Waitlist Request Form:

The first step in the enrollment process is that the applicant completes the Waitlist Request Form and PHI Release Form. Once Universal Home Care receives these forms, we confirm the applicant’s eligibility and they are added to the ALW waitlist.

• If the applicant has a Durable Power of Attorney (DPOA) for Healthcare, that individual must submit the DPOA documentation and sign all forms used in the ALW program. The DPOA should be noted on the Waitlist Request Form.

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Waitlist Time and Enrollment Process

Currently, there is an estimated waitlist time of 18 - 24 months when transitioning from the community (home). Below are some exceptions to this waitlist period.

• There is no waitlist time when transitioning from a Skilled Nursing Facility or Hospital (Normally, the applicant must have been in this acute setting for at least 60 consecutive days, however, due to COVID-19, the applicant can begin enrollment without first being put on the waitlist)
• If there is an active Adult Protective Services order, there is no waitlist time as long as we receive verification from the applicant’s case worker on APS letterhead.

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The state will notify us when this waitlist time is finished and there is an open spot ready. At that time, Universal Home Care will request the following in order to complete the ALW Application, Assessment, and Individualized Service Plan for the applicant.

• Amenity Form
• Face Sheet from SNF or Hospital (if applicable)
• FORM 602A – Physician’s Report for RCFE
• Freedom of Choice Form
• Medication List

After receiving the above, Universal Home Care will then submit the complete ALW Program Application. The state will review the application for approval into the program and notify us within 10 business days whether the application is approved, denied, or additional information is requested.

Once approved, the applicant is considered Pended status and can be moved into a participating assisted living. It is usually recommended that the applicant or their family tour (in person or virtually) their top 3 desired facilities in advance. The top choice can often become unavailable during the enrollment process, so having backup locations is recommended.

After move-in, any share of cost or social security income issues must be resolved to be considered Enrolled status and ensure continued eligibility for the waiver program. Universal Home Care will continue to follow-up with the client on a monthly basis and revise the Care Plan every 6 months and as needed.