What the Assisted Living Waiver is.
The Assisted Living Waiver is a Medi-Cal Home and Community-Based Services waiver authorized under federal Section 1915(c). California operates it to let qualifying Medi-Cal members live in a licensed assisted-living setting instead of a nursing home, when their care needs would otherwise require nursing-facility care. The waiver covers the assisted-living service component. It does not cover room and board.
The simplest framing: if your parent qualifies for ALW, Medi-Cal pays the facility for care, and your parent pays the facility for the room. The room-and-board portion is calibrated to SSI level. For most families the only out-of-pocket cost is that room-and-board amount, which sits far below the private-pay rates documented in our 2026 cost of care dataset.
Nursing, custodial, board and care: same waiver, different words.
Families search for this program under many names. The nursing assisted living waiver, the nursing care assisted living waiver, the custodial care assisted living waiver, the board and care assisted living waiver, and the long term assisted living waiver all point to one program: ALW. The variation comes from the kind of care a parent needs, not from a difference in the waiver.
- Nursing-level care. ALW requires that the resident qualify for a nursing-facility level of care. The waiver exists precisely to fund nursing-level support outside a nursing home, in a residential setting.
- Custodial care. Most of what ALW pays for is custodial: help with bathing, dressing, eating, mobility, medications, and supervision. Medicare does not cover custodial care; Medi-Cal, through ALW, does.
- Board and care. Smaller RCFEs are often called board and care homes. ALW funds care at participating board and care homes as well as larger assisted-living communities. See the board and care guide for how these smaller settings work.
How to qualify for ALW in California.
Four eligibility criteria, all four required, assessed in this order by the state-authorized Care Coordination Agency that handles your application:
- Full-scope Medi-Cal without a share of cost. If your parent has Medi-Cal with a share of cost, they do not qualify for ALW until the share-of-cost issue is resolved. An elder-law attorney or Medi-Cal planner can sometimes restructure income to eliminate the share. See the share-of-cost explainer for the mechanics.
- Age 21 or older. ALW is open to any adult Medi-Cal member who meets the other criteria; it is not age-restricted to seniors despite being a common senior-care path.
- Nursing-facility level of care.The Care Coordination Agency assessor determines whether your parent’s care needs would otherwise justify nursing-facility placement. The assessment looks at activities of daily living, medical complexity, and behavioral or cognitive needs.
- Safe to reside in an RCFE. If the assessor determines care needs exceed what a Residential Care Facility for the Elderly can safely provide, ALW is not authorized; the recommendation will be nursing-facility care instead.
For the does-Medi-Cal-pay coverage answer, see the Medi-Cal assisted-living coverage page. For the participating-facility list and how to find one near you, see the ALW facilities guide.
Does ALW cover dementia care?
Yes, within limits. ALW funds care for residents with dementia when their needs reach a nursing-facility level of care and an RCFE can serve them safely. Many participating facilities are licensed for dementia care and offer secured settings, awake overnight staff, and behavioral support. There is no separate memory-care benefit inside ALW; the waiver funds the assisted-living services the resident needs, which may include dementia care, at a facility equipped to provide it. If acuity is too high for a residential setting, the state may direct the family toward nursing-facility Medi-Cal instead. For the care itself, see our memory care services guide and dementia care in California.
What ALW pays for in an RCFE.
Inside a participating RCFE, ALW pays for the care, and the resident pays for the room. Covered services include:
- Care coordination and an individualized service plan.
- Personal care assistance with activities of daily living: bathing, dressing, grooming, eating, and mobility.
- Medication management and oversight.
- Awake overnight staff and supervision.
- Assistance for residents with dementia at facilities licensed to provide it.
County participation: where ALW operates.
ALW does not run statewide. It operates in 15 counties. The table below shows the number of participating assisted-living facilities in each, derived from the DHCS facilities dataset accessed on May 30, 2026. Los Angeles and Orange counties hold most of the supply; several Bay Area counties have only a handful of facilities. If your parent lives in a county not listed here, ALW is not available there.
| County | Participating facilities |
|---|---|
| Los Angeles | 404 |
| Orange | 215 |
| Riverside | 132 |
| Fresno | 96 |
| San Diego | 89 |
| Sacramento | 81 |
| San Bernardino | 69 |
| Kern | 47 |
| Contra Costa | 35 |
| Alameda | 22 |
| San Joaquin | 13 |
| Sonoma | 7 |
| San Mateo | 6 |
| Santa Clara | 5 |
| San Francisco | 3 |
We track these figures and the statewide enrollment and waitlist numbers as an open dataset. For the full table with licensed capacity per county, CSV and JSON downloads, and quarterly updates, see the California ALW county tracker.
The waitlist, and how the queue works.
The ALW waitlist is real. As of December 2025, about 14,847 people were enrolled statewide and roughly 18,365 were on the waitlist, per the DHCS enrollment and waitlist dashboard. DHCS publishes those figures statewide, not by county, so we do not state a specific wait in months for any one county; the public data does not support that number.
The mechanism is a queue. You apply through a Care Coordination Agency. When a funded slot opens, you are notified and given a limited window to identify a participating facility and move in. The practical takeaway: get on the list early, and research participating facilities while you wait so you can act fast when a slot opens.
What an RCFE is, and how ALW fits inside it.
A Residential Care Facility for the Elderly, or RCFE, is a non-medical residential setting licensed by the California Department of Social Services to provide care and supervision to people 60 and older. RCFEs are what most families mean by assisted living or board and care. They range from small six-bed board and care homes to large assisted-living communities. The state licenses and inspects them; they are not nursing homes and do not provide skilled nursing on site.
ALW works inside a participating RCFE. Medi-Cal pays the facility for the resident’s care services, and the resident pays the facility for room and board. Not every RCFE participates, because the ALW reimbursement rate is below the private-pay rate, so the participating list is narrower than the full universe of licensed RCFEs. For the full explanation of the setting itself, see our RCFE explainer.
How to apply, step by step.
- Confirm full-scope Medi-Cal with no share of cost. If there is a share of cost, resolve it first; see the share-of-cost explainer.
- Find the Care Coordination Agency for your region. The DHCS ALW page lists current Care Coordination Agencies by area. Applications run through them, not through the facility.
- Request the level-of-care assessment. The agency assessor evaluates whether your parent meets a nursing-facility level of care and can be served safely in an RCFE.
- Join the waitlist. Once eligibility is confirmed, your parent enters the queue for a funded slot.
- Research participating facilities while you wait. Use the ALW facilities guide so you can move quickly when a slot opens.
- Accept the slot and move in within the window. When a slot opens, coordinate with a participating facility and complete the move before the reservation window closes.
If the waitlist is too long.
For families who cannot wait, the most common bridges are:
- IHSS at home, potentially with Protective Supervision if dementia is present. IHSS does not run out the way private pay does. See IHSS eligibility.
- Private-pay assisted living for the bridge period, with a transition plan to an ALW slot when one opens.
- CalAIM Community Supports, particularly Personal Care and Homemaker Services, Environmental Accessibility Adaptations, and, in some plans, Short-Term Post-Hospitalization Housing.
- PACE if your parent is in a PACE service area and meets the criteria. See the PACE guide.
- MSSP for community-based case management. See the MSSP guide.
Common misunderstandings.
- ALW is not the same as CalAIM. CalAIM is the umbrella Medi-Cal reform program. ALW is a specific waiver with much narrower eligibility. They can run in parallel.
- ALW has no separate memory-care benefit. ALW can fund care at a participating facility that happens to be a memory care RCFE, but only if the resident also meets ALW criteria generally.
- Applying does not guarantee approval. The level-of-care assessment is real. Some applicants are deemed too high acuity for an RCFE and are directed toward nursing-facility Medi-Cal instead.
- Approval does not guarantee a facility accepts your parent. Participating facilities can decline residents based on care needs, capacity, or behavioral considerations.