Q.  My mother needs full-time round-the-clock care, but she wants to remain in her home rather than move to a nursing home. If she meets the financial eligibility requirements, will Medi-Cal pay for her care at home?

A.  Unfortunately, your mom would most likely need to be in a nursing facility in order to receive the benefits of a Medi-Cal subsidy for round-the-clock care. Essentially, the Medi-Cal Long-Term Care program generally assumes that a nursing facility is the most effective, and the cheapest, way, to deliver quality care for persons who need it on a 24/7 basis.

That said, there are various Medi-Cal and other programs ‘on the books’ which do offer care to a select few persons in their own home or in other home-like settings, such as Assisted Living Facilities.  These are called “waiver programs”, so named because for these few individuals the state waives the requirement of residence in a nursing home as a condition of receiving a Medi-Cal subsidy.  However, these programs typically have very few slots and very long waiting lists, sometimes of several years duration, so that very few people actually qualify to receive these waiver program benefits. For the most part, these programs are experimental.

Therefore, for more realistic options for help with the cost of care outside of a nursing home setting, you might look into one or more of the following benefit programs:

In-Home Supportive Services (“IHSS”): For persons who are Medi-Cal eligible, the IHSS program offers nonmedical services in the home, such as meal preparation, cleaning, laundry, bathing, feeding, dressing, grooming, toileting, and monitoring for persons with cognitive impairments who are at risk of injury at home.  The number of available hours varies with the disability, and typically would be a maximum of 195 hours per month, but up to 283 hours for those persons who are severely impaired.  Your mother would hire her own caregiver, and the county would pay the caregiver rate of $13.85 per hour (in Alameda County, in 2019, and to increase to $14.25/hour on 01/01/2020), and your mother might have a co-payment depending upon her income. For more on this program click here.

Veterans Survivor’s Pension:  If your mother is the widow of a veteran who served during a qualifying war time, she might qualify for a pension of up to $1,149 per month (in 2016) to help with the cost of care. For more on this program click here and for pending changes in the program click here.

Assisted-Living Waiver: If your mother is willing and able to move to an assisted living facility, which is generally a more homelike setting than a nursing home, there are a few facilities in select California Counties authorized to accept Medi-Cal payments toward the monthly fee. Alameda is one of these counties. Unlike other waiver programs, if beds are available there is generally no waiting list.  As of this writing, there were actually a few available beds in Alameda County. For a list of Assisted Living Facilities that participate in this program click here.

PACE Program:  The Program for All Inclusive Care Of the Elderly (“PACE”) is another option.  Under this program, your mother would be bused several days per week to a local community health center where she would receive medical care, rehabilitation therapy, social services, recreation and hot meals. At the end of the day, she would be transported back home. PACE would also provide some in home care services.  Most of the fees would be paid by Medicare and Medi-Cal, but your mother might have a modest co-pay. For more on PACE click here.

For more information on these and other programs in Alameda County, contact Senior Information & Assistance at 1-510-577-1900 (www.acgov.org), or visit our website for links to additional information.