The short answer
If your parent is going to stay at home, IHSS is the program to apply for. If your parent needs to move into assisted living and cannot pay privately, the Assisted Living Waiver is the Medi-Cal path, as long as they live in one of the 15 counties where it runs and need a nursing-facility level of care. The two do not stack inside a facility: IHSS stops once your parent lives in a licensed care facility.
The difference in timing matters most. IHSS has no slot cap, so an eligible parent can get hours authorized after the county assessment. ALW has a capped number of slots. In December 2025, DHCS reported 14,847 people enrolled and 18,365 on the statewide waitlist. DHCS does not publish waits by county, so nobody can honestly tell you how many months your parent will wait.
Can you have both at once?
Generally not. To get IHSS, CDSS says your parent must live at home or in “an abode of your own choosing”, and it lists acute care hospitals, long-term care facilities and licensed community care facilities as places that do not count as home. Assisted living facilities in California are licensed by the CDSS Community Care Licensing Division. So the day your parent moves into an RCFE under ALW, IHSS for care at home no longer applies.
That rule is what makes the two programs work well in sequence. A common path looks like this:
- Apply for Medi-Cal, and for IHSS, while your parent is still at home.
- Ask a Care Coordination Agency for an ALW assessment and get on the waitlist early, because the waitlist runs while IHSS covers the hours at home.
- Use the waiting time to visit participating facilities near you.
- When a slot opens, move in, and let the county IHSS office know your parent has moved.
One exception to check: ALW can also be delivered in public subsidized housing, through a home health agency, rather than in a facility. We could not find a published DHCS or CDSS rule that spells out how IHSS and ALW combine in that setting. If that is your parent’s situation, ask the Care Coordination Agency and the county IHSS office before you give up any IHSS hours.
Which one fits your parent
IHSS tends to fit when:
- Your parent wants to stay at home, or can move in with a relative, and home is still safe with help.
- A family member is able to be the paid caregiver for some or all of the hours.
- Your parent has a Share of Cost, which IHSS allows and ALW does not.
- Your parent lives in a county with no ALW, which is most of California’s 58 counties.
ALW tends to fit when:
- Your parent needs supervision around the clock that home and family cannot provide.
- Their care needs already match a nursing home resident’s, but a residential setting would suit them better.
- They have full-scope Medi-Cal with no Share of Cost, and income to cover room and board, usually SSI/SSP.
- They live in, or can move to, one of the 15 ALW counties, and a participating facility will accept them.
If neither fits, other Medi-Cal routes exist: PACE where it operates, MSSP for care management at home, or a Medi-Cal nursing home when needs go beyond what a residential setting can safely provide.
How the ALW waitlist decides who moves first
DHCS manages one statewide ALW waitlist and releases slots to Care Coordination Agencies, aiming to do it on or before the 10th of each month. Under its 2024 policy letter, slots go first to people who have lived in an institution such as a nursing home for at least 60 days, then to people with an urgent need documented by Adult Protective Services, then to people referred by the Long-Term Care Ombudsman. People applying from home are served after those groups, in the order they joined the list, and only when slots remain.
Two practical points follow. A parent living at home should get on the list as early as possible. And once a slot is assigned, the Care Coordination Agency has 60 days to submit a complete application, so have participating facilities in mind before the call comes. Our ALW facilities guide and the ALW county tracker show where participating facilities are concentrated.
How to apply for each
ALW.Your parent needs full-scope Medi-Cal with no Share of Cost first; the county Medi-Cal office decides that, not DHCS. Then contact a Care Coordination Agency that serves your county. The agency does a short phone pre-screening, then a registered nurse assesses whether your parent’s care needs match a nursing-facility level of care. For married couples, DHCS applies spousal impoverishment rules when it counts income and assets for ALW. Full steps are in our Assisted Living Waiver guide.
IHSS.Send the IHSS application, form SOC 295, to your county IHSS office. A county social worker interviews your parent at home and decides which services they need and how many hours a month. The county must also receive a Health Care Certification (SOC 873) from a health care provider before services can start. Once approved, your parent hires a caregiver, who can be a friend or relative, and acts as that caregiver’s employer. Details, including Protective Supervision for dementia, are in our IHSS eligibility guide.
Related guides and next steps
- The Assisted Living Waiver, explained
- IHSS eligibility, including Protective Supervision
- How to find an ALW participating facility in California
- California ALW county tracker, 2026
- What Share of Cost means, and why it blocks ALW
- Medi-Cal vs Medicare for assisted living
- Assisted living vs board and care homes
- What happens if my mom can't afford assisted living?
This guide explains differences and coverage, not medical advice. Talk to a licensed clinician about care decisions.Our referral service may receive payments from facilities or service partners; families do not pay us. See How we work.