In the face of overwhelming demand, a Medi-Cal program providing assisted living for low-income patients is expanding, slowly, but surely.
Assisted living and memory care centers are approximately $5,000 to $7,000 monthly — a high cost even for families with reasonably comfortable incomes.
Medi-Cal is a special project that covers assisted living costs for eligible low-income seniors and people with disabilities in 15 counties including Los Angeles.
Demand for the program is high and the slots are limited. Scoring a spot in Medi-Cal’s assisted living program is a years-long odyssey for some, leaving family members who serve as caregivers stretched thin as they scramble to find workarounds for their loved one’s care and living situation.
California has been expanding the program, which is good news for families interested in this service; but not for the ones still in line – it could take over a year before they’re placed in a facility.
Since spots are limited — those interested must first get on a waitlist, which can be a lengthy process; some people have now been waiting since 2019 to be placed.
According to California, there are currently 6,301 people enrolled in Medi-Cal’s assisted living program, and 4,754 people waiting to get in.
In the meantime, family caretakers struggle with jobs, child care and other responsibilities as they wait.
Supply and demand
The waitlist to get into these programs continues to outgrow supply and demand — signaling that California is in need of more housing and care options for low-income seniors who can no longer live on their own.
Aging and health advocates say this is concerning, especially as one quarter of Californians are expected to be older than 60 by 2030.
In response to the growing demand, California sought approval from the federal government in January to secure 7,000 additional slots for its Medi-Cal assisted living program.
California Department of Health Care officials said they started rolling out these new spots in May and plan to clear the waitlist or at least reduce it substantively by Feb. 28, 2024.
“The Department recognizes that achieving this goal is dependent on several external factors, including [coordinating agencies’] capacity, bed availability, and continued growth of the demand,” said spokesperson Katharine Weir of the Department of Health Care Services.
“The department is also working toward integrating the assisted living services with another one of its long-term care programs, which should streamline services and allow more people to access assisted living.”
Many Californians do not know that assisted living, including some memory care programs, is an option for eligible low-income people on Medi-Cal.
Navigating the system
Seniors who need round-the-clock medical care often require a nursing home setting, which is a mandated benefit under Medi-Cal, and people who qualify are often placed immediately in those facilities.
Assisted living is considered an alternative for people who don’t need to be in a clinical environment, but may need assistance completing daily tasks.
In California, 55% of older residents need help from another person for routine care, such as completing chores, shopping or getting to appointments, according to the UCLA Center for Health Policy Research.
About 21% need help with personal care, like eating, bathing and getting dressed; Of those, 40% reported needing more assistance, or none at all.
People on Medi-Cal generally have two entryways into assisted living. They can be placed immediately after being discharged from a hospital or transferred from a nursing home.
These individuals are prioritized for the assisted living program because hospital care and nursing home living is more expensive, so this move saves the state money.
People who are transitioning into assisted living from their home must first get on a waitlist; Once it’s their turn, they can submit an application to enroll in the program.
About 60% of people on the waitlist end up enrolling in the program, meaning the caregiver duties typically fall on a relative who bears the brunt of the cost and work in the meantime.
Through this process, the county agency sends a case worker to people’s homes to assess their living situation. If this agency decides that a person is experiencing abuse or neglect, it can fast-track a person’s move into assisted living.
Self-neglect, when a person is no longer able to care for themselves — can’t feed, clothe or take care of their own health — can also qualify a person for an expedited process.
“Agencies don’t always tell people where they stand in line because they don’t want to deter people from seeking services; plus, that number could change quickly from one month to another,” said Neil Rotter, CEO of Libertana, a California care coordination agency.
Rotter added that “part of the challenge is the state’s move from a single statewide waitlist to an agency-specific waitlist. That’s when the state department started issuing an equal number of slots to each agency every month, which has prompted questions about how fair that is.”
In other words, those who sign up with newer agencies with shorter waitlists may be placed before someone who has been waiting longer at an older agency.
Lauren Firenze, program director at Senior Care Solutions, echoed this concern, and expressed that families should contact more than one agency and figure out which is the most helpful and responsive, and also advises families not to wait until you’re in crisis to get on the waitlist because some people wait too long to access services.