For residents and families
Hospice and the Assisted Living Waiver
If someone on the Assisted Living Waiver (ALW) is thinking about hospice, nothing is automatic. Whether hospice can be added in the same assisted-living home is worked out for each person. The hospice, the home, the payer and Beta as the Care Coordination Agency work it out together. You choose the hospice. Beta's ALW team does not steer that choice. This page says what the written rules settle, what is decided for each person, who pays for what, and who Beta is.
What hospice is
Hospice is care for a person whose doctor has certified a terminal illness. It is a benefit under Medicare and under Medi-Cal. Medicare covers hospice for a person whose doctor expects a life of six months or less. The person or their representative chooses the hospice and signs an election with it. The hospice provides the hospice services for that illness. Under California rules, a licensed assisted-living home may keep a resident who receives hospice care if the state has approved the home for that. The approval is called a hospice care waiver.
Can hospice be added while someone is on ALW?
Hospice and ALW do not automatically work together. For each person, the hospice, the home, the payer and Beta as the Care Coordination Agency settle these things in writing:
- Whether the person is eligible for hospice, and who pays.
- Whether the home holds the hospice care waiver and can keep the resident safely. If the resident becomes bedridden, the home also needs a fire clearance.
- Which medications, supplies and equipment the hospice supplies.
- Which services stay under ALW or another benefit, so that nothing is paid twice.
- Whether the ALW care plan (the Individualized Service Plan, or ISP) must change, including after a hospital stay or if hospice ends.
No written rule Beta can point to says whether ALW continues once hospice starts. That is worked out for each person too. Ask your care coordinator about your own situation.
Who pays for what
- Medicare covers hospice care. It does not pay room and board, except during a short inpatient or respite stay the hospice arranges.
- Medi-Cal pays hospice room and board only when the person lives in a certified nursing home or an intermediate care facility. Neither Medicare nor Medi-Cal pays room and board in an assisted-living home.
- ALW does not pay room and board either. You keep paying the home for room and board (the room and meals), as before.
- The hospice and the payer decide, under their own rules, which medications, supplies and equipment relate to the terminal illness and are covered. Do not assume that every medication becomes hospice-covered. Ask the hospice to tell you in writing what it supplies.
- Beta does not charge you for care coordination. Medi-Cal pays Beta.
What the care coordinator does, and does not do
While you are enrolled in ALW, the care coordinator keeps the ALW assessment, the care plan and the monthly visit. If you choose hospice, the care coordinator records it, updates the care plan so that the home, the hospice and your family know who does what, and checks that your choice is respected.
The care coordinator does not choose a hospice, does not recommend one and does not provide hospice care. Beta shares your information with a hospice only after you or your representative have chosen it and authorized that.
How to choose a hospice
- Start with Medicare's Care Compare, which lists Medicare-certified hospices: medicare.gov/care-compare.
- Ask the assisted-living home which hospices already visit residents there. That is information, not a recommendation. You may still choose any hospice.
- Call two or three. Ask them the questions below.
- Tell your care coordinator which hospice you chose. The care plan is updated then.
Questions to ask any hospice
- How often will a nurse visit, and who do we call at night?
- Which medications and equipment will you supply, and which will you not?
- Have you cared for residents in this home, or in homes like it?
- Who is on the team, and how soon can you start?
- What happens if we change our minds, or if the person gets better?
Who Beta is
Beta is listed by DHCS as a participating Care Coordination Agency under the name Beta Hospice Care. That name comes from the organization's original line of work, hospice and palliative care, which runs separately from ALW care coordination. Beta's ALW team coordinates ALW care in all fifteen ALW counties.
DHCS requires a Care Coordination Agency's case management to be independent of the services it arranges. Beta's ALW team does not recommend a hospice. You may choose any qualified hospice. If anyone pushes you toward one hospice, you can tell DHCS at ALWGrievances@dhcs.ca.gov. Your rights and the complaint route are on Your rights in ALW.
Sources
- Medicare, hospice care coverage
- Medicare Care Compare, hospice
- Medicaid.gov, hospice benefits
- DHCS, APL 25-008, hospice services and Medi-Cal managed care
- DHCS, 2026 ALW reimbursement rates
- DHCS, Care Coordination Agencies provider enrollment
- DHCS, ALW Freedom of Choice form
- DHCS, ALW patient rights
- DHCS, ALW grievance fact sheet
- 22 CCR 87632, hospice care waiver
- CDSS PIN 22-24-ASC, collaborating with home health and hospice agencies
Facts checked through August 27, 2026, against the sources above. Reviewed by [REVIEWER: TO CONFIRM] on [DATE: TO CONFIRM]. This page provides general California ALW information. It is not an official eligibility decision or a promise of waiver enrollment, and it does not guarantee a place in a home. The hospice, the home and the state decide what applies to a particular person.