ALW document checklist: what to gather and when

You don't need any papers to start. For the first call about the Assisted Living Waiver (ALW), a name, date of birth, county and a rough idea of Medi-Cal status is enough. Documents come later, when your opening is released. Your agency completes the official state forms with you.

Apply for ALW

Applying asks Beta to be your Care Coordination Agency. The state decides eligibility and releases openings. If you'd rather talk first, request a callback.

For the first call

Don't put off calling because a record is missing. It helps to know these things. None of them need to be on paper.

The person's full name and date of birth
Where they live now: at home, in a hospital, in a nursing home or in an assisted-living home
Their county
The dates of any recent hospital or nursing-home stay
Their Medi-Cal status, and whether there is a monthly share of cost, if you know
The help they need with daily tasks, moving around, memory and safety
Who can speak or sign for them, if anyone
A phone number and email to reach you
Which counties they would live in, and whether they want assisted living rather than a nursing home

Important: Please don't send a Social Security number, a full medical chart or ID numbers by ordinary email or through a web form. A first inquiry never needs them. If Beta needs records later, your coordinator names the way to send them on the call. In an emergency, call 911.

When your opening comes

When the state releases your opening (the state calls it a slot), it notifies your agency. The agency then generally has 60 days to send the state a complete application. Build this folder while you wait.

Government ID, if there is one. It confirms identity on the forms.
Medi-Cal card details and the latest county eligibility notice. They confirm full-scope Medi-Cal with no monthly share of cost.
Medicare, health-plan and benefit letters, including SSI/SSP (Supplemental Security Income and the State Supplementary Payment). They show how room and board will be paid. ALW does not pay room and board.
Power of attorney, conservatorship or advance directive papers, if they exist. They show who can sign. If no one holds legal authority for the person, say so on the call.
The current medication list and the doctor's contact details. The home checks that it can manage the medications.
A recent hospital discharge summary or the nursing home's face sheet (its one-page summary). The nurse uses them.
Notes on mobility, equipment, memory and supervision. They go into the care plan.
Contacts for any home health, hospice or behavioral-health services already involved. This avoids duplicate services.
Room preferences, accessibility needs, and what matters for culture, language and family visits. They help you choose a home.

A folder prepared months ago is still useful. Medi-Cal status, medications, doctors and contact details often need a refresh when the opening arrives. Keep originals safe and share copies only when your coordinator asks.

Forms and PDFs

The three documents people search for by name, and who fills in each one. Every ALW form, with its DHCS number: the ALW forms page.

Form	Who fills it in	When	Where it is
ALW Waitlist Request Form (DHCS)	Your Care Coordination Agency, with you; Beta files it for the people it serves	At the start, once you choose an agency	The request goes to DHCS from an agency, and your place on the waitlist dates from the day DHCS receives it, so the agency fills it in with you. Apply for ALW or see how the waitlist works. The state's form is on the DHCS ALW page.
DHCS 0062, Freedom of Choice	The person or representative signs; the agency explains it	At enrollment, with the care plan	DHCS 0062 Freedom of Choice form (PDF)
Beta's one-page list: what to have ready for the ALW application	You, for yourself	Before the first call and while you wait	ALW application: what to have ready

Forms your agency completes with you

You won't be asked to find or fill out the official state forms on your own. Your Care Coordination Agency is the state-listed organization that does the ALW paperwork with you. Beta is one. When the time comes, your agency completes the forms with you. They include:

the ALW assessment and level-of-care paperwork
your care plan, which the state calls the Individualized Service Plan (ISP)
the patient rights form and the freedom of choice form
the home's own forms and the physician's report
the transition checklist for your starting point, if one applies

Coming from a nursing home, or already in an assisted-living home?

Those two starting points have their own state checklists and timing rules. See leaving a nursing home for ALW or already living in an assisted-living home.

Referring a patient or client?

Professionals have a separate list of what a useful referral includes. Call Beta's ALW team and give the professional context by phone. Do not send records by email or web form. See the professional referral checklist.

Every official form by its DHCS name and number, and who fills in each one: the ALW forms page.

No documents are needed for the first conversation. Applying asks Beta to be your agency. The state decides eligibility and releases openings. Already on the waitlist? Read the waitlist readiness checklist for what to keep current. The ALW glossary explains ISP, SSI/SSP and other terms.