Assisted Living Waiver
How ALW works and who decides what
Who decides what in California's Assisted Living Waiver: the state, your Care Coordination Agency, the home and you. The ten steps to get in.
The Assisted Living Waiver (ALW) is a Medi-Cal program. It pays for care in an assisted-living home for people who would otherwise need a nursing home. The state decides who is eligible and when it releases an opening. Each home decides whether to admit you. Once you're in, five groups share the work, and none of them decides everything: you or the person you're helping, a Care Coordination Agency (CCA) like Beta, the assisted-living home, the state and your doctors.
Read the transcript
Can Medi-Cal help with assisted living? For some people, yes. California's Assisted Living Waiver, called ALW, lets some Medi-Cal members get care in assisted living instead of a nursing home. ALW pays for care, not rent. The state decides who's eligible. Room and meals come out of the resident's own income.
Six things all have to be true. One. You're 21 or older. Two. You have full-scope Medi-Cal with no monthly share of cost. Full scope means not restricted or limited. A share of cost is an amount some people must pay toward care before Medi-Cal pays. Your Medi-Cal card alone doesn't show this. The eligibility notice your county sends does. The county decides Medi-Cal, so if it isn't sorted out yet, start with the county. Three. You need the level of care a nursing home gives. Help with bathing, dressing or medications may count. A nurse looks at the whole picture. Four. You can live safely in an assisted-living home. Each home decides whether it can meet your needs, and whether it has a room. Five. You're willing to live in a county where ALW operates. You don't have to live there yet when you first ask. Six. You'd rather live in assisted living, or qualifying public subsidized housing, than a nursing home. Only you can answer this one.
The state controls a waitlist. You can ask to be added from home. The state calls an opening a slot. A slot is not a bed. When an opening is released, a registered nurse from a Care Coordination Agency does the assessment. That's the state-listed organization that does the ALW paperwork and care planning with you. You choose which agency. Beta is one, in all fifteen ALW counties. After that, the state's Department of Health Care Services, called DHCS, decides whether you're eligible. Beta can't control eligibility, slot release or the wait.
ALW pays for care, not rent. The state decides who's eligible. Check whether ALW may fit on alwbeta.com. The quick fit check is educational. When you're ready, you can apply online there too.
This video provides general California ALW information. It is not an official eligibility decision, a promise of waiver enrollment or a guarantee of facility placement.
Who does what
These are the roles.
| Who | What they do | What they don't decide |
|---|---|---|
| You, or your family | Make the choices, share information, take part in planning, pay the room and board | Eligibility, when an opening is released, or whether a home admits you |
| Your care coordinator, at a Care Coordination Agency listed by the state (Beta is one) | Assesses needs, writes your care plan, arranges and checks on services, makes a monthly visit, by telehealth if you choose | When the state releases an opening, or whether a home admits you |
| The assisted-living home, licensed as a Residential Care Facility for the Elderly (RCFE) or an Adult Residential Facility (ARF) | Provides the day-to-day care and ALW services within its license | Your eligibility for the program. The home isn't your coordinator |
| The state (the Department of Health Care Services, DHCS) | Runs the program, sets policy, keeps the master waitlist, approves enrollment | The day-to-day running of any home or agency |
| Your doctors, home health or hospice | Provide medical care under their own coverage | Your ALW eligibility or your care plan |
Important: ALW pays for care and care coordination. It does not pay room and board. The room and meals come from the resident's own income or benefits. DHCS keeps the master waitlist and decides when an opening (the state calls it a slot) is released, so no agency can promise a waiting time. Being on the state's list of homes is not the same as having a bed open. Beta's ALW team can help with everything in the "care coordinator" row; Beta can't make the state release a slot, decide eligibility, or make a home admit someone.
Getting in, in ten steps
Getting in is a series of stages rather than one form.
- Find out if ALW may fit.
- Choose a Care Coordination Agency. Beta can be yours.
- Ask to be added to the state's waitlist.
- Wait, and stay ready.
- The state releases an opening to you.
- A nurse from your agency assesses your needs and writes your care plan with you.
- Choose a home that takes ALW.
- Your agency submits the enrollment paperwork to the state.
- Move in.
- Your coordinator visits you each month.
See the step-by-step application process.
Your care plan
Once the state releases an opening, a nurse from your agency does the ALW assessment. With you, the nurse writes your care plan (the state calls it the Individualized Service Plan, or ISP). It lists what help you need, who provides it, and how your coordinator will check on it. See what the assessment covers.
Being enrolled isn't the same as having a home
Four separate things all have to be true before you move.
- You're eligible and the state has released a slot to you.
- The home you want takes ALW.
- The home can meet the needs in your care plan safely, and agrees to admit you.
- The room and board can be paid.
A home can be on the state's ALW list and still have no room today. See homes on the state list.
Your choices
DHCS and your agency must tell you your options for services, homes and providers, and you choose. You never have to accept a particular home or provider. You can change your agency with the state's form (DHCS 0061), and the change takes effect on the date you write on it. No one should steer you toward a provider because of a business relationship. Your rights in ALW.
Common questions
What's the difference between an RCFE and an ARF?
Both are licensed assisted-living homes, often called "board and care." A Residential Care Facility for the Elderly (RCFE) mainly serves older adults; an Adult Residential Facility (ARF) serves adults more generally. Either must enroll with DHCS to take ALW residents.
Can I get ALW in subsidized housing?
Some people receive ALW services while living in qualifying public subsidized housing, where the care arrangement works differently. ALW in public subsidized housing.
Where does ALW operate?
ALW is available in fifteen California counties, and Beta coordinates care in all of them: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara and Sonoma. The current waiver term runs from March 1, 2024 through February 28, 2029. See ALW by county.
Check the six requirements first; if they look like a fit, the application page walks you through the ten steps.
About this informationReviewed 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.