Assisted Living Waiver
ALW tier rates 2026: Tier 1 to Tier 5
The five ALW care tiers and what Medi-Cal pays an assisted-living home for each in 2026, from $95.69 to $270.80 a day, and how the nurse assessment and DHCS decide the tier.
The Assisted Living Waiver (ALW) pays an assisted-living home one of five daily rates, Tier 1 to Tier 5, set by the California Department of Health Care Services (DHCS): $95.69 to $270.80 a day in 2026. A nurse assessment that DHCS reviews sets the tier; the rate goes to the home, never to the resident's bill. Beta ALW can explain how the tiers work.
| Tier | Per participant per day, 2026 | What decides the tier |
|---|---|---|
| Tier 1 | $95.69 | The nurse assessment, reviewed by DHCS: the least care of the five |
| Tier 2 | $114.33 | The nurse assessment, reviewed by DHCS: more care than Tier 1 |
| Tier 3 | $132.97 | The nurse assessment, reviewed by DHCS: more care than Tier 2 |
| Tier 4 | $179.58 | The nurse assessment, reviewed by DHCS: more care than Tier 3 |
| Tier 5 | $270.80 | The nurse assessment, reviewed by DHCS: the most care of the five |
These are the DHCS maximum payable rates effective January 1, 2026, billed under code T2031 with a modifier for the tier (U1 to U5). All ALW rates, with the care coordination rate, the monthly arithmetic and 2023. Try the rate calculator.
Important: A tier rate is not a bill to the resident. A home or agency should not promise a tier before the nurse assessment, because DHCS sets the tier after it. Beta can't promise a tier, eligibility, an opening or a placement.
How the tier is decided
A registered nurse from the Care Coordination Agency assesses how much help the person needs, day and night. DHCS reviews the assessment and applies its level-of-care standard. The tier comes from the person's needs: a higher tier means more care and a higher daily rate. Nobody can say in advance which tier a person will get, and no home or agency should promise one. Understating the needs, or overstating them to reach a higher tier, can lead to a home that does not fit. How the assessment works.
What the tier rate pays for
DHCS describes each tier as "Assisted Living Services: Homemaker; Home Health Aide; Personal Care". In plain words, the tier rate pays the home for the assisted-living care in the participant's care plan: help with bathing, dressing, eating and medications, supervision day and night, and the care the plan assigns to the home. It is paid to the home for each day the person lives there as an enrolled ALW participant.
Care coordination is paid separately, $320.00 per participant per month, to the Care Coordination Agency (CCA), the state-listed organization that does the ALW paperwork and care planning with the resident. Beta is one.
ALW never pays room and board. The resident pays the room and the meals from income; in 2026 a resident whose only income is SSI/SSP pays at most $1,444.07 a month for basic services. What ALW pays for and what you pay.
Can the tier change?
Yes, when the person's needs change. The agency does a new nurse assessment, and DHCS reviews it; the state's Tier Change Assessment Checklist (DHCS 1329) is the form for it. A change may mean an updated care plan, a different tier or a different home. It does not automatically produce one particular outcome. The current forms are on the DHCS provider resources page.
Tier questions
Is the tier rate what the resident pays the home?
No. The tier rate is what Medi-Cal pays the home for care. The resident pays room and board separately, from income.
Can I choose a tier, or ask for a higher one?
No. The tier comes from the nurse assessment and DHCS's review of it. A higher tier means the person needs more care; it is not a better deal for the resident, whose room and board charge does not depend on the tier.
Do the tier rates go up every year?
Not automatically. DHCS publishes a rate sheet when the rates change. The 2026 increase followed the state minimum wage increase to $16.90. As of October 2026, DHCS has not published 2027 rates. ALW rates by year.
About this informationReviewed October 19, 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 October 19, 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.