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Assisted Living Waiver Program
The Assisted Living Waiver Program (ALW) aims to help Medi-Cal-eligible seniors and individuals with disabilities transition safely from nursing facilities to community-based settings, such as Residential Care Facilities for the Elderly (RCFEs), Adult Residential Care Facilities (ARFs), or subsidized public housing, with the support of ALW services. It also provides an alternative for those already residing in the community who are at risk of institutionalization, allowing them to receive the necessary care while remaining in a safe and supportive home-like environment.
HCBA Waiver Agency
The HCBA Waiver offers care management services to individuals at risk of nursing home or institutional placement. A multidisciplinary Care Management Team (CMT), consisting of a nurse and social worker, coordinates Waiver and State Plan services—including medical, behavioral health, and In-Home Supportive Services—while also arranging additional long-term supports available in the community. These services are provided in the participant’s community-based residence, whether privately owned, leased, or a family member’s home.
Enhanced Care Management
Enhanced Care Management (ECM) is a free Medi-Cal benefit that helps people with complex health needs. ECM services include care planning, connecting people to community resources, and coordinating care with healthcare providers.
Care Coordination & Transitional Care
Care Coordination is a person-centered approach to managing healthcare and support services, ensuring that individuals receive the appropriate care at the right time. It involves collaboration between healthcare providers, social workers, and community resources to develop and implement a comprehensive care plan that meets the individual's medical, behavioral, and social needs. Care coordination helps improve health outcomes, enhance quality of life, and prevent unnecessary hospitalizations or institutional placements.
Transitional Care Services focus on supporting individuals as they move between different healthcare settings, such as from a hospital or nursing facility to their home or a community-based setting. These services aim to ensure a smooth, safe, and timely transition by providing care planning, medication management, follow-up care, and access to necessary support services. Transitional care helps reduce hospital readmissions, improve recovery, and promote long-term stability.