ALW Glossary: CCA, RCFE, Waitlist and More

The forms and letters for the Assisted Living Waiver (ALW) use a lot of shorthand. Here's what the common terms mean in everyday language, and the plain word we use for each one on this site. Definitions are simplified for practical use; the current DHCS, CDSS, CMS or Medi-Cal source controls when technical language matters. Still unsure about a word? Ask Beta's ALW team.

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Important: A definition here is not a decision about you. Eligibility, waitlist priority, care tier and placement are decided only through the official steps, and Beta's ALW team can't guarantee any of them.

A

Activities of Daily Living (ADLs)

The basic personal tasks, bathing, dressing, eating, using the toilet, getting from bed to chair, getting around. The nurse assessment looks at the help you need with them, but no set number decides ALW eligibility. See the assessment.

Adult Protective Services (APS)

The county service that investigates abuse, neglect or exploitation of adults. The ALW waitlist gives priority to people whose urgent need APS has documented. Calling APS only to move up the waitlist is not a shortcut.

Adult Residential Facility (ARF)

One of the two kinds of licensed assisted-living home in California, for adults generally. An ARF has to enroll separately with the state to take ALW residents.

Appendix K

A temporary emergency rule change the state can make to a waiver during a declared emergency. See what's changed in ALW for any that are active.

Applicant

Someone who has asked to join ALW but isn't enrolled yet. After enrollment, the state calls you a participant.

Assisted living / board and care

An assisted-living home is a licensed home where staff help residents with daily tasks, meals and medications. Many families call it "board and care." In California it's licensed as an RCFE or an ARF.

Assisted Living Services

The care an assisted-living home provides to an ALW resident and is paid by Medi-Cal for, help with daily tasks, meals, medications, supervision. These are separate from room and board, which you pay.

Assisted Living Waiver (ALW)

The California Medi-Cal program that pays for care in an assisted-living home, or in qualifying public subsidized housing, for adults who would otherwise need a nursing home. See how ALW works.

C

Care Coordination Agency (CCA)

The state-listed organization that does the ALW paperwork and care planning with you: eligibility, the nurse assessment, your care plan, finding a home and monthly check-ins. Beta is one. See what a CCA does.

Care coordinator

The person at your Care Coordination Agency who works with you, as distinct from the agency itself. On this site, "your Beta care coordinator" means that person.

Care Tier

The level, from 1 to 5, that the assessment assigns to your care needs. It sets what Medi-Cal pays the home for your care; it is not a package you choose and not your housing price. See costs.

Community Applicant

Someone on the ALW waitlist who is living at home or in the community rather than in an institution, and who isn't in an urgent-need group. Community applicants are served in the order their requests were received.

Community-Based Adult Services (CBAS)

A separate Medi-Cal daytime program for adults, with health and social services at a center. It isn't the same as ALW.

Conservator

A person a court has appointed to make decisions for an adult who can't make them alone. If there is one, the conservator signs for the applicant.

D

Department of Health Care Services (DHCS)

The state agency that runs Medi-Cal and ALW. DHCS sets the rules, keeps the master waitlist, releases openings, and lists the agencies and homes that take part. On this site, "the state" usually means DHCS.

The state agency that licenses assisted-living homes and publishes the yearly SSI/SSP payment figures. Complaints about a home go here or to the Long-Term Care Ombudsman. See your rights.

Durable Medical Equipment (DME)

Equipment like a wheelchair, hospital bed or oxygen. Who provides or pays for it depends on the item, its medical purpose, the payer, and whether another benefit such as hospice is involved.

F

Face sheet

The one-page summary a nursing home or hospital keeps for each patient, name, diagnoses, medications, contacts. It's useful for the ALW assessment if the person is coming from a facility.

Freedom of Choice

Your right to be told your options and to choose among the available homes and providers, and to choose or change your Care Coordination Agency. It doesn't mean every home you pick has a room or can meet your needs.

Full-Scope Medi-Cal

Medi-Cal that covers the full range of benefits for your category, as opposed to restricted or limited coverage. ALW requires full-scope Medi-Cal with no monthly share of cost. See the Medi-Cal guide.

H

Home and Community-Based Services (HCBS)

The general name for Medicaid programs, including ALW, that pay for care in someone's home or community instead of an institution.

Home Health

Skilled nursing or therapy delivered where you live, when a doctor orders it and your coverage allows it. It's separate from ALW care coordination and from the home's own care.

Hospice

Care and support for people with a terminal illness who choose comfort care. An ALW resident can receive hospice, but it takes case-by-case coordination between the hospice, the home, your Care Coordination Agency and the payer.

I

Imminent Need

The waitlist term for an urgent situation documented by Adult Protective Services or the Long-Term Care Ombudsman. The exact criteria are in the state's current policy letter, and a person, not a website, has to apply them.

Individualized Service Plan (ISP)

Your care plan, written with you by your Care Coordination Agency after the assessment. It lists your goals, the help you need, who provides it, and how your coordinator checks on it. We say "care plan (the ISP)."

Institutional Setting

For waitlist priority, being in a nursing home or similar institution for at least 60 days when the waitlist request is submitted. The current policy controls how it's applied.

Institutional and Spousal Impoverishment Rules

Medi-Cal financial protections that can apply when one spouse needs long-term care, so the other isn't left without income or assets. They need a benefits specialist's individual review.

L

Level of Care (LOC)

Short for "nursing-facility level of care", see the next entry.

Long-Term Care Ombudsman

A free, independent advocate for people living in nursing homes and assisted-living homes. The ALW waitlist gives priority to people whose urgent need the Ombudsman has documented; it isn't a general shortcut.

M

Medi-Cal

California's Medicaid program, the health coverage that pays for ALW. ALW needs full-scope Medi-Cal with no monthly share of cost, along with the other five requirements.

Medi-Cal Benefits Identification Card (BIC)

Your Medi-Cal card. It shows you're enrolled but not whether your coverage is full scope or has a share of cost; your county notice shows that.

Monthly CCA Visit

The check-in your care coordinator makes every month after you're enrolled, to see that services are happening, your safety is fine, and your care plan still fits.

N

Non-Medical Out-of-Home Care (NMOHC)

The SSI/SSP payment level for someone living in a licensed care home. CDSS publishes it each year, split into room and board, care and supervision, and your personal-needs amount. It's not a care tier. See costs.

Nursing Facility (NF)

A nursing home, a licensed facility providing round-the-clock nursing care. ALW is for people who could get that level of care safely in an assisted-living home instead.

Nursing-Facility Level of Care

The ALW requirement that you need about as much help as people in a Medi-Cal-funded nursing home. On this site we say "needs the level of care a nursing home gives." A nurse decides it through the assessment.

P

Participant

Someone enrolled in ALW. Before enrollment, the state uses "applicant."

Program of All-Inclusive Care for the Elderly (PACE)

A separate program that combines medical and social care for eligible people generally age 55 or older in a PACE service area. PACE and ALW solve different needs. See ALW compared with PACE.

Personal and Incidental Needs Allowance

The part of your SSI/SSP that you keep for personal spending after the home is paid. The current amount is in the costs guide and changes each year.

Person-Centered Planning

Planning that starts with what you want and need, rather than fitting you into a set package of services. ALW care plans are meant to be written this way.

Power of attorney

A document in which someone names another person to make decisions for them, for health care, for finances, or both. If one exists, bring it; it says who can sign.

Public Subsidized Housing (PSH)

Rent-assisted housing where some ALW participants can receive waiver services through a separate care provider. It works differently from an assisted-living home. See ALW in public subsidized housing.

R

Residential Care Facility for the Elderly (RCFE)

The most common kind of licensed assisted-living home in California, mainly for older adults, what many families call "board and care." An RCFE has to enroll separately with the state to take ALW residents.

Reassessment

A repeat of the nurse assessment, on a schedule or when your needs change, to update your care plan and tier.

Reserve Capacity

The share of ALW openings the state sets aside for the priority groups, people in institutions and people with documented urgent need, before openings go to community applicants.

Residential Habilitation

A separately defined ALW service that can be authorized under current program rules. It is not another name for room and board.

Room and Board

Your room and your meals. ALW itself does not pay room and board; you pay it from your own income or benefits. See costs.

S

An amount some people on Medi-Cal must pay toward their care each month before Medi-Cal pays. ALW requires no monthly share of cost.

Slot

An opening in the ALW program. The state releases slots to Care Coordination Agencies from the waitlist. A slot is not a facility bed, a final eligibility decision or an admission.

Supplemental Security Income / State Supplementary Payment (SSI/SSP)

The federal and state monthly benefit for people with low income who are older or have a disability. Many ALW residents pay room and board from it. Getting SSI isn't itself an ALW requirement.

T

Telehealth

Care or coordination delivered by phone or video. Current ALW policy allows some care-coordination and transition services by telehealth when it's appropriate, you choose it, and privacy and consent rules are met. It can't replace hands-on care.

Tier Change

A change to your care tier after a reassessment and the state's process. It doesn't happen just because someone asks for it or a home prefers it.

W

Waitlist

The state's list of people waiting for an ALW opening, kept by DHCS. Your Care Coordination Agency screens and sends your request; DHCS decides when openings are released. See how the waitlist works.

Waiver

Federal permission for a state Medicaid program to pay for services, like assisted-living care, that it otherwise wouldn't cover for a defined group of people. ALW is one such waiver.

Your next step

Start with the main ALW guide, or ask Beta's ALW team about a word you don't see here.

Start With the ALW Guide