Does my Medi-Cal plan cover assisted living?

Your Medi-Cal plan does not pay the room and meals in assisted living. Two separate things can help with the care. Some plans, such as IEHP and L.A. Care, offer a CalAIM Community Support called Assisted Living Facility Transitions to members who meet its rules. The Assisted Living Waiver (ALW) is a state program run by the California Department of Health Care Services (DHCS) in fifteen counties, and which plan you are in does not change whether you can get it.

Check whether ALW may fit

Important: What a plan offers can change. Call the plan to confirm. The plan decides its own support. DHCS decides ALW eligibility after a nurse assessment. Beta's ALW team can't promise eligibility, an opening, a home or a date.

What does a Medi-Cal plan pay for in assisted living?

Not the room and meals. A plan's assisted-living support, where a plan offers it, helps with the move and with care in the home. The person still pays room and board from their own income. Kaiser Permanente's referral form says so in plain words: if approved, the member pays room and board. San Francisco Health Plan's form says the service does not include room and board.

The same is true under ALW. In 2026 a resident on SSI/SSP pays the home at most $1,444.07 a month for room and board and keeps at least $182.00. What ALW pays and what you pay.

What are the two kinds of help?

The first is the plan's Community Support. CalAIM lets each Medi-Cal plan choose extra services called Community Supports. One of them helps a member move from a nursing home into assisted living, or move into assisted living instead of a nursing home. Its current name is Assisted Living Facility Transitions. The older name is Nursing Facility Transition/Diversion to Assisted Living Facilities, and some plan pages still use it. Each plan decides whether to offer it and who meets its rules.

The second is the Assisted Living Waiver, a Medi-Cal program that DHCS runs, separate from your plan. It pays a licensed assisted-living home on the state's list for care, in fifteen counties. It has six requirements, including full-scope Medi-Cal with no monthly share of cost and the level of care a nursing home gives. None of the six is about which plan you are in. Who qualifies for ALW.

A person can be eligible for both, but under DHCS policy cannot get the plan support and ALW at the same time. The plan support and ALW, side by side.

Does IEHP cover assisted living?

IEHP does not pay the room and meals. IEHP's Community Supports page lists Nursing Facility Transition/Diversion to Assisted Living Facilities among the supports it offers, for members who meet the rules. Call IEHP Member Services at 1-800-440-4347 (TTY 1-800-718-4347) and ask whether your family member qualifies. IEHP serves Riverside and San Bernardino counties, and both are ALW counties, so you can also ask about ALW. ALW in San Bernardino County and Riverside County.

What each plan's own page says

This table lists only what each plan's own public page or form said when Beta read it on October 28, 2026. "Ask the plan" means the page did not say clearly, or Beta could not read it. The phone number is the one on that page; your plan card has the number for your plan.

TTY is 711 for every plan above except IEHP (1-800-718-4347) and Health Plan of San Mateo (1-800-735-2929). The table does not list every plan in each county. DHCS has a Community Supports search tool ↗ that shows which plans offer which supports.

What to ask your plan

Call the member services number. Ask for Community Supports. Write down who you spoke to and when.

• Do you offer Assisted Living Facility Transitions in our county?
• Does my family member meet the rules?
• What would we still pay each month?
• Which homes do you work with?
• Can my family member stay on the ALW waitlist while using your support?

Kaiser Permanente's referral form says that a member who lives in an ALW county should be placed in a home on the ALW list. Ask your plan whether it has the same rule.

If the plan says no

Ask for the answer in writing and ask how to appeal. Then look at ALW, which does not depend on your plan. A Care Coordination Agency (CCA) sends the waitlist request to DHCS. The CCA is the state-listed organization that does the ALW paperwork with you; Beta is one, in all fifteen counties. DHCS keeps one waitlist and releases openings in priority order when the state releases capacity. How the waitlist works.

If ALW isn't a fit either, there are other kinds of help. What to do if ALW isn't a fit.

What people ask

Does IEHP pay for assisted living?

IEHP does not pay the room and meals. Its Community Supports page lists help moving into assisted living for members who meet the rules. Call IEHP at 1-800-440-4347 to ask. ALW is a separate state program, and IEHP members in Riverside and San Bernardino counties can ask a CCA about it.

Is CalAIM the same as the Assisted Living Waiver?

No. CalAIM is a set of changes to Medi-Cal. It includes the Community Supports each plan may choose to offer. ALW is a separate waiver program run by DHCS. A person can be eligible for both but cannot get both at the same time.

Do I have to change plans to get ALW?

No. ALW's six requirements do not include which plan you are in. What matters is full-scope Medi-Cal with no monthly share of cost, the level of care a nursing home gives, and the other four. The six requirements.

My plan ended its assisted living support. What now?

Ask the plan in writing what it will do for members already getting the support, and how to appeal. Then ask a CCA about ALW, which is separate from the plan. Keep the plan support until any ALW start date is confirmed in writing, so there is no gap.

Can I use my Social Security to pay the room and board?

Yes. Under either kind of help, the resident pays room and board from their own income, and Social Security can be part of it. Assisted living on Social Security explains the numbers.

Not sure whether ALW could fit? Request a callback and Beta's ALW team will tell you which of the six requirements looks uncertain. You can also read what Medi-Cal pays in assisted living, board and care compared with assisted living, signs it may be time and how to talk with a parent about it.