Compare your options
Paying privately for assisted living compared with ALW
Paying privately means you pay the home for everything. With ALW, Medi-Cal pays the care part and you pay room and board. What to check before moving in.
In private-pay assisted living, you pay the home for everything: room, meals and care. With the Assisted Living Waiver (ALW), Medi-Cal pays the home for care and you pay room and board (the room and meals). ALW pays only after four things are true. The state must find your family member eligible and release an opening to them. The home must take ALW and be able to meet their needs. Paying privately first doesn't reserve an opening or change your place on the waitlist.
Important: ALW does not pay room and board. You pay it under ALW and under private pay. 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, and a private-pay move does not reserve an opening. 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.
Find out about ALW before you sign
ALW is 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. Read the six requirements. If that looks like a fit, a Care Coordination Agency sends the waitlist request to DHCS. The agency is the state-listed organization that does the ALW paperwork and care planning with you. Beta is one. Read what the agency does. The state decides eligibility and releases openings in priority order, when it releases capacity. What ALW pays, and what you pay has the 2026 figures.
Private pay and ALW, side by side
The ALW column comes from DHCS's ALW pages. Private pay is not a program. It means you pay the home yourself.
| Question | Assisted living with ALW | Private-pay assisted living |
|---|---|---|
| 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. | Anyone the home agrees to admit who can pay its charges. |
| What it pays for | Care in the home, and care coordination. You pay room and board. | You pay for everything: room, meals, care and any extras. |
| 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). | Any licensed home that admits you. |
| Is there a waitlist? | Yes. DHCS keeps one master waitlist and releases openings in priority order, when the state releases capacity. | No state waitlist. The home tells you whether it has a room. |
Can we pay privately now and switch to ALW later?
Maybe. The state has to find your family member eligible and release an opening to them. The home has to take ALW on that date and agree to keep your family member under ALW. And room and board has to be workable on ALW's terms, because ALW doesn't pay it. Paying privately doesn't change the order of the waitlist. If the home doesn't take ALW, switching means moving to one that does. Already in a home and paying privately? Read the guide for current residents.
See the other alternatives to ALW, with a comparison page for each.
Moving in now: get written answers first
- Does this home take ALW today, and will it keep my family member under ALW if the state releases an opening?
- Which charges stop and which stay when ALW starts? Is anything already paid credited?
- What if the opening takes much longer than we hope?
Ask for every charge in writing before you sign. The guide to choosing a home has questions for a tour. See homes on the state list. A home on the list is not an open room, an admission or a care fit. Not sure whether to wait or move? Request a callback.
Before anyone moves
Keep the private-pay agreement 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 new charges under ALW. Ask the home for the date the private-pay charges stop.
If you're a case manager
Private-pay status doesn't change the Medi-Cal or level-of-care tests. A private-pay admission doesn't reserve a slot or start the waitlist request. A CCA submits that request to DHCS. 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.
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.