Compare your options
Help at home with the HCBA waiver or an assisted-living home with ALW
The HCBA waiver brings Medi-Cal care management and services to a person's own home. ALW pays an assisted-living home for care. Both have waitlists, and a person can be in only one at a time.
The Home and Community-Based Alternatives (HCBA) Waiver and the Assisted Living Waiver (ALW) are both Medi-Cal waivers for people who need the level of care a nursing home gives. HCBA brings a care team and services to the person's own home. ALW pays a licensed assisted-living home for care. Both have waitlists, and under state policy a person can be enrolled in only one at a time.
Important: The California Department of Health Care Services (DHCS) runs both programs. For HCBA, you apply through the Waiver Agency for your county. For ALW, a Care Coordination Agency (CCA), the state-listed organization that does the ALW paperwork with you, sends the waitlist request to DHCS. Beta's ALW team is a CCA. It can't promise eligibility, an opening, a date or a room, in either program.
HCBA and ALW, side by side
The HCBA column comes from the HCBA Waiver page at DHCS, the ALW column from DHCS's ALW pages. "Your agency" means your CCA.
| Question | HCBA Waiver | ALW |
|---|---|---|
| Who it's for | People with full-scope Medi-Cal, of any age, who need the level of care a nursing home gives and want to live at home. | Adults 21 or older with full-scope Medi-Cal and no monthly share of cost. They need the level of care a nursing home gives and can live safely in an assisted-living home. |
| What it pays for | Care management by a nurse and social worker team, plus waiver services brought into the home. | Care in the home, and care coordination. You pay room and board (the room and meals). |
| Where you live | Your own home, a rented home or a family member's home. | A licensed assisted-living home that takes ALW, in one of the fifteen ALW counties. The state licenses these homes as a Residential Care Facility for the Elderly (RCFE) or an Adult Residential Facility (ARF). |
| Who you apply through | The HCBA Waiver Agency for your county or zip code. | A CCA, which sends the request to DHCS. |
| Is there a waitlist? | Yes, since July 12, 2023, when DHCS says the program reached capacity. | Yes. DHCS keeps one master waitlist and releases openings (the state calls them slots) in priority order, when the state releases capacity. |
Can you have both?
Not at the same time. DHCS says a person with Medi-Cal may be enrolled in only one home and community-based services waiver at a time (the DHCS policy letter on dual enrollment, HCBA Policy Letter 23-001, dated September 26, 2023). HCBA and ALW are both that kind of waiver. A place on a waitlist is not enrollment. Ask the Waiver Agency and your CCA before changing programs, so the end date of one and the start date of the other line up.
Which fits when
HCBA fits someone who wants to stay in their own home, or a family member's home, with a care team that comes to them. It has no minimum age. ALW fits someone 21 or older who will live in an assisted-living home, or already does, and who meets the six ALW requirements. Read the six requirements. Both programs give waitlist priority to people who have been in a health care facility for at least 60 days when the application is submitted. Who gets priority on the ALW waitlist.
Ask the Waiver Agency what it would bring to the home. Ask your agency what ALW would cover. You decide which fits. Not sure? Request a callback. See the other alternatives to ALW, including In-Home Supportive Services and the PACE program.
Before anyone moves
Keep HCBA services in place until the ALW side is confirmed in writing: eligibility from DHCS, the enrollment date from your agency and the home's agreement to admit your family member under ALW. Ask the Waiver Agency how and when leaving HCBA takes effect, so the dates line up.
If you're a case manager
A person can hold only one 1915(c) waiver enrollment at a time (HCBA Policy Letter 23-001). Confirm the HCBA end date with the Waiver Agency and the ALW enrollment date with the CCA before advising a change. To refer someone, call with professional context only: your organization and role, a callback number, the person's county and setting, and the general need. Send no records. Beta's ALW team names the route for records once you are in touch.
What people ask
Can a child use ALW?
No. ALW is for adults 21 and older. HCBA has no minimum age, and DHCS gives applicants under 21 priority when HCBA openings are released.
Does HCBA pay for an assisted-living home?
No. DHCS says HCBA services are provided in the participant's own residence. ALW is the Medi-Cal program that pays an RCFE or ARF for care. See what ALW pays, and what you pay.
About this informationReviewed October 12, 2026. Program details may change. View official sources and page limitations.
Written by Beta's ALW team and checked against the official sources this page lists; facts checked through October 12, 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.