CALA News & Views | Issue 49 | Top 5

5

5

JANUARY 2010, VOLUME 1 20 CALIFORNIA ASSISTED LIVING ASSOCIATION Supplemental Security Income/ State Supplementary Payment (SSI/SSP) SSI/SSP is a program funded by the federal government and the state for people who are 65 and older or blind or disabled. Other eligibility requirements include income and resources, and the individual cannot be living in an institution, among others. Some Assisted Living providers provide care and services specifically to individuals on SSI/SSP, however, the rates are extremely low making it challenging for providers to operate accepting residents receiving SSI/SSP. Residents that are also enrolled in the ALW or other state program have additional funds for care and services paid to the Assisted Living provider. negotiations rather than artificially set rates by the state that do not address geographical variation or rising minimum wages. CALA staff are working to educate managed care health plans about the benefits of Assisted Living and help facilitate conversations between CALA members and interested health plans. There are also companies working to bring the two parties together and serve as the Medi-Cal provider and subcontract with the Assisted Living provider, which minimizes the complexities for the Assisted Living provider. Learn more about which health plans are offering Nursing Facility Transition/ Diversion and in which counties by clicking here, and click here for a Medi-Cal Community Supports Explainer. 4 Living community a daily rate for care and services. Assisted Living providers must become a Medi-Cal provider to participate in the program. The ALW was recently approved by the federal government for another five years. DHCS has stated their intent to transition ALW residents into the CalAIM Community Supports program and to discontinue the ALW program once all current residents have transitioned. This plan will likely take several years and may not be completed during the new five-year waiver period. CALA will continue to be involved in these stakeholder conversations and keep members updated. Learn more about the ALW and signing up to become a provider here. California Advancing and Innovating Medi-Cal (CalAIM) is an effort by the state to provide whole person care for Medi-Cal beneficiaries. Like the ALW, CalAIM Community Supports allows for individuals to transition from a nursing facility into an Assisted Living community or divert someone who would otherwise have to go into a nursing facility into an Assisted Living community. As with the ALW, residents pay for their room and board with their SSI/SSP NMOHC payment, but providers negotiate directly with managed care health plans for payment for care and services instead of the state paying the Assisted Living provider. This program holds a lot of promise for expanding access to Assisted Living services to Medi-Cal beneficiaries beyond the 15 counties in the ALW to the entire state and could lead to adequate reimbursement rates for providers through independent

Community Care Expansion (CCE) In recent years, the state saw several closures of adult and senior care communities serving residents that receive SSI/SSP due to low reimbursement rates. The CCE is a program within the Department of Social Services with the goal of creating additional beds to serve this population while preserving communities at risk of closure to help prevent homelessness for residents on SSI/SSP. According to the CCE website, funds are used to help these adult and senior care programs remain open and expand access to individuals also at risk of homelessness by supporting “acquisition, construction and rehabilitation” of those communities. The expansion component has made $570 million available to accomplish these goals. The state closed the application portal for capital grants on June 1, 2023 and is still working through some of the applications received. As of March 6, 2024, the CCE Capital Grants data dashboard shows that 55 expansion awards totaling $464.06 million have been granted resulting in an anticipated 2,465 beds. Another component of the program provides funds to help make critical repairs or upgrades that are needed to these communities so they can remain in operation and serving these individuals receiving SSI/SSP and at risk of homelessness. These funds are awarded to approved counties who will then work with providers in need of these funds. A list of county leads for participating counties can be accessed here. Thirty-four counties are participating in the preservation component of the program, which has made $249 million available to achieve the program’s stated goals.

Share your Experience with CALA

If your company or community has participated in any of these programs, let us know about your experience. Was the enrollment or application process difficult to navigate? What has your experience been like working with the payor? If your company or community has not participated in any of these programs but is interested in learning more, please let us know. Email Selena Coppi Hornback to share your experiences or learn more about these programs.

Karli Holkko is Director of Government Affairs for the California PACE Association, CalPACE. CalPACE works to support, safeguard and promote the Program of All-Inclusive Care for the Elderly (PACE) model of care through education and advocacy.