If qualified, benefits can provide up to $1,788 per month to a veteran, $1,149 per month to a surviving spouse, or $2,120 per month to a couple.

Assisted Living Waiver/ Medi-Cal Waiver:
Medi-Cal waiver contributes $52-82 per day toward the cost of assisted living costs, covering the gap between the senior’s social security and the full cost of assisted living.
The goal of the Medi-Cal waiver is to: 1) facilitate a safe and timely transition of Medi-Cal eligible seniors and persons with disabilities from a nursing facility to a community home-like setting in a Residential Care Facility for the Elderly (RCFE) or public subsidized housing, utilizing waiver services; and 2) offer eligible seniors and persons with disabilities, who reside in the community, but are at risk of being institutionalized, the option of utilizing ALW services to develop a program that will safely meet his/her care needs while continuing to reside in an RCFE or public subsidized housing.
The Medi-Cal waiver is a Home and Community-Based Services (HCBS) waiver that was created by legislation that directed the California Department of Health Care Services (DHCS) to develop and implement the project to test the efficacy of assisted living as a Medi-Cal benefit.

SSI/ SSDI increase:
Seniors whose social security or disability income is less than $1,145 per month can apply for an increase of their benefits once they have moved into a licensed assisted living community. See information HERE.

Skilled Nursing Facility Programs Medicare:
Medicare does not pay for all medical expenses, and usually, must be supplemented with Medi-Cal or private insurance if Medi-Cal is unavailable. After three days of prior hospitalization, Medicare will pay up to 100% for the first 20 days of skilled nursing care. For the 21- 100 days, the patient will pay a co-payment. The premiums and copayments are increased every year. There will be no Medicare coverage for nursing home care beyond 100 days in any single benefit period.
It should be noted that Medicare only pays for “skilled nursing care,” does not pay for “custodial care” and the average stay in a nursing home under Medicare is usually less than 24 days. Thus, few can look to Medicare to pay for any substantial, long-term, nursing home costs.

Medi-Cal:
Nursing home care is covered if there is prior authorization from the physician/health care provider. Residents are admitted on a doctor’s order and their stay must be “medically necessary”. Residents are allowed to keep $35 of their income as a personal needs allowance. Residents with no income may apply for the Supplemental Security Income/State Supplemental Program (SSI/ SSP), and, if eligible, they will receive a payment of $50 as a personal needs allowance.

HMO/PPO:
Payment from these sources is limited and varies per insurance plan. Average length of stay under private insurances is significantly less than when working directly with Medicare or Medi-Cal.

Please call 909-326-8038 to learn more about AMAZING resources!