ALW words, explained

The forms and letters for the Assisted Living Waiver (ALW) use a lot of shorthand. Here is what the common terms mean in everyday language, and the plain word we use for each one on this site. A definition is not a decision about you. When the exact wording matters, the current source controls: the California Department of Health Care Services (DHCS), the California Department of Social Services (CDSS) or the federal Centers for Medicare & Medicaid Services (CMS). 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.

Five pairs people mix up

Waitlist request vs enrollment

Asking to be added to the waitlist adds your name to the state's list. It is not enrollment, and it is not an eligibility decision.

Slot vs approval

A slot is the state's permission for one more person to start the enrollment steps. Getting one means the work can begin. It is not by itself final approval.

Participating facility vs available facility

"Participating" means the home is enrolled with the state to take ALW residents. It does not mean an open bed, acceptance or care fit.

Care Coordination Agency vs facility

The Care Coordination Agency (Beta is one) assesses, plans, coordinates and checks in. The facility is where the person lives and gets day-to-day care.

ALW services vs room and board

ALW pays for covered care services. It does not pay room and board.

A

Activities of daily living (ADLs)

The basic personal tasks: bathing, dressing, eating, using the toilet, getting from bed to chair and 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.

Aging and Disability Resource Connection (ADRC)

A local network that helps people find services for older adults and people with disabilities. Your county page lists the county's aging services contact.

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, or 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, which Medi-Cal pays for through ALW: help with daily tasks, meals, medications and supervision. Room and board is separate. You pay that.

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. It is for adults 21 or older and runs in fifteen counties. See how ALW works.

B

Basic-services amount

The most a licensed home may charge a resident on SSI/SSP each month for room and board plus basic care and supervision. CDSS publishes it each year with the NMOHC figures; in 2026 it is $1,444.07. You pay it, not ALW. See costs.

C

California 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, decides ALW eligibility after the nurse assessment, and lists the agencies and homes that take part. On this site, "the state" means DHCS.

California Department of Social Services (CDSS)

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.

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. On family pages we say "agency". 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.

Centers for Medicare & Medicaid Services (CMS)

The federal agency that oversees Medicare and Medicaid and approves state programs like ALW.

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. The court papers show what the conservator can decide and sign; the state's ALW forms are signed by the individual or the legally responsible person.

D

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 and contacts. It's useful for the ALW assessment if the person is coming from a facility.

Fair hearing

An appeal of a Medi-Cal decision. A written notice of a denial, a reduction or the end of a benefit explains your right to a fair hearing and the deadline for asking for one. Follow the destination and deadline on that notice. See your rights.

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.

G

Grievance

The official word for a complaint. DHCS lists three routes: services in your care plan go to your agency, a problem with the agency goes to DHCS, and everything else goes to CDSS. See who to call.

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, and a home health agency (HHA)

Skilled nursing or therapy delivered where you live, when a doctor orders it and your coverage allows it. A home health agency is the licensed agency that sends the nurses and aides. Home health is 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. Under Medicaid it starts with an election statement and a doctor's certification. Whether ALW and hospice can run together for one person is reviewed case by case by the hospice, the home, your Care Coordination Agency and the payer. No page can settle coverage for an individual.

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)".

In-Home Supportive Services (IHSS)

A separate California program that pays for help in your own home, such as cooking, cleaning and personal care. A licensed assisted-living home does not count as your own home, so IHSS ends on an ALW move-in. See ALW compared with IHSS.

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.

Institutional setting

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

L

Level of care (LOC)

Short for "nursing-facility level of care". See that entry under N.

Long-Term Care Ombudsman

A free, independent advocate for people living in nursing homes and assisted-living homes. It is not a licensing or enforcement agency. 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 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. It may be by telehealth if you choose that.

N

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

The SSI/SSP payment standard for someone living in a licensed care home. CDSS publishes it each year. In 2026 the total is $1,626.07 a month, of which $706.07 is the room and board component, and you keep at least $182.00 for personal needs. 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 from your agency assesses your needs; the state applies the standard and decides eligibility.

O

Opening

The family word this site uses for a slot. See Slot.

P

Participant

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

Personal and incidental needs allowance

The part of your SSI/SSP that you keep for personal spending after the home is paid. In 2026 it is at least $182.00 a month. See the costs guide.

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.

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

A separate program that combines medical and social care for people 55 or older who live in a PACE service area and need nursing-home level of care. PACE and ALW solve different needs. See ALW compared with PACE.

Protected health information (PHI)

Medical details, diagnoses, ID numbers and anything else that identifies a person's health. Never send it by ordinary email; Beta's ALW team tells you how to send records once you are in touch.

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

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 each release the state sets aside for the priority groups before openings go to community applicants. Policy Letter 24-002 sets it at 50% for the institutional group, 25% for APS referrals and 25% for Ombudsman referrals.

Residential Care Facility for the Elderly (RCFE)

The most common kind of licensed assisted-living home in California, what many families call "board and care". It is mainly for people 60 or over. Someone under 60 may be admitted when their needs are compatible with the other residents. An RCFE has to enroll separately with the state to take ALW residents.

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

Share of cost (SOC)

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.

Skilled nursing facility (SNF)

A nursing home. At least 60 days in one when the waitlist request is submitted puts a person in the first priority group. See Institutional setting.

Slot

An opening in the ALW program. The state releases slots to Care Coordination Agencies from the waitlist; the agency then has 60 days from DHCS's notice to submit a complete application. A slot is not a facility bed, a final eligibility decision or an admission. On family pages we say "opening".

Supplemental Security Income and 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.

Still unsure about a word? Ask Beta's ALW team, or read how the program fits together.