Compare your options
A nursing home or an assisted-living home with ALW
If your family member is in a nursing home, ALW may pay for care in an assisted-living home instead. Who decides whether that is safe, and what to ask.
Sometimes a person in a nursing home can move to an assisted-living home with the Assisted Living Waiver (ALW). ALW is for people who need the level of care a nursing home gives but can live safely in an assisted-living home. A nurse assesses that, and DHCS decides. There is a waitlist, and a nursing-home stay of at least 60 days gives first priority on it.
Important: A nursing-home stay can give waitlist priority. It does not give an opening or a date. 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. ALW pays the home for care and pays for care coordination, not room and board (the room and meals). A home on the state's ALW list is not an open room, an admission or a care fit. Beta's ALW team can't guarantee eligibility, enrollment, an opening, a placement or a date.
Who decides whether assisted living is safe
A registered nurse from your Care Coordination Agency assesses care needs. The agency is the state-listed organization that does the ALW paperwork and care planning with you, and Beta is one. Read what the agency does. See what the assessment covers. DHCS decides eligibility after that assessment. The home decides whether it can meet your family member's needs within its staff and license, and whether it has a room.
Tell the home everything: diagnoses, medications, wounds and equipment, transfers, fall risk, continence, memory and behavior, and nighttime supervision. If a need is left out to make the move look easier, the home may not be able to keep the person later. How to choose a home.
Nursing home and assisted living with ALW, side by side
The ALW column comes from DHCS's ALW pages. This page does not cover nursing-home Medi-Cal rules.
| Question | Assisted living with ALW | Nursing home |
|---|---|---|
| Who it's for | 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. | People whose needs an assisted-living home can't safely meet. |
| What it pays for | Care in the home, and care coordination. You pay room and board. | Ask the nursing home's business office and the county Medi-Cal office who pays for the stay. |
| Where you live | 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). | The nursing home. |
| Is there a waitlist? | Yes. DHCS keeps one master waitlist and releases openings in priority order, when the state releases capacity. | Ask the nursing home about admission. |
Can you have both?
Not at the same time. ALW doesn't pay for services while someone is a nursing-home inpatient. You can be on the ALW waitlist while your family member is in a nursing home. First priority goes to people in a nursing facility or other institutional setting for at least 60 days when the waitlist request is submitted. The nursing-home transition guide covers that priority rule, the steps in order and the paperwork.
Which fits when
A nursing home fits when the person needs more nursing or supervision than an assisted-living home can give, or needs a place today. Assisted living with ALW fits when the person meets the six ALW requirements and a home that takes ALW can meet their needs. The family also has to be able to wait for an opening. Read the six requirements. See homes on the state list. Not sure which fits? Request a callback.
See the other alternatives to ALW, with a comparison page for each.
Not sure it is time yet? Signs it may be time for assisted living.
Before anyone moves
Keep the nursing-home placement 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. Don't plan a discharge date around an unconfirmed opening or room. Give the nursing home the discharge date in writing too.
If you're a discharge planner or case manager
Has the resident been in a skilled nursing facility (SNF) or other institutional setting for at least 60 days? Then ask the person's Care Coordination Agency (CCA) to submit the waitlist request to DHCS while the person is still there. The CCA completes the state's SNF transition checklist as part of enrollment. The hospital and SNF guide covers what to send. 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.
About this informationReviewed August 27, 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 August 27, 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.