ALW forms: which one, who fills it in

The DHCS, CDSS and federal documents that families and referrers meet most in the Assisted Living Waiver (ALW). Each has one line on when you need it. Where Beta has a plain-language page on the topic, it is linked beside the document. Not sure which you need? Ask Beta's ALW team.

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Every ALW form at a glance

Form	What it is	Who fills it in	When
ALW Waitlist Request Form (DHCS)	The request that puts a person on the state's waitlist	Your Care Coordination Agency, with you; Beta files it for the people it serves	At the start, once you choose an agency
DHCS 1327, SNF Transition Checklist	The checklist for someone moving out of a nursing facility into ALW	The agency, with the facility and the person	When an opening is released for someone in a nursing facility
DHCS 1331, Existing Facility Resident Transition Checklist	The checklist for someone already living in a participating home	The agency, with the home and the person	When an opening is released for a current resident
DHCS 0062, Freedom of Choice	Records the person's choice of setting, services and providers	The person or representative signs; the agency explains it	At enrollment, with the care plan
DHCS 1322, Patient's Rights	The state's statement of the participant's rights in ALW	The person or representative signs that they received it	At enrollment
DHCS 0063, ALW Informing Notice	The state's notice that the person has been enrolled, with the effective date; it describes the waiver and the roles of the person, the doctor, the providers and DHCS	DHCS issues it; the person or representative receives it	When enrollment is approved
DHCS 0060, ALW Amenity Form	Tells the person what every participant is offered at enrollment, a private or semi-private room with a full bathroom shared by no more than two people and a kitchenette with a refrigerator and a microwave, and records any of these the person chooses to waive	The person or representative signs	At enrollment
DHCS 0061, Change of Care Coordination Agency	Moves a participant to a different agency	The participant or representative, with the new agency	Any time the participant wants to change agencies
DHCS 1328, Community Transition Assessment Checklist	The checklist for someone moving into ALW from home in the community	The agency, with the person	When an opening is released for someone living at home
DHCS 1329, Tier Change Assessment Checklist	The checklist when a participant's needs change enough for a different tier	The agency, after a new nurse assessment	When needs change
DHCS 1330, Re-Assessment Checklist	The checklist for the regular reassessment of an enrolled participant	The agency	At each reassessment
DHCS 1332, Re-enrollment Checklist	The checklist for re-enrolling a former participant	The agency, with the person	When a former participant re-enrolls

The checklists numbered 1327 to 1332 are the agency's assessment packages for each starting point and change; the person signs only what the agency asks them to. The forms and checklists above are the ones DHCS lists on its ALW provider resources page, read on October 19, 2026. The state's current version always controls.

Where is the ALW waitlist request form?

People search for it by name. The request goes to DHCS from a Care Coordination Agency, and your place on the waitlist dates from the day DHCS receives it, so the agency fills it in with you rather than you sending it alone. That is why no copy of the form is linked here. If you want to be added, apply with Beta or choose any agency on the DHCS list; how the waitlist works explains what happens next.

Can I email the waitlist request form to DHCS myself?

Send it through an agency. The 2017 form on the DHCS website says to email it to DHCS, but it also asks for your Care Coordination Agency's name, and under current DHCS policy the agency screens the request within 7 calendar days and sends it. Your place on the waitlist dates from the day DHCS receives it. Choose any agency on the DHCS list, or apply with Beta online or by phone.

Important: These are links to the official sources; they open on state or federal sites. A rate sheet is not a resident housing price list, and the facility roster does not establish live availability. Beta's ALW team can explain what a form is for and when it applies; the state's current version always controls.

Getting started

Document	You need it when	Open
The ALW page of the California Department of Health Care Services (DHCS)	You want the state's own page on eligibility, counties, the waitlist, policy letters and rates.	DHCS Assisted Living Waiver page · How ALW works
The DHCS list of Care Coordination Agencies	You are choosing an agency.	DHCS publishes the current agency list · What a Care Coordination Agency does

Eligibility and the waitlist

Document	You need it when	Open
The six ALW requirements	You want to know who may fit.	Who qualifies for ALW
DHCS Policy Letter 24-002	You need the state's rules on priority groups, screening deadlines and how openings are released.	DHCS Policy Letter 24-002 (PDF) · How the waitlist works
The waitlist request	You are looking for the waitlist request form.	Your agency submits the request to DHCS, and your place on the waitlist dates from the day it reaches DHCS. No form is linked here. How the waitlist works
DHCS 1327	Someone is leaving a nursing home for ALW.	DHCS 1327 SNF Transition Checklist (PDF) · Leaving a nursing home for ALW
DHCS 1331	Someone already living in a participating home is enrolling.	DHCS 1331 Existing Facility Resident Transition Checklist (PDF) · Already living in an assisted-living home

Costs and rates

Document	You need it when	Open
The 2026 ALW rate sheet (DHCS)	You need the rates Medi-Cal pays providers. It is not a resident housing price list.	DHCS 2026 ALW reimbursement rates (PDF) · What ALW pays and what you pay
CDSS PIN 25-19-CCLD (California Department of Social Services)	You need the 2026 SSI/SSP and NMOHC amounts for someone in a licensed home (what those terms mean).	CDSS PIN 25-19-CCLD, 2026 SSI/SSP payment standards (PDF) · What ALW pays and what you pay

Facilities and providers

Document	You need it when	Open
The DHCS list of participating facilities	You want the state's roster of homes that take ALW. Being listed does not mean an open bed, admission or care fit.	DHCS list of participating ALW facilities · See homes on the state list
DHCS provider enrollment for RCFEs and ARFs	You run an RCFE or ARF (what those mean) and want to enroll as an ALW provider.	DHCS provider enrollment page for RCFEs and ARFs · Becoming an ALW provider
DHCS provider resources, forms and memorandums	You need a current form: Freedom of Choice, Patient's Rights, Re-Assessment Checklist, Change of CCA, the transition checklists, Tier Change Checklist, the ISP Desk Guide or the list of public subsidized housing agencies.	DHCS ALW provider resources, forms and memorandums

Rights, choice and changes

Document	You need it when	Open
DHCS 1322	You want the state's own statement of your rights in ALW.	DHCS 1322 Patient's Rights form (PDF) · Your rights and who to call
DHCS 0062	Your coordinator asks you to sign the form recording your choice of setting and providers.	DHCS 0062 Freedom of Choice form (PDF)
The ALW grievance fact sheet	You want to know where a complaint goes: services in your plan to your agency, a problem with the agency to DHCS, everything else to CDSS.	DHCS ALW grievance fact sheet (PDF) · Your rights and who to call
DHCS 0061	You want to switch to a different agency.	DHCS 0061 Change of Care Coordination Agency form (PDF) · How to change your agency

Hospice and healthcare coordination

Document	You need it when	Open
The Medicaid hospice benefit	You need the federal scope of the Medicaid hospice benefit.	Medicaid.gov hospice benefits page
Medicare hospice coverage	You want to know what Medicare hospice covers and its limit on room and board.	Medicare.gov hospice care coverage page

Two Beta checklists you can use now: the waitlist readiness checklist and what to gather for an application. Cannot find what you need? Request a callback and Beta's ALW team will point you to the right document.