Assisted Living Waiver
Who qualifies for ALW? The six things that have to be true
To get into California's Assisted Living Waiver, six things have to be true: age, Medi-Cal, level of care, safety, county and choice. What each one means.
To get into the Assisted Living Waiver (ALW), six things all have to be true: age, Medi-Cal type, level of care, safety, county and choice. No single diagnosis or income figure decides it. The state's Department of Health Care Services (DHCS) decides after a nurse assessment.
Read the transcript
Can Medi-Cal help with assisted living? For some people, yes. California's Assisted Living Waiver, called ALW, lets some Medi-Cal members get care in assisted living instead of a nursing home. ALW pays for care, not rent. The state decides who's eligible. Room and meals come out of the resident's own income.
Six things all have to be true. One. You're 21 or older. Two. You have full-scope Medi-Cal with no monthly share of cost. Full scope means not restricted or limited. A share of cost is an amount some people must pay toward care before Medi-Cal pays. Your Medi-Cal card alone doesn't show this. The eligibility notice your county sends does. The county decides Medi-Cal, so if it isn't sorted out yet, start with the county. Three. You need the level of care a nursing home gives. Help with bathing, dressing or medications may count. A nurse looks at the whole picture. Four. You can live safely in an assisted-living home. Each home decides whether it can meet your needs, and whether it has a room. Five. You're willing to live in a county where ALW operates. You don't have to live there yet when you first ask. Six. You'd rather live in assisted living, or qualifying public subsidized housing, than a nursing home. Only you can answer this one.
The state controls a waitlist. You can ask to be added from home. The state calls an opening a slot. A slot is not a bed. When an opening is released, a registered nurse from a Care Coordination Agency does the assessment. That's the state-listed organization that does the ALW paperwork and care planning with you. You choose which agency. Beta is one, in all fifteen ALW counties. After that, the state's Department of Health Care Services, called DHCS, decides whether you're eligible. Beta can't control eligibility, slot release or the wait.
ALW pays for care, not rent. The state decides who's eligible. Check whether ALW may fit on alwbeta.com. The quick fit check is educational. When you're ready, you can apply online there too.
This video provides general California ALW information. It is not an official eligibility decision, a promise of waiver enrollment or a guarantee of facility placement.
The six requirements, in everyday terms
What each one means, and how you can usually tell:
| Requirement | How to tell |
|---|---|
| You're 21 or older | ALW is not only for people 65 and older. |
| You have full-scope Medi-Cal with no monthly share of cost | Your Medi-Cal card alone doesn't show this. The eligibility notice your county sends does, and Beta's ALW team can help you check. |
| You need the level of care a nursing home gives | A nurse assesses this. Help with bathing, dressing or medications may count, but there is no "three daily tasks means approval" rule. |
| You can live safely in an assisted-living home | The home must be able to meet your needs within its staff and license. Admission is a separate decision from ALW eligibility. |
| You're willing to live in a county where ALW operates | You don't have to live there yet when you first ask. |
| You'd rather live in assisted living or qualifying public subsidized housing than a nursing home | Only you can answer this one. |
Important: A quick fit check on this site is educational. It is not an official eligibility decision, and Beta's ALW team cannot guarantee that the state will find someone eligible or enroll them. We can tell you which of the six looks uncertain and what would settle it.
Full-scope Medi-Cal with no monthly share of cost
A Medi-Cal card is not enough. Your coverage has to be full scope (not restricted or limited), active, and free of a monthly share of cost. A share of cost is an amount some people must pay toward care before Medi-Cal pays.
Medi-Cal's financial rules depend on your age, disability status, household, income and assets, and since January 1, 2026 Medi-Cal counts assets again for some groups, so the county checks both income and assets. So there is no single income or asset number that says yes or no. Your county, not Beta or DHCS, decides whether you have Medi-Cal. Read the guide to full-scope Medi-Cal with no share of cost.
The level-of-care assessment
A registered nurse from your Care Coordination Agency (CCA) does the ALW assessment. The agency is the state-listed organization that does the ALW paperwork and care planning with you. Beta is one. The nurse looks at daily needs, health conditions, medications, memory and behavior, mobility, risks, and recent records. After that assessment, DHCS decides whether you are eligible. See what the assessment covers.
Things people are often told that aren't true
- "Three activities of daily living means you're in." There is no such rule; the whole picture counts.
- "Once you're eligible, any assisted-living home will take you." Each home decides whether it can meet your needs and has a room. How to choose a home.
- "You need SSI to be eligible." No ALW rule requires SSI; what you need is a workable plan for the room and meals, because ALW does not pay room and board. See current costs and room and board.
- "You have to already live in an ALW county." You only need to be willing to live in one. ALW by county.
If one of the six isn't in place, see what to do if ALW isn't a fit.
ALW at 21 to 64
The first requirement is 21 or older, so ALW is open to an adult with a disability long before retirement age, and the other five requirements are the same at 34 as at 84. What changes is the kind of home: the state licenses a Residential Care Facility for the Elderly (RCFE) for adults 60 and over and an Adult Residential Facility (ARF) for adults 18 to 59, and both kinds are on the state's ALW list. ARF homes and ALW for adults 21 to 64 with a disability.
Where you're starting from
In a nursing home now? That can affect your place on the waitlist, not the six requirements themselves. First priority goes to people in a nursing facility or other institutional setting for at least 60 days when the waitlist request is submitted. Nursing-home transition guide.
At home? You can ask to be added to the waitlist from there. Applying from home.
Already in an assisted-living home? You may be able to join ALW there if the home takes ALW. Guide for current residents.
What to have handy when you call
You don't need documents for a first call. It helps to know the person's age, county and Medi-Cal status, including any share of cost. It also helps to know their main care needs, any recent hospital or nursing-home stay, and whether someone holds power of attorney. Please don't send a Social Security number or medical records by email. If we need records, a coordinator will tell you how to send them.
What people ask
Do I need Medi-Cal before I apply for ALW?
ALW requires full-scope Medi-Cal with no monthly share of cost. Enrollment cannot start until that is in place, so if Medi-Cal is not sorted out yet, that is the first thing to do. The kind of Medi-Cal ALW needs, and how to check yours.
Can someone under 65 get ALW?
Yes. ALW is for adults 21 and older who meet the six requirements; age alone does not decide it.
Does ALW cover someone with dementia?
It can, in a participating home whose licence allows dementia care. The nurse assessment looks at the care the person needs, including supervision. Memory care and Medi-Cal.
What if the person is in a nursing home now?
The six requirements are the same. A stay of at least 60 days in a nursing facility when the waitlist request is submitted puts the person in the first priority group when DHCS releases openings. Nursing-home transition guide.
What if my county is not one of the fifteen?
ALW runs only in the fifteen counties DHCS names. Outside them, other Medi-Cal programs may help at home or in a facility. No ALW in your county? What exists instead.
Not sure about one of the six? Do the quick fit check, or read how the waitlist works first. Nothing you enter is saved.
About this informationUpdated October 26, 2026. Reviewed 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.