My father has Madi-Cal. I was told that there is some type of waiver in California that he can get on the list for Assisted Living facilities that accept this insurance. Anyone know where I can find this waiver? How do I do this? It is so hard to get a helpful Medicaid/cal person to help me :(

This question has been closed for answers. Ask a New Question.
Based on what other posters on this site have written in the past year or so, planning on / hoping to get a “waiver” to pay for your dads AL is a total non-starter for how CA administers it’s medicaid programs.

I think it’s important to have a bit of understanding of what a Medicaid “waiver” is & importantly is not. Medicaid as an shared federally funded entitlement requires a state to provide for coverage for skilled nursing care aka care in a NH. BUT as each states administers it’s medicaid program uniquely (cause it shares funding for Medicaid by providing state $$), a state can opt to divert or “waive” some of that federally earmarked $ to be diverted via a “waiver” to pay for nonNH programs with state $ kicking in to make the budget work. Some states do very very few waiver programs; others - like MN - have very extensive waiver programs for all ranges of its citizens. So states ultimately decide what to have for waivers for community based programs..... like AL, or PACE, or IHHS. So that’s the first issue for waivers.......

Then add in that Waivers are funded on 3 - 8 year cycles with very narrow eligibility for BOTH the elder and for the participanting vendor. They almost always start as a 5 - 7 yr demonstration project that has to show cost effectiveness or gets defunded. Because of this, there is insecurity in funding for vendors so lots just never ever opt to get waiver funding. For AL’s, if they can easily fill their occupancy with private pay there would be no reason to ever, ever venture into having beds in the Medicaid waiver system. AL as it’s a 1-on-1 benefit does not have the cost benefit effectiveness for state support that a community based program like PACE does. Federally Medicaid only needs to be provided for skilled nursing care. Add all this in & it’s why you find that most AL is private pay OR requires the resident to private pay for 2-3 years before they will be eligible for the Medicaid waiver bed OR a state does not have any AL waiver programs at all OR is defunding current AL waivers to have $ instead go to broader community based programs (like PACE).

What CA has is county managed IHHS (In Home Health Service program) that actually pays family to be a caregiver for an elder living in their home. Most other states have no such system. Have you looked into IHHS? 

For IHHS (as for any Medicaid program), they must be evaluated to show to be “at need” both medically and financially. Is your elder “at need” medically? Just being old, iffy on their ADLs, living solo, needing medication management is just not enough. 

Based on what others have posted, CA Medicaid LTC eligibility now is only for NH (skilled nursing care) only and must come via a post hospitalization stay for rehab. From a planning & policy perspective (I’m an old health planner) this makes total sense to do.... as they come into a skilled facility (so covered federally for payment forever) with a documented health chart  (so less in person/on site RN, PA, SW state worker verification needed) & with Medicare paying 100% the first 20/21 days through the post hospitalization rehab benefit before it hits on Medicaid to ever pay. If they can stay on Medicare rehab past the first 20/21 days even better for the state as MediCARE is paying 80% and hopefully a secondary insurer like BCBS, Humana, whatever kicking in the 20% up to day 100. Lots le$$ cost$ to the state. 

Medicaid for a LTC facility is not exactly insurance per se but rather covers the daily room & board fees at a low negotiated rate in addition to whatever covered health care costs (physicians, PT, OT, hospitalization charges, etc) that Medicaid pays for as the dual insurer to MediCARE as the primary health insurer.
Helpful Answer (1)

This question has been closed for answers. Ask a New Question.
Subscribe to
Our Newsletter