ALW guide
If ALW doesn't fit right now: your alternatives
If ALW does not fit today, the next step depends on the reason. Name it, then compare IHSS, PACE, CalAIM Community Supports, private pay or a nursing home.
It depends on the reason. "Not right now" isn't the same as "never." Name the reason the Assisted Living Waiver (ALW) doesn't fit. Then compare what people try next: IHSS, PACE, CalAIM Community Supports, private pay or a nursing home.
Important: If the person isn't safe where they are, don't wait for an ALW slot (the state's word for an opening) to solve an emergency. Call 911 for immediate danger or a medical emergency. Then work with the current doctor or hospital on a safe placement today. You can stay on the ALW waitlist in the meantime.
Start by naming the reason
ALW has six requirements: age, Medi-Cal type, level of care, safety, county and choice. IHSS is In-Home Supportive Services. PACE is the Program of All-Inclusive Care for the Elderly. Full-scope Medi-Cal covers all Medi-Cal services, not only emergencies. A share of cost is a monthly amount some people pay before Medi-Cal pays.
| The reason ALW doesn't fit today | What most people try next |
|---|---|
| Age: the person is under 21 | Ask the county or the Medi-Cal plan about programs for younger adults with disabilities. |
| Medi-Cal type: it isn't full-scope | Ask the county Medi-Cal office what it would take to change that. How to check the kind of Medi-Cal ALW needs |
| Medi-Cal type: there's a share of cost | Get a benefits review. It can show whether the person fits a Medi-Cal group with no share of cost. The Medi-Cal guide has the 2026 figures. |
| Level of care: they don't need nursing-home-level care | Home and community services, or private-pay assisted living, may fit better. |
| Safety: they can't live safely in an assisted-living home | A setting with more nursing or supervision, such as a nursing home. |
| Choice: they want to stay at home | IHSS, PACE or the health plan's Community Supports bring help into the home. |
| County: no home nearby can meet their needs | Widen the search to another ALW county, or look at another kind of setting. See homes on the state list |
| There's no opening yet | Put a support plan in place now. Use the waitlist readiness checklist |
| The monthly room-and-board amount isn't workable | Benefits, housing or financial counseling can sometimes change the picture. What ALW pays, and what you pay |
| They need a place today | Make a safe short-term plan that doesn't depend on ALW, and keep the ALW request open. |
Programs people compare with ALW
Each program has its own comparison page, which also answers whether you can have both.
- IHSS (In-Home Supportive Services) pays for help at home, such as personal care and cooking, through the county. It ends when the person moves into a licensed home. Compare ALW and IHSS
- PACE (Program of All-Inclusive Care for the Elderly) provides all medical and long-term care through one team. It is generally for people 55 and older in a PACE service area who need nursing-home-level care. Compare ALW and PACE
- CalAIM Community Supports are extra services some Medi-Cal health plans offer, in some plans including help moving into assisted living. Compare ALW and CalAIM assisted-living transitions
- A nursing home fits when the person needs 24-hour nursing or skilled care that an assisted-living home can't safely give. It also fits when the person needs a place now. Compare ALW and nursing-home care
- Private-pay assisted living gives more choice of homes to people who can afford it and doesn't depend on a waiver opening. Compare ALW and private-pay assisted living
- The HCBA waiver brings a care team and services to the person's own home, with no minimum age. Compare ALW and the HCBA waiver
- MSSP (Multipurpose Senior Services Program) brings care management and some purchased services to a person 60 and over at home, where an MSSP site serves the county. Compare ALW and MSSP
- CBAS (Community-Based Adult Services) is a Medi-Cal daytime program at a center; the person lives elsewhere. CBAS day programs while you wait for ALW
- California Community Transitions (CCT) helps Medi-Cal members move out of a facility into the community. CCT or ALW for leaving a nursing home
- Enhanced Care Management (ECM) is care management through a Medi-Cal plan under CalAIM. ECM and ALW: can a member have both?
County aging and disability offices offer benefits counseling, caregiver support, meals, transportation and legal help. Find your county's resources
What can change the answer later
The answer can change. A Medi-Cal renewal, a resolved share of cost, the right representative papers or new clinical records can all change it. Tell us which requirement wasn't met, and tell us when something changes.
Not sure which requirement is the problem? Take the fit check. Or tell us which reason in the table is yours, and we'll help you think through the next option.
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.