Bypassing the Waitlist: New COVID-19 Hotspot Protocols for the California Assisted Living Waiver (ALW)

Published by the National Association of Social Workers - California E-Newsletter (December 2020)

By Jason Bloome

On September 17, 2020, the Centers for Medicare and Medical Services allowed the California Department of Health Care Services (DHCS) to temporarily modify its 1915c waiver for the Assisted Living Waiver (ALW) program to prioritize intake processing by applicants in designated COVID-19 hotspot areas including Los Angeles, Orange, San Bernardino and Riverside counties. The new protocols allow ALW applicants in hotspot areas to bypass the normal ALW waitlist (currently at 4,400) when coming as a hospital inpatient or from a skilled nursing facility. The new COVID-19 hotspot ALW “priority” status also allows applicants coming from nursing homes to bypass the normal 60-day minimum stay requirement. The hotspot protocols do not impact the 1-2 year wait time for ALW applicants coming from the community (e.g. home).

The ALW priority status temporarily suspend the 60-day enrollment period for applicants who are unable to complete the application submission process or secure a bed because they or the facility has been impacted by COVID-19. Instead, applicants who secure an ALW spot are allowed to keep the spot and not be put on the ALW waitlist through February 21 or until the end of the pandemic.

Normally, the ALW protocols allow a resident who transfers to a hospital from the assisted living home to have 30 days to return to the assisted living home. Under the new protocols if the 30-day window expires, the resident will be disenrolled from the ALW program but once the state of emergency is lifted the resident will have 30 days to transfer to an ALW provider without having to resubmit the ALW application.

Processing time to apply for the waiver, evaluation for acceptance is 2 weeks to 1 month depending on how quickly the consent forms, physician’s paperwork, etc. is completed. ALW slot availability is also dependent on which ALW providers are COVID-19 free.

The ALW enrollment as of September 2020 is 4,818 enrollees. The maximum allowable enrollment is 5,744. A bill introduced last year, AB 50, to expand the number of waiver slots to 18,500 over the next 3 years, died in the senate aging committee. The future status of the bill is currently unknown.