Roselie Aiello spent decades working on a cattle ranch in Mount Shasta, Northern California. As her physical strength declined from years of manual labor, she required help with daily tasks like bathing and dressing. Her brother John returned to the family property to provide care but found balancing his writing career with full-time caregiving unsustainable.
The siblings sought assisted living for Roselie, who qualified for Medi-Cal, California’s Medicaid program. However, John discovered that Medi-Cal does not cover assisted living in Siskiyou County or 42 other counties across the state. Only 15 counties, primarily urban areas, offer this specific waiver coverage.
This disparity forces many rural seniors into nursing homes or out of their communities because they cannot afford private pay for assisted living facilities. John Aiello argued that placing his sister in a skilled nursing facility wastes resources and reduces her quality of life without medical necessity.
Managed care providers determine which services to offer, though they are encouraged but not required to provide community supports. Partnership HealthPlan, the largest Medi-Cal plan in Northern California, covers nearly one million residents. It is the only managed care option available in a separate group of 15 counties.
The state’s CalAIM initiative aims to help low-income residents age in place through services like transitional rent and caregiver respite. These benefits are intended to prevent more serious health issues and reduce costs. Even after current waivers expire, these community supports will continue through managed care plans.
