輔助生活豁免

HCBS 提供者最低工資增加

由於參議院第 3 號法案的頒佈，加州全州所有雇主的最低工資將於 1 月1 ，2026 ，從 16.50 美元提高到 16.90 美元。由於加州最低工資上調，2026 年特定醫療服務提供者類型和程序代碼的居家和社區服務補償費率也將上調。以下是適用於 ALW 的 2026 年增加的最高應付費率清單。

服務說明	服務代碼和修正因子	2026 年最高應付費率	單位	放棄
第一級-輔助生活服務-家庭主婦; 家庭健康援助; 個人護理	第 2031 歲以下	美元 95.69	每日	永遠
第 2 級-輔助生活服務-家庭主婦; 家庭健康援助; 個人護理	第 2031 歲以下	美元 114.33	每日	永遠
第三級-輔助生活服務-家庭主婦; 家庭健康援助; 個人護理	第 2031 歲以下	美元 132.97	每日	永遠
第 4 級-輔助生活服務-家庭主婦; 家庭健康援助; 個人護理	第 2031 歲以下	美元 179.58	每日	永遠
第 5 級-輔助生活服務-家庭主婦; 家庭健康援助; 個人護理	第 2031 歲以下	美元 270.80	每日	永遠

為了按新的費率獲得補償，各機構將需要對自1 年 1 月起生效的所有服務使用上述較高的費率提交索賠申請，2026 。這可讓您的機構立即按照新的費率獲得補償，而不必重新提交索賠申請。

如有任何其他問題，請發送電子郵件給 ALW 化妝品收件箱。

生活輔助豁免資格

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.

要符合ALW 參與者資格並獲得服務，個人必須滿足以下ALW 資格標準：

21歲或以上；
擁有全面的加州醫療補助健康保健計劃資格，費用分攤為零；
具有與加州醫療補助健康保健計劃資助的在護理機構生活和接受護理的居民相同的護理需求；
願意居住在輔助生活環境中作為護理機構的替代方案；
能夠安全地居住在輔助生活設施或公共補貼住房；
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 僅限於有資格享受加州醫療補助健康保健計劃、沒有加州醫療補助健康保健計劃分攤費用、需要護理機構水平的護理並希望居住在寄宿護理機構或公共場所的個人資助的老年人和/或殘障人士住房。 ALW 參與者必須有足夠的資金來支付食宿費用，並剩餘一些資金來滿足個人和偶然的需求。在確定申請加入 ALW 的個人的加州醫療補助健康保健計劃資格時，適用機構和配偶貧困預防規則。

ALW 的目標是：

促進符合加州醫療補助健康保健計劃資格的老年人和殘疾人從護理機構安全及時地過渡到老年住宅護理機構 (RCFE) 中類似社區之家的環境，這是一個成人住宅護理機構 (RCFE) ARF），或利用ALW 服務的補貼公共住宅；和
為居住在社區但有被收容風險的符合資格的老年人和殘疾人提供利用 ALW 服務開發專案的選擇，該方案將安全地滿足他/她的護理需求，同時繼續居住在 RCFE、ARF 中，或公共補貼住宅。

ALW 申訴

如果您是 ALW 參與者並且對您的 ALW 設施、護理協調機構 (CCA) 或您收到的 ALW 服務不滿意，您可以透過以下方式提出 ALW 申訴：

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.
有關 CCA 護理協調的申訴必須透過電子郵件提交給衛生保健服務部： 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.

有關 ALW 申訴的更多信息，請查看ALW 申訴情況說明書。

目前的豁免

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 插槽擴充修正案 (Effective January 1, 2024), CMS approved DHCS’ amendment to the ALW to add 1,800 slots to year 5 of the 2019-2024 ALW.
遠程醫療修正案（從 12 月 2023 生效，此修訂將遠程醫療添加為以下項目的永久性服務提供選項：護理協調，增強照護發展和跟進計劃，NF 過渡護協調。）
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 #24 -002 ALW 插槽和候補名單管理

批准的緊急修正案

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.