Assisted living
A brother's fight with Medi-Cal helps open assisted living coverage in rural California
Only 15 of California's 58 counties offer Medi-Cal's assisted living waiver, CalMatters reports, and one man's nine-month fight for his sister in Siskiyou County helped spark a rural pilot program.
Key facts
- CalMatters reported on September 8 that John Aiello spent nine months fighting Medi-Cal so his sister Roselie, who qualified for Medicaid, could move into assisted living instead of a nursing home.
- Medi-Cal does not offer its assisted living waiver in Siskiyou County or in 42 other counties; only 15 California counties, most of them urban, offer it.
- A pilot program providing more assisted living coverage in rural California emerged from his effort.
What happened
CalMatters reported on September 8 that John Aiello spent nine months fighting Medi-Cal so his sister Roselie, who qualified for Medicaid, could move into assisted living instead of a nursing home. Medi-Cal does not offer its assisted living waiver in Siskiyou County or in 42 other counties; only 15 California counties, most of them urban, offer it. A pilot program providing more assisted living coverage in rural California emerged from his effort.
The article says the gap gives older adults in urban areas more options than those in rural areas, pushing some into nursing homes not because they need that level of care but because they cannot afford assisted living. Availability varies county to county based on decisions by the managed care plans that serve the state's lowest-income residents.
What it means for families
Whether Medicaid will pay for assisted living can depend on where your parent lives and which health plan they have. Asking early, and asking in writing, can open options a family did not know existed.
For example: a sister who needs help showering and dressing but not round-the-clock nursing may do well in assisted living. If the local plan says no, families can ask about waivers, pilots and appeal rights.
What this means in New York: New York's Assisted Living Program, which Medicaid can pay for, has a limited number of slots and is not available everywhere. Ask your local Department of Social Services or NY Connects what exists in your county.
Quick answers
How many California counties offer Medi-Cal's assisted living waiver?
CalMatters reported on September 8 that John Aiello spent nine months fighting Medi-Cal so his sister Roselie, who qualified for Medicaid, could move into assisted living instead of a nursing home. Medi-Cal does not offer its assisted living waiver in Siskiyou County or in 42 other counties; only 15 California counties, most of them urban, offer it. A pilot program providing more assisted living coverage in rural California emerged from his effort.
What to do this week
- Ask your parent's Medicaid plan in writing whether it covers assisted living, and in which programs.
- If the answer is no, ask whether there is a waiver, pilot or waiting list, and how to appeal.
- Keep a log of each call, with the name of the person and the date.
Sources
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