辅助生活豁免
HCBS 提供商最低工资上涨
由于参议院第 3 号法案的颁布，加州全州所有雇主的最低工资将从 1 月1 增至 16.90 美元，2026 。由于加州提高了最低工资标准，2026 年特定服务提供者类型和程序代码的家庭和社区服务补偿标准也将提高。以下是适用于 ALW 的 2026 年增加的最高应付费率清单。
| 服务说明 | 服务代码和修饰符 | 2026 年最高支付率 | 单元 | 放弃 |
|---|---|---|---|---|
| 第 1 级 - 辅助生活服务 - 家庭主妇；家庭健康援助；个人护理 | T2031 U1 | $ 95.69 | 每日津贴 | 轻武器 |
| 第 2 级 - 辅助生活服务 - 家庭主妇；家庭健康援助；个人护理 | T2031 U2 | $ 114.33 | 每日津贴 | 轻武器 |
| 第 3 级 - 辅助生活服务 - 家庭主妇；家庭健康援助；个人护理 | T2031 U3 | $ 132.97 | 每日津贴 | 轻武器 |
| 第 4 级 - 辅助生活服务 - 家庭主妇；家庭健康援助；个人护理 | T2031 U4 | $ 179.58 | 每日津贴 | 轻武器 |
| 第 5 层 - 辅助生活服务 - 家庭主妇；家庭健康援助；个人护理 | T2031 U5 | $ 270.80 | 每日津贴 | 轻武器 |
为了获得新费率的报销，各机构将需要使用上述较高的费率提交所有服务的报销申请，从 1 月1 ，2026 。这样，贵机构就可以立即按新费率报销，而不必重新提交报销申请。
如还有其他问题，请发送电子邮件至 ALW 虚荣收件箱。
辅助生活豁免资格
The Assisted Living Waiver (ALW) 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 program to test the efficacy of assisted living as a Medi-Cal benefit. Additional information about this legislation can be found on the Social Security Administration website. The Centers for Medicare and Medicaid Services (CMS) approves waiver renewals in five-year increments, and expansion of the program into additional counties. Currently, the ALW is available in 15 counties and the current five-year waiver term is approved for March 1, 2024 – February 28, 2029.
要 获得作为 ALW 参与者接受服务的 资格 ，个人必须满足以下 ALW 资格标准 ：
- 年满 21 岁；
- 拥有全方位的 Medi-Cal 资格，且无需分担任何费用；
- 其护理需求与在疗养院生活和接受护理的 Medi-Cal 资助居民相同；
- 愿意住在辅助生活环境中，而不是护理机构中；
- 能够安全地居住在辅助生活设施或公共补贴住房中；
- Willing to live in an assisted living setting located in one of the following counties providing ALW services: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma counties.
ALW 仅限于符合 Medi-Cal 资格、无需承担 Medi-Cal 分担费用、需要护理机构级别护理并希望居住在住宅护理环境或公共资助的老年人和/或残疾人住房中的个人。 ALW 参与者必须有足够的资金来支付食宿费用，并保留一些资金以满足个人和偶然需要。 在确定申请加入 ALW 的个人是否符合 Medi-Cal 资格时，将适用机构和配偶贫困预防规则。
ALW 的目标是：
- 利用 ALW 服务，帮助符合 Medi-Cal 资格的老年人和残疾人安全及时地从护理机构过渡到老年人住宅护理机构 (RCFE)、成人住宅护理机构 (ARF) 或补贴公共住房中的社区家庭式环境；以及
- 为居住在社区但面临被机构收容风险的符合条件的老年人和残疾人提供利用 ALW 服务的选择，以制定一个能够安全地满足他/她护理需求的计划，同时继续居住在 RCFE、ARF 或公共补贴住房。
ALW 申诉
如果您是 ALW 参与者，并且对 ALW 设施、护理协调机构 (CCA) 或您收到的 ALW 服务不满意，您可以通过以下方式提出 ALW 申诉：
- Grievances regarding the quality or receipt of ALW services must be submitted to your CCA via email, mail, or telephone. Find your CCA’s contact information.
- 有关 CCA 护理协调的申诉必须通过电子邮件提交给卫生保健服务部： ALWGrievances@dhcs.ca.gov
- All other grievances not listed above must be submitted to the California Department of Social Services, which will direct your grievance to your local ombudsman. Grievances can be submitted via telephone at (844) LET-US-NO ((844) 538-8766), via email at letusno@dss.ca.gov, or online at the California Department of Social Services Community Care Licensing Division webpage.
有关 ALW 申诉的更多信息，请查阅 ALW 申诉概况介绍。
当前豁免
批准的 ALW 修正案
- ALW Slot Expansion Amendment WY 1 (Effective October 1, 2024), CMS approved DHCS’ amendment to the ALW to increase the waiver capacity for waiver year 1 of the 2024-2029 ALW.
- ALW Slot Expansion Amendment WY 2-5 (Effective March 1, 2025), CMS approved DHCS’ amendment to the ALW to increase the waiver capacity for waiver years 2-5 of the 2024-2029 ALW.
- ALW 时隙扩展修正案 (Effective January 1, 2024), CMS approved DHCS’ amendment to the ALW to add 1,800 slots to year 5 of the 2019-2024 ALW.
- 远程医疗修正案（该修正案于12年2023月生效，将远程医疗添加为以下服务的永久服务提供选项：护理协调、增强型护理制定和跟进计划、NF 过渡护理协调。）
- ALW Slot Expansion Amendment (Effective July 1, 2021, CMS approved DHCS’ amendment to the ALW to add 7,000 slots to eliminate the current waitlist and expand waiver capacity.)
- ALW 政策信函 #24-002 ALW 席位和候补名单管理
批准紧急修正案
- Approved Appendix K Southern California Wildfires (Effective January 7, 2025), in response to the Los Angeles and Ventura Counties Fire, which has burned over 70,000 acres, prompted evaluation orders and road closures, and continues to threaten structures, homes, and critical infrastructure. This amendment, temporarily expands the settings in which services can be provided and permits retainer payments for certain services. Additionally, the amendment authorizes a temporary suspension of the enrollment period and extension of the reenrollment period.. The listed flexibilities are authorized under this amendment apply to waiver participants impacted by the State of Emergency in Los Angeles and Ventura Counties.
DHCS obtained approval for flexibilities accepted under the federal 1135 waiver authority which will expire January 7, 2026, for Los Angeles and Ventura Counties. The following flexibilities are available immediately.
Permit evacuating facilities (such as ICF-DDs, SNFs) to be fully reimbursed for services rendered to affected beneficiaries in alternative physical settings, such as temporary shelters or other care facilities.
Permit some services to continue to be provided without a requirement for a new or renewed prior authorization.
Temporarily allow services to be provided in settings that have not been determined to meet the HCBS Settings Rule criteria.
Temporarily extend the timeframe to reinstate services and benefits to an individual who files a fair hearing request.
辅助生活豁免当前注册
Current enrollment and waitlist information for the Assisted Living Waiver can be found on the enrollment dashboard, which is updated monthly. New applicants to the ALW should be aware the number of available slots is limited and there is a waitlist. Open waiver slots are release to Care Coordination Agencies on a regular basis. Please contact the Care Coordination Agency of your choice for the information.
豁免已过期
其他计划资源：
- ALW PL #24-001 远程医疗政策
- 辅助生活豁免说明和资格信息
- RCFE 和 ARF 设施列表
- 护理协调机构名单
- 公营住房描述
- 公营房屋机构名单
- 辅助生活豁免续签批准函
- Assisted Living Waiver – Approved 3/1/19 to 2/29/24
- ALW 注册和候补名单 - 2019 年 1 月至 2025 年 12 月- 2026 年 2 月更新
- 提供商注册信息
- 提供商资源、表格和备忘录
- 2026 年 ALW 报销率
Please submit your ALW comments and questions to: ALWP.IR@dhcs.ca.gov