IHSS or the Assisted Living Waiver in California

In-Home Supportive Services (IHSS) pays for help in your family member's own home. The Assisted Living Waiver (ALW) pays for care in an assisted-living home. IHSS ends when the person moves into a licensed home, so the two don't run together after a move. Which one fits depends on where your family member will live.

Check whether ALW may fit

Important: IHSS decisions sit with the county IHSS office, not with Beta. ALW pays the home for care and pays for care coordination. It does not pay room and board (the room and meals). The California Department of Health Care Services (DHCS) keeps the master ALW waitlist. It releases openings (the state calls them slots) in priority order, when the state releases capacity. No one can promise how long that takes. Beta's ALW team can't guarantee eligibility, enrollment, an opening, a placement or a date.

IHSS and ALW, side by side

The IHSS column comes from the DHCS page on In-Home Supportive Services and the CDSS IHSS rules. The ALW column comes from DHCS's ALW pages. "Your agency" means your Care Coordination Agency, the state-listed organization that does the ALW paperwork and care planning with you. Beta is one. Read what the agency does.

Question	IHSS	ALW
Who it's for	People who need help to stay in their own home. IHSS is arranged through the county.	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	Help at home, such as personal care and cooking.	Care in the home, and care coordination. You pay room and board.
Where you live	Your own home. A licensed care home, a nursing home or a hospital doesn't count as your own 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).
Is there a waitlist?	Ask the county IHSS office how it handles new requests.	Yes. DHCS keeps one master waitlist and releases openings in priority order, when the state releases capacity.

Can you have both?

Not after the move. IHSS pays only while the person lives in their own home. A licensed RCFE or ARF does not count as their own home, so IHSS ends when your family member moves in under ALW. That rule is in the CDSS IHSS regulations, section 30-701.

Before the move, ask the county IHSS office how your hours are handled while your family member is on the ALW waitlist. The ALW waiver says nothing about IHSS, so the county IHSS office is the one to ask.

Which fits when

IHSS fits someone who will stay in their own home and whose needs can be met there. ALW fits someone who will move to an assisted-living home, or already lives in one, and who meets the six ALW requirements. Read the six requirements.

Two questions help: can your family member keep living safely at home, and are they willing to move? You and your family member decide where they live. Beta's ALW team can tell you which of the six requirements looks uncertain and what would settle it. Not sure which fits? Request a callback.

See the other alternatives to ALW, with a comparison page for each.

Before anyone moves

Keep IHSS in place until the ALW side is confirmed in writing. That means eligibility from DHCS, the enrollment date from your agency and the home's agreement to admit your family member under ALW. Then tell the county IHSS office the move-in date. While you wait, tell your agency about any change in health, address or Medi-Cal.

If you're a case manager

After a move into a licensed home, IHSS ends and ALW pays the home for care. Confirm with the county how IHSS hours change on the ALW move-in date. 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.

Refer a patient or client