California Assisted Living Waiver: Eligibility and How to Apply

How the Assisted Living Waiver works

The ALW is a Medicaid home and community-based services (HCBS) waiver, approved by the federal government under section 1915(c) of the Social Security Act. The California Department of Health Care Services (DHCS) runs it. The current waiver term runs from March 1, 2024, through February 28, 2029, according to the DHCS Assisted Living Waiver page.

The ALW does not pay for care in your own house. Services are delivered in one of three kinds of places:

• A Residential Care Facility for the Elderly (RCFE)
• An Adult Residential Facility (ARF)
• A Public Subsidized Housing (PSH) site, where a licensed home health agency comes to you

The California Department of Social Services licenses RCFEs and ARFs. In public subsidized housing, you pay your rent directly to the housing authority, and the home health agency provides the care.

Every participant works with a Care Coordination Agency (CCA). A registered nurse or social worker from the CCA assesses you, writes your Individualized Service Plan, checks your Medi-Cal eligibility each month and reassesses you every six months.

Who qualifies

You need to meet all of these:

• You are 65 or older, or you are 21 to 64 and have a physical or other disability. There is no upper age limit.
• You live in, or are willing to move to, one of the 15 counties where the ALW operates.
• You have full-scope Medi-Cal with no share of cost.
• You need a nursing facility level of care, as measured by the ALW assessment.
• You are willing to live in an RCFE, ARF or public subsidized housing site that takes part in the ALW.

Counties where the ALW is available

The approved waiver lists these 15 counties:

Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara and Sonoma.

In its 2024 renewal, DHCS said it is not expanding the ALW into other counties at this time. If you live somewhere else, you can choose a participating facility in one of these counties, or look at the other programs listed below.

Medi-Cal financial rules

The waiver requires full-scope Medi-Cal with no share of cost. A share of cost is a monthly amount some people must pay toward their care before Medi-Cal pays, so if your Medi-Cal comes with one, you do not qualify for the ALW until that changes.

Your county Medi-Cal office decides whether you meet the income and asset rules. For adults 65 and older and people with disabilities, one common route to no-share-of-cost Medi-Cal is the Aged & Disabled Federal Poverty Level program, which has an income limit of 138% of the federal poverty level. These are the 2026 monthly figures from DHCS's FPL chart:

Household size	138% FPL monthly income limit (2026)
1 person	$1,836
2 people	$2,490

The county counts your income using Medi-Cal's own rules, so check with them even if you are a little over. People on SSI are also among the groups the waiver serves.

Medi-Cal started counting assets again on January 1, 2026, for people who are 65 or older or have a disability. According to DHCS's asset limit FAQ:

• Through June 30, 2027, the limit is $130,000 for one person, plus $65,000 for each extra person in the household (up to 10 people).
• Starting July 1, 2027, the limit drops to $21,000 for one person and $31,000 for two, plus $1,550 for each extra person.
• Your main home, your main vehicle, household items and retirement funds you get regular payments from are not counted. Cash, bank accounts, second homes and second vehicles are counted.
• If you may need long-term care, giving assets away for less than they're worth on or after January 1, 2026, can delay that coverage. Ask your county before you transfer anything.

For ALW applicants, DHCS applies institutional and "spousal impoverishment" rules, which protect part of a married couple's income and assets for the spouse who stays at home. Ask your county Medi-Cal office how these rules apply to you.

Level of care

The CCA nurse or social worker uses the ALW Assessment Tool, which is based on the federal Minimum Data Set used in nursing homes. It checks whether you meet California's nursing facility level of care (called NF-A or NF-B) and places you in one of five tiers:

• Tier 1 is for people with the lowest support needs.
• Tiers 2 to 4 are for people with more significant support needs.
• Tier 5 is for people who need intense, focused help with daily activities. It is limited to people with a traumatic brain injury who have had one or more failed placements in the past.

DHCS reviews every assessment and makes the final decision. Your tier can change at reassessment if your needs change.

What the ALW covers

The assisted living provider (the facility, or the home health agency in public housing) must provide or arrange:

• 24-hour awake staff (six-bed facilities can be exempt from the overnight rule under state licensing)
• Personal care and help with activities of daily living, such as bathing and dressing, and with everyday tasks
• Help taking medications, or medications given by licensed nursing staff when needed
• Three meals a day plus snacks in a facility, or meals coordinated for you in public housing
• Housekeeping and laundry (you supply cleaning products and laundry coins)
• Licensed nursing as needed, though not 24-hour skilled nursing
• Transportation, or help arranging it, to medical appointments and other services in your plan
• Recreational activities, or referrals to them in public housing
• A 24-hour emergency call system in public housing

With prior approval from DHCS, some participants also get residential habilitation (extra staff to build daily living and social skills). People in tiers 4 and 5 can get an augmented plan of care with a behavior assessment and closer mental health coordination.

If you are moving out of a nursing home, the CCA can help with the move for up to 180 days beforehand, from checking your Medi-Cal to showing you facilities and writing your service plan.

In a facility, you get a private or shared bedroom with a lockable door, and no more than two people share a room.

What you pay: room and board

Federal rules do not let Medicaid pay for room and board in these settings. In an RCFE or ARF, you pay the facility directly at the start of each month for your room and meals, from your SSI/SSP income, and keep a personal needs allowance set by state regulation. In public subsidized housing, you pay rent to the housing authority.

Medi-Cal cannot cap or regulate what facilities charge for room and board, DHCS said in its 2024 waiver renewal. Ask each facility for its room and board rate in writing before you choose. If you are not on SSI yet, our guide to SSI and SSDI explains the difference.

How to apply

1. Get Medi-Cal first, if you don't already have it. DHCS's Apply for Medi-Cal page lists four ways: online through BenefitsCal or Covered California, by mail with an application you download in your language, by phone through your county office, or in person at a county office. Use DHCS's county office finder for phone numbers and addresses. For general questions, call the Medi-Cal Helpline at 800-541-5555 (or 916-636-1980). Our guide to enrolling in Medicaid covers what documents to have ready.
2. Pick a Care Coordination Agency in the county where you want to live. DHCS's list of participating Care Coordination Agencies gives each agency's counties, phone number and email. Some agencies are marked as restricted from enrolling new participants, so skip those. DHCS's Assisted Living Waiver page also links to lists of participating facilities and public subsidized housing sites.
3. Ask the CCA to start an ALW application. The CCA does the assessment, confirms your Medi-Cal and sends the application to DHCS.
4. Choose a setting. The CCA must show you the RCFEs, ARFs and public housing sites in your chosen county and explain how they differ. CCAs are not allowed to steer you to one provider.
5. Watch for DHCS's response. If your application is incomplete, DHCS defers it until the CCA sends what is missing. If no slot is open, DHCS tells the CCA the date you were placed on the waitlist.

Your county decides Medi-Cal eligibility, and only DHCS approves ALW enrollment. Care coordination is a waiver service that Medi-Cal pays the CCA for, so you apply through the CCA, not a paid middleman. If anyone asks you to pay to apply or to "hold a spot," check with your county office or DHCS before you pay anything.

The waitlist and how slots open

The ALW has a fixed number of slots set in the federal approval, and DHCS says there is currently a waitlist. DHCS releases open slots to Care Coordination Agencies on a regular basis and posts a monthly enrollment and waitlist report on its ALW page. In its 2024 renewal, DHCS said it had added 7,000 slots using American Rescue Plan Act funding.

Waiver year (starts March 1)	Most people served during the year	Most people enrolled at one time
Year 1 (2024)	21,084	16,344
Year 2 (2025)	21,084	16,344
Year 3 (2026)	23,406	18,144
Year 4 (2027)	25,728	19,944
Year 5 (2028)	28,050	21,744

The waiver requires new enrollments to follow a ratio of 60% people moving out of institutions to 40% people coming from the community. To count as an institutional transition, you must have lived in a nursing facility or similar institution for at least 60 days.

DHCS may move people up the list based on imminent need found in the assessment, and it prioritizes:

• People displaced because a skilled nursing facility closed
• People moving out of institutional settings
• People referred by Adult Protective Services or the Long-Term Care Ombudsman

When a slot opens, your CCA has 60 days to send DHCS a completed application. If it does not, the slot goes to the next person on the list. Keep in touch with your CCA and answer its requests quickly so you don't lose your turn, and ask it where you stand on the list.

If you are denied or your services are cut

DHCS mails a Notice of Action (NOA) if it denies your enrollment, or reduces, ends or denies a service. The NOA comes with a "State Fair Hearing Notice Request" form and a letter explaining your right to appeal.

• You have 90 calendar days from the date the NOA was mailed to ask for a State Fair Hearing before an administrative law judge.
• If you already get ALW services, ask for the hearing before the date printed at the top of the NOA, or within 10 calendar days of the notice, and your services continue while you wait for the decision.

For free help with a hearing, search for legal aid near you at lawhelp.org.

Other California options

If you are outside the 15 counties, want to stay in your own home, or are waiting for a slot, California has other Medi-Cal programs listed on medicaid.gov's California waiver summary:

• The Multipurpose Senior Services Program (MSSP) waiver serves people 60 and older who meet a nursing facility level of care. It covers care management, respite, homemaker and personal care, adult day care, minor home repairs, nutritional services and transportation.
• The Home and Community Based Alternatives waiver serves people who are medically fragile or technology dependent and meet a hospital or nursing facility level of care. It includes case management, personal care and private duty nursing.
• PACE (Program of All-Inclusive Care for the Elderly) is for people 55 and older who live in a PACE organization's service area, are eligible for nursing home care and can live safely in the community. PACE becomes your source for all Medicare and Medicaid services, and you can leave at any time, according to medicaid.gov.

For help at home, our guide on whether Medicaid pays for in-home care covers in-home services more broadly. If housing cost is the main problem, Section 202 senior housing may be worth a look.

Similar waivers in other states

Other states run their own version of this program. Nearly all states and Washington, D.C., offer home and community-based services waivers, and about 257 HCBS waiver programs are active nationwide, according to medicaid.gov's 1915(c) page.

Each state chooses who its waivers serve, what they cover, which areas they reach and the maximum number of people enrolled, so there may be a waitlist. You must need an institutional level of care, as in California. Names vary; many are called something like an "elderly and disabled waiver."

To find yours:

1. Open the State Waivers List on medicaid.gov and filter by your state. Look for approved 1915(c) waivers that serve older adults or people with physical disabilities.
2. Contact your state Medicaid agency through medicaid.gov's state contact page to ask how to apply and whether there is a waitlist.

You can also use our benefit finder to see what other programs you might qualify for.

Frequently asked questions

Can the Assisted Living Waiver pay for care in my own home?

No. The ALW pays for care in a participating RCFE, ARF or public subsidized housing site. For help in your own home, ask about MSSP, PACE or in-home services through Medi-Cal.

I live in a county without the ALW. Can I still use it?

Yes, if you are willing to move to a participating facility in one of the 15 counties and meet the other rules. Your CCA in that county can show you the options.

How long is the waitlist?

DHCS does not publish an expected wait time, but its ALW page links to a monthly enrollment and waitlist report. Your place depends on when you applied, whether you are moving out of an institution and whether you fall into a priority group. Ask your CCA.

What happens to my slot if I go into the hospital?

Your CCA works on your return for up to 30 days. After 30 days away you are disenrolled, but DHCS holds your slot for another 60 days so you can come back.

What if Medi-Cal says I have a share of cost?

The ALW requires Medi-Cal with no share of cost. Ask your county eligibility worker whether you might qualify under a different Medi-Cal program with no share of cost.

Sources

• Assisted Living Waiver, California Department of Health Care Services, accessed October 2026
• Participating Care Coordination Agencies, California Department of Health Care Services, accessed October 2026
• Apply for Medi-Cal, California Department of Health Care Services, accessed October 2026
• Asset Limit Frequently Asked Questions, California Department of Health Care Services, accessed October 2026
• 2026 FPL Calculation Chart (Monthly Values), Enclosure 1, California Department of Health Care Services, accessed October 2026
• Program Descriptions by FPL, Enclosure 3, California Department of Health Care Services, accessed October 2026
• Medi-Cal Eligibility Division: Beneficiaries, California Department of Health Care Services, accessed October 2026
• CA Assisted Living Waiver (0431.R04.00), Centers for Medicare & Medicaid Services, accessed October 2026
• Application for 1915(c) HCBS Waiver: CA.0431.R04.02, effective October 1, 2024 (approved application), Centers for Medicare & Medicaid Services and California Department of Health Care Services, accessed October 2026
• Waiver descriptions: California, Centers for Medicare & Medicaid Services, accessed October 2026
• Home & Community-Based Services 1915(c), Centers for Medicare & Medicaid Services, accessed October 2026
• State Waivers List, Centers for Medicare & Medicaid Services, accessed October 2026
• Program of All-Inclusive Care for the Elderly, Centers for Medicare & Medicaid Services, accessed October 2026
• Where Can People Get Help With Medicaid & CHIP?, Centers for Medicare & Medicaid Services, accessed October 2026
• How to apply for Medicaid and CHIP, USAGov, accessed October 2026