day, seven days a week. An assisted living facility does not provide round-the-clock care but helps residents manage their medical and dental needs with off-site professionals.
The website AssistedLiving.org breaks down the services provided by assisted living facilities in California into two categories: basic services, and care and supervision services. These two categories of services supplement the room and board provided for those under the facility’s care.
Basic services include personal assistance, care, observation, supervision, planned activities, and arrangements for obtaining incident medical and dental care. Care and supervision encompass assistance with daily living – dressing, bathing, personal hygiene; assistance with self-administered medications; and monitoring food intake or adherence to a specialized diet.
Each assisted living facility in California must provide in writing a rundown of the services it will provide, so it is vital to read the literature to see if it fits your needs or the needs of the loved one who will be relying on the facility’s services.
Assisted living, however, is not cheap. The resident is usually responsible for paying for the room and board, so where does the rest come from? Medi-Cal, the California version of the federal-state program called Medicaid, offers assisted living waivers (ALWs) to help pay for the services at the facility.
If you or a loved one is seeking the services of an assisted living facility in Redlands, California, contact The Elder & Disability Law Firm, APC. Our staff will help with obtaining an assisted living waiver, and the benefits that accrue from the waiver will help pay for the facility and its services.
The Elder & Disability Law Firm, APC, also proudly serves the elderly and disabled throughout Southern California, including Redlands, Riverside, Rancho Cucamonga, and Palm Springs.
DETERMINING WHETHER MEDI-CAL
WILL PAY FOR ASSISTED LIVING
Medi-Cal, under federal Medicaid rules, is not allowed to pay for services that do not include medical care, such as those offered in a nursing home. However, a waiver is available to allow Medi-Cal to help with funding for assisted living and other programs that do not offer constant medical care. (See next section.)
In addition, California’s SSI/SSP program will pay for some of the costs of assisted living. SSI, or Supplemental Security Income (SSI), is offered through the Social Security Administration (SSA). California helps by providing a State Supplementary Payment (SSP). Together SSI/SSP pays $1,365.77 a month in 2022. Of this amount, the facility resident is allowed to retain $154 a month as a Personal Needs Allowance (PNA).
THE MEDI-CAL ASSISTED LIVING WAIVER
An Assisted Living Waiver (ALW), offered through the Home and Community-Based Services (HCBS) waiver program, allows Medi-Cal to help pay for some expenses of an assisted living program. The waiver allows Medi-Cal to help cover assisted living expenses despite the absence of in-facility medical care. Most recipients of ALW services, however, still have to pay most of their income to the assisted living facility for room and board charges.
Currently, California offers the assisted living program only in certain counties: Sacramento, San Joaquin, Los Angeles, Sonoma, Fresno, San Bernardino, Contra Costa, Alameda, San Diego, Riverside, Kern, Orange, Santa Clara, and San Mateo.
Note, however, that waivers are limited in number, and there is usually a waiting list. The state is moving to close this gap by using funds from the American Rescue Plan Act passed in March 2021 by the federal government to fund the addition of new facilities.
QUALIFYING FOR MEDI-CAL COVERAGE
Before you can apply for an ALW, you must first qualify for enrollment in Medi-Cal. To qualify, your income is limited to 138 percent of the Federal Poverty Level (FPL), which through March 2023 equals $1,564 a month for a single person. For a couple, the limit is $2,106 a month. These amounts change every April to reflect any cost-of-living increases.
Prior to July 2022, applicants were severely limited in the assets they could control and still qualify -- $2,000 for an individual and $3,000 for a couple. Your home, furnishings, personal effects, and a vehicle were exempt from the asset calculation. In July 2022, however, California raised the asset limit to $130,000 for an individual and $195,000 for a couple. The asset limitation will be removed altogether on January 1, 2024.
IN-HOME SUPPORTIVE SERVICES (IHSS)
If you or your loved one find yourself on an assisted living waiting list, you might consider the In-Home Supportive Services (IHSS) program, which covers services in one’s home, that is not necessarily medical in nature. These include housecleaning, meal preparation, laundry, grocery shopping, bathing, bowel and bladder care, accompaniment to medical appointments, and protective supervision for the mentally impaired. To qualify, you must be able to live at home safely without IHSS services and qualify for Medi-Cal.
HELPING YOU PLAN FOR THE FUTURE
Assisted living and other services that may be required in your later years should be planned for in advance, along with concrete estate planning to take care of your loved ones. You may never need Medi-Cal, nursing care, or assisted living, but a comprehensive estate and long-term care plan will help you qualify if such services are required in the future.
A living trust, for instance, can protect your home’s equity from being tapped by Medi-Cal to recover the cost of services rendered once you are gone.
For all your estate and long-term care planning needs in or around Redlands, California, or in surrounding communities, contact The Elder & Disability Law Firm, APC. We offer everyone personalized and individualized service. We also serve clients in Riverside, Rancho Cucamonga, and Palm Springs, California.