These are options for a person living with dementia (PLWD) and their family to get Medi-cal covered payment of in-home care and RCFE (Residential Care Facility for the Elderly).

What is a RCFE? 

• assisted living
• memory unit
• board and care

What does Medi-Cal pay regarding RCFEs?

• You pay the Board & Care rate (in 2025, $1420.07)
• Medi-Cal pays the care cost services based on the assessed tier level (level of need)

Medi-Cal will pay for RCFEs if you are on a waiver program. Note the waiver program waitlist can take years. It's best to get on the waitlist as soon as possible.
 

The 7 Medi-Cal waiver programs that pay for care with the goal to help the PLWD remain out of the nursing home:

1. IHSS (in-home care)
   • Maximum amount of IHSS hours varies by county.
     • Generally, less than 200 hours / month.
   • Patients receiving IHSS through medi-cal can also get approved for Day Programs through medi-cal.
   • Apply: https://hottocare.helpjuice.com/en_US/public-articles/ihss-in-home-supportive-services-tips-n-tricks
2. Custodial care at a skilled nursing facility
3. Assisted living waiver (ALW) program with Medi-Cal - 1.5 - 2 year average *wait time from time of application. (Yes, it really takes years). They give a list of facilities that participate & they will help pay for the cost once you get a bed. Many Board and Care that participate in the program as well as assisted living. Must have Medi-Cal with a $0 share of cost. 
   * Staying in a skilled nursing facility (SNF) for 60 days will qualify you for the shorter wait time of several months. Additional waitlist types listed below.
   • Details & eligibility: https://www.dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx
   • List of Participating RCFEs in the ALW program (select county): https://www.dhcs.ca.gov/services/ltc/Pages/List-of-Approved-RCFE-ARF.aspx 
   • Apply via option #1: Care Coordination Agencies: https://www.dhcs.ca.gov/services/ltc/Pages/List-of-Approved-CCAs.aspx
   • Apply via option #2: All Hours Agency.
     • All the registration documents are on their website: https://allhoursadultcare.com
   • SOC - Share of Cost. Best way/common way to lower SOC is via purchase of supplemental health plan.
4. Golden Gate CAOHF Chapter resource pathway - if you are at a skilled nursing facility for at least 60 days (after a hospitalization) can help to find alternative pathway. (Accelerates placement into a RCFE)
5. Day Program for participants who meet the Medi-Cal Community Based Adult Services (CBAS) eligibility criteria 
   • Generally 2-4 days/week. Maximum amount varies
   • Eligibility Tool: https://aging.ca.gov/Care_Options/Adult_Day_Services_Programs/CBAS Eligibility Determination Tool (CEDT)
   • List of CBAS Programs: https://www.aging.ca.gov/Providers_and_Partners/Community-Based_Adult_Services/CBAS_Providers/
6. Home and Community-Based Alternatives (HCBA) Waiver - home modifications & nursing care. Long waitlist of years. Apply at the county location, waiver application found here & check waitlist length here: Go to county of the PLWD. 
   Details and list of agencies that manage the waiver program: https://www.dhcs.ca.gov/services/ltc/Pages/Home-and-Community-Based-(HCB)-Alternatives-Waiver.aspx
   Application program happens through the waiver 
7. CalAIM NFTD (Nursing Facility Transition/Diversion) CS (Community Supports) - Requires $0 SOC Medi-Cal  and enrolling in a managed Medi-Cal plan that offers the NFTD CS. https://www.dhcs.ca.gov/Documents/MCQMD/Community-Supports-Elections-by-MCP-and-County.pdf

References:
Applying for Medi-Cal: https://hottocare.helpjuice.com/en_US/public-articles/medi-cal-income-eligibility-tip-n-trick

American Council on Aging: https://www.medicaidplanningassistance.org/medi-cal-cbas-program/

California Department of Health Care Services (DHCS): https://www.dhcs.ca.gov/services/ltc/Pages/AssistedLivingWaiver.aspx

California Advocates for Nursing Home Reform (CANR): https://canhr.org/understanding-the-share-of-cost-for-medi-cal/

Share of cost (SOC) info: https://canhr.org/understanding-the-share-of-cost-for-medi-cal/

How Deductions Work to estimate RCFE costs: https://canhr.org/board-care-medi-cal-deduction/

1. Community Waitlist - 18 to 24 months from your waitlist request submission date. 
2. SNF/ Hospital Waitlist - 6-12 months from your waitlist request submission date 
   1. You MUST remain in your SNF/Hospital/Acute Care facility for at least 60 days to be recognized as an institutional transfer. You can be discharged on or after your 61st day. 
   2. If you are facing an involuntary discharge, please contact the ombudsman office IMMEDIATELY and request an Imminent Services Prioritization Letter. This must be sent to our office so you can be placed on a shorter waitlist. 
3. Adult Protective Services (APS) Waitlist- 3 to 6 months from your waitlist request submission date (must have submitted a referral letter from your APS office/social worker.) 
4. Long Term Care (LTC) Ombudsman Waitlist- 30 to 60 days from your waitlist request submission (must have submitted an Imminent Services Prioritization Letter) 
   1. To be eligible for a Long Term Care (LTC) Ombudsman referral, the individual must meet the following criteria: 
      1. Individual is residing in an institutional setting. 
      2. Individual has received a medical assessment and discharge notice states they are eligible for a lower level of care. 
      3. Individual is eligible to receive services through the ALW program but unable to afford assisted living. 
      4. If all three of the criteria are met, the individual and or their authorized representative may contact the Long Term Care (LTC)

Version: YT 12/2025