Plain-language ALW guide
How ALW works: who does what, in plain terms.
Once you're in the Assisted Living Waiver, four groups are involved: you, a care coordination agency, the assisted-living home and the state. Who decides what.
The Assisted Living Waiver (ALW) is a Medi-Cal program that pays for care in an assisted-living home for people who would otherwise need a nursing home. Once you're in it, four groups are involved: you (or the person you're helping), a care coordination agency like Beta, the assisted-living home, and the state. Each decides different things, and none of them decides everything. Here's the short version.
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 | You never have to accept a particular home or provider |
| Your care coordinator (a Care Coordination Agency, or CCA, the state-listed organization that does the ALW paperwork with you; Beta is one) | Assesses needs, writes your care plan, arranges and checks on services, visits monthly | When the state releases an opening, or whether a home admits you |
| The assisted-living home (licensed as an RCFE or ARF) | Provides the day-to-day care and ALW services within its license | Your eligibility for the program; it 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 | They don't replace the coordinator's or the home's duties |
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. Steps 1–5: 1 Find out if ALW may fit · 2 Choose a Care Coordination Agency (Beta can be yours) · 3 Ask to be added to the state's waitlist · 4 Wait, and stay ready · 5 An opening is released to you.
Steps 6–10: 6 The nurse assessment and your care plan · 7 Choose a home that takes ALW · 8 Enrollment paperwork · 9 Move-in and first month · 10 Ongoing check-ins.
See the step-by-step application process.
Your care plan
Once an opening is released, a nurse from your care coordination agency does the ALW assessment and, with you, 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. Search participating facilities.
Your choices
You should be told about your options for services and homes, and you can change your care coordination agency through the state's process at any time. 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 15 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.
Your next step
Check the six requirements first; if they look like a fit, the application page walks you through the ten steps.
Official sourcesChecked against the official sources
Use the official sources below to confirm time-sensitive program details.
This page provides general California ALW information. It is not an eligibility decision or a promise of enrollment, and it is not a guarantee of facility placement. You may choose any Care Coordination Agency listed by DHCS and any participating facility.