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Board and care or assisted living: what is the difference?
In California both are licensed RCFEs under the same rules. Board and care is a small home of six beds or fewer. How they differ, who each fits, and Medi-Cal.
In California the difference is size, not the licence. Both are Residential Care Facilities for the Elderly (RCFEs), licensed by the California Department of Social Services under the same rules. "Board and care" usually means a home of six beds or fewer in an ordinary house; "assisted living" usually means a larger community. Either can take Medi-Cal through the Assisted Living Waiver (ALW) if it is on the state's list: of the 1,213 listed homes with an open licence, 821 have six beds or fewer.
Are board and care and assisted living the same thing?
For the law, yes. The state has one licence for both: the RCFE licence from Community Care Licensing, part of the California Department of Social Services (CDSS). It allows non-medical care: meals, help with bathing, dressing and medications, and supervision. The words "board and care" and "assisted living" are everyday names, not licence types. You can look up any home's licence, inspections and citations in the CDSS facility search.
A few rules change with the number of residents, such as night staffing and activity planning. The table shows those.
Board and care and assisted living, side by side
| Question | Board and care home | Assisted-living community |
|---|---|---|
| Licence | RCFE, from CDSS Community Care Licensing | The same RCFE licence |
| Size | Usually six beds or fewer | Larger, with more residents |
| Setting | A house on a residential street; the licensee often lives there or nearby | A larger building or campus |
| Staff at night (10 p.m. to 6 a.m.) | Under 16 residents: a qualified person on call on the premises | 16 to 100 residents: at least one staff member awake on duty, and a second on call who can arrive within 10 minutes |
| Activities | Planned activities are required in every RCFE | The same, plus a posted schedule from 7 residents, a named activities lead from 16, and a full-time activities staff member from 50 |
| Typical private price | No published median we can cite; ask each home in writing | No California median we can cite; the 2024 national median for assisted living was $70,800 a year (Genworth and CareScout survey) |
| Medi-Cal | Only through ALW, and only if the home is on the state's list | The same |
The staffing and activity rows come from Title 22 of the California Code of Regulations, sections 87415 and 87219. Ask any home how many caregivers work each shift, because daytime staffing depends on the residents' needs.
Which one fits your parent?
A board and care home often suits someone who does better with a small group, the same few faces and a quiet house. It can also suit someone who needs a lot of hands-on help and little else.
A larger community often suits someone who wants a full activity calendar, a dining room and more people around. It may also have more services on site.
Care needs decide more than size. Before you choose, ask the home whether it can meet your parent's needs within its staff and licence, including memory care, night help and help moving. How to choose a home has the questions to ask on a visit. Not sure your parent needs either yet? Signs it may be time for assisted living.
Does Medi-Cal work the same in both?
Yes. The Assisted Living Waiver pays a participating home for care in the same way, whatever its size. The resident pays room and board from income in both. The home must be on the DHCS list of participating facilities, and your parent must qualify and enroll. A listing is not an open bed. Does Medi-Cal pay for board and care? has the 2026 figures and the county counts. What ALW costs shows who pays what.
The 1,213 and 821 figures count homes on the state's list checked September 18, 2026 with an open licence in the CDSS licence file of October 17, 2026. See the homes on the state list, filtered by county and size.
What about adults under 60?
An Adult Residential Facility (ARF) is the same kind of home for adults 18 to 59. ARFs can be on the ALW list too, for adults 21 and older. ALW for adults under 60.
What people ask
Is a board and care home cheaper than assisted living?
We have no published California figures to compare. Ask each home for its monthly rate and every extra charge in writing. Under ALW, the most a home may charge a resident on SSI/SSP is the same in a small home and a large one.
Do board and care homes accept Medi-Cal?
Some do, through the Assisted Living Waiver. A home is paid under ALW only if it is on the state's list, and taking the waiver is the home's choice. Does Medi-Cal pay for board and care?
Is a board and care home safe?
Both kinds of home follow the same licensing rules and get inspected by CDSS. Check a home's inspection reports and citations in the CDSS facility search before you visit.
Can my parent on Social Security afford either one?
Private pay usually costs far more than a Social Security check. With ALW, Medi-Cal pays the care and the resident pays room and board from income. Assisted living on Social Security.
Can a board and care home join the waiver?
Yes. A licensed home in a waiver county can apply to DHCS as an ALW provider. How a home enrolls.
Request a callback and Beta's ALW team will tell you which counties have the size of home you want. Beta does not rank or recommend homes.
About this informationReviewed October 28, 2026. Program details may change. View official sources and page limitations.
Written by Beta's ALW team and reviewed by Sergio B., Program Coordinator, against the official sources this page lists; facts checked through October 28, 2026. Where this page and an official source differ, the source controls.
This page gives general California ALW information. DHCS decides eligibility after the nurse assessment and releases openings. Each home decides its own admissions. Nothing here is an eligibility decision or a promise of enrollment, and it does not guarantee a place in a home. You may choose any Care Coordination Agency listed by DHCS and any participating home.
Something out of date? Tell Beta's ALW team.