info_outline
213: Choice in Aging: How Medi-Cal Programs Help Seniors Age in Place
10/14/2026
213: Choice in Aging: How Medi-Cal Programs Help Seniors Age in Place
What if staying home as you age cost a fraction of what a nursing facility does? In California, a shared room in a skilled nursing facility averages about $130,000 a year. Choice in Aging's Medi-Cal waiver program works with about $6,000 per person per year to help people remain in their own homes, with the care, connection, and dignity they want. This week, Kirsten Howe sits down with Debbie Toth, President and CEO of Choice in Aging, a 77-year-old Bay Area nonprofit that helps older adults and people with disabilities live and age in community. Debbie explains how the Multipurpose Senior Services Program pays for support that traditional Medi-Cal won't, such as transportation, emergency response buttons, and home modifications. She also describes how California Community Transitions helps people move out of skilled nursing and back into the community, and why Choice in Aging is building a $32 million Aging in Place campus with housing and services right outside residents' front doors. If you're planning for your own future or caring for an aging parent, this conversation shows what's possible with the right support. This is Part 1 of a two-part conversation. In Part 2, Debbie shares the story behind Choice in Aging's intergenerational program. Time-stamped Show Notes: 0:00 Introduction 0:39 Kirsten introduces Debbie Toth, President and CEO of Choice in Aging, whose programs now reach Contra Costa, Solano, Napa, and Sacramento counties. 2:21 Choice in Aging's mission: helping people learn, grow, and age in community with dignity, and out of institutions. 2:33 77 years of evolving, from treating children with polio to the independent living movement to serving older adults. 3:51 The 1970s nursing facility exposés that pushed the California State Legislature to look for a better way. 4:33 How adult day health care works: skilled nursing staffing in a setting that looks and feels like a senior center. 5:06 Debbie's north star: no one should age or become disabled out of the ability to experience joy and community. 5:41 The Multipurpose Senior Services Program (MSSP), and what a Medicaid waiver actually is. 6:08 Who qualifies: adults 60 or older on Medi-Cal who need hands-on help with at least two activities of daily living. 6:34 Complex care management, explained, and why so few people know what it is. 7:07 The biopsychosocial approach: the nurse looks at health, and the social worker asks what brings you joy. 8:02 Caregivers, transportation, training, and in-home hours: building a plan around the whole person. 8:36 What MSSP can pay for, from emergency response buttons to a tablet so Mrs. Smith can attend church on Zoom. 9:35 Why these services fall outside what traditional Medi-Cal pays for, and the paperwork that comes with a waiver. 10:53 The Medicare misconception: Medicare is health insurance, and Medicaid is what pays for long-term care. 11:27 The cost gap: about $130,000 a year for a shared skilled nursing room, versus $6,000 a year to help someone stay home. 12:08 Why funding still favors institutions over community, and why advocacy matters. 12:36 In more than 2,000 presentations, Debbie has never seen anyone raise a hand for a nursing facility. 13:42 California Community Transitions, California's version of the federal Money Follows the Person program. 14:24 How the program begins when someone in a skilled nursing facility says yes to exploring community options. 15:01 Housing, care teams, ramps, and grab bars: a transition that can take three months to two years. 16:46 Why words matter, and how ageism and ableism live in our minds until we train ourselves to see them. 17:49 Saving adult day health care, and the realization that Medi-Cal doesn't cover the true cost of care. 18:25 The SWOT analysis that uncovered nearly two unused acres, and the board's “let's just build housing.” 19:08 Accessible, affordable housing for older adults, and the secret sauce Choice in Aging has had since 1980. 19:37 The Aging in Place campus: housing with health, social services, transportation, and nutrition right outside the front door. 20:35 Thousands of funding streams for housing, and none for the services that keep people housed. 21:02 Where the campaign stands: about $17 million raised toward a $32 million goal. 22:14 Why the right donor could close the gap, and how listeners can help. 22:58 Where to find Choice in Aging, and how to join a lunch-and-learn tour of the adult day health care program. 23:58 Coming up in Part 2: a closer look at Choice in Aging's intergenerational programs. Take the Next Step in Your Estate Planning Journey If this episode resonated with you, we'd love to help you with your own estate planning needs in California. Schedule a complimentary discovery call with our team at Absolute Trust Counsel. During this no-obligation conversation, we'll: Learn about your unique situation and goals Answer questions about our services Determine if we're the right fit to work together Visit or call 925-943-2740 to schedule your free discovery call today. Follow and Review: We’d love for you to follow us if you haven’t yet. Click that purple '+' in the top right corner of your Apple Podcasts app. We’d love it even more if you could drop a review or 5-star rating over on Apple Podcasts. Simply select “Ratings and Reviews” and “Write a Review” then a quick line with your favorite part of the episode. It only takes a couple second and it helps spread the word about the podcast. Episode Credits: The Absolute Trust Talk podcast is brought to you with the help of Q2Mark, led by Chief Marketing Officer Susie Hays. Since 2016, Q2Mark has partnered with Absolute Trust Counsel on all marketing communications—from brand development and website design to this podcast series with over 192 episodes, social media management, video production, and more. If you're business owner looking for comprehensive marketing support, visit .
/episode/index/show/absolutetrusttalk/id/43295599