The Assisted Living Waiver Program: What It Covers and Who Qualifies

What the Assisted Living Waiver actually pays for

Standard Medi-Cal does not pay a facility's rent. That is the single most important thing to understand before you build a plan around it. The Assisted Living Waiver is a waiver, meaning an exception carved out of the normal rules for a specific group of people, and what it covers is the care side rather than the housing side.

As of now, the waiver is generally designed to cover assisted living care services for eligible Medi-Cal enrollees in participating facilities, so that people who would otherwise need nursing facility level care can live in a licensed residential setting instead. It generally also covers care coordination and a nurse led care plan.

Room and board stays with the resident. For many enrollees that is paid out of SSI or other monthly income, up to a limit tied to the SSI board and care rate. Rates, county participation, and program details change over time, so treat all of this as general information and verify current rules with the program before you make a decision.

Who runs the program, and what the names mean

The program is administered by the California Department of Health Care Services, the same department that runs Medi-Cal. Day to day enrollment runs through designated Care Coordination Agencies, which are the organizations that actually take your intake call, verify eligibility, arrange the nurse assessment, and build the care plan.

The settings the waiver works with are licensed as Residential Care Facilities for the Elderly, or RCFEs, by the California Department of Social Services through Community Care Licensing. That includes both large assisted living communities and small board and care homes. Skilled nursing facilities are a different license under a different regulator, the California Department of Public Health, and Medi-Cal covers long term skilled nursing under its own rules rather than through this waiver.

Who generally qualifies

Eligibility is assessed, not self declared. A nurse evaluation is part of the process, and that assessment drives both approval and the service level assigned.

• Medi-Cal coverage, generally full scope, with share of cost questions worth asking directly since a share of cost can affect participation
• Age and disability criteria set by the program, which in practice focuses on adults who need substantial daily help
• A level of care need that would otherwise justify placement in a nursing facility, established by a nurse assessment
• Willingness and ability to live safely in a licensed residential care setting rather than a nursing facility
• Residence in a participating county, which includes Los Angeles County
• A participating facility with an available waiver slot that can meet the person's care needs

A note on income and asset rules

You will find pages that state exact Medi-Cal income and asset figures for this program. We are deliberately not publishing one, because California's Medi-Cal financial rules have changed in recent years and a confidently stated number that is one revision out of date can cost a family months.

Confirm eligibility directly. The Department of Health Care Services, your county Medi-Cal office, or a Care Coordination Agency serving Los Angeles County can tell you where your parent stands under the current rules, including whether a share of cost applies and what that means for waiver participation. If someone tells you a figure, ask them what date it is current as of.

Where it works, and the participating facility problem

A facility has to choose to participate, and most Los Angeles RCFEs do not. The ones that do tend to be a mix of larger assisted living communities holding a set number of waiver beds and smaller licensed homes that have built their model around the program. That narrows your list far below what the private pay market offers.

This is where families get hurt. They hear a facility say it takes Medi-Cal and assume the placement is settled. What you need to confirm is that the facility is an approved Assisted Living Waiver provider, that it has an open waiver slot now, and that the specific room being offered is one the waiver arrangement covers.

Get all three confirmed by the Care Coordination Agency as well as the facility. A sales office and a program record do not always agree, and the version that governs is the program record.

How to apply, and what the waiting list means

Enrollment generally runs through a designated Care Coordination Agency rather than through the facility itself. That agency handles intake, verifies eligibility, arranges the nurse assessment, helps identify a participating facility, and develops the care plan with the resident and family.

There is typically a waiting list, and for most families it is the deciding factor in whether the waiver is a realistic plan right now. The wait is not a formality to work around. It is the actual constraint, and building a plan that ignores it is how families end up in a crisis.

• Confirm the person has Medi-Cal, and if there is a share of cost, ask what that means for waiver eligibility
• Contact a Care Coordination Agency serving Los Angeles County to begin intake and get on the list
• Complete the nurse assessment that establishes the level of care need
• Identify participating facilities with an open slot that can accept the person's care needs
• Confirm exactly how room and board will be paid, and what the facility expects each month
• Get the placement, the care plan, and the start date in writing before anyone moves

What families do while they wait

A waiting list does not help a parent who cannot safely be alone tonight. In practice families bridge the gap in a few ways, and it is far better to plan the bridge deliberately than to discover it in an emergency room at midnight.

• Private pay in a lower cost board and care home, often a shared room, while the waiver application moves. In this market small homes commonly run roughly $3,500 to $6,000 a month.
• A family contribution split among siblings for a defined number of months, agreed in writing so nobody is guessing
• In Home Supportive Services, or IHSS, if the person is staying at home for now and qualifies
• VA benefits, if the person is a wartime veteran or a surviving spouse, since those can stack with other resources
• A long term care insurance policy, if one exists. Families often forget to check whether a parent bought one decades ago.
• Proceeds or rental income from a home, which is worth discussing with a professional before you act

What the waiver is often confused with

Most of the bad advice families receive comes from mixing up programs that sound similar and work nothing alike.

• Medicare. Medicare does not pay for long term assisted living or custodial care. It may cover a limited, short skilled nursing stay after a qualifying hospital stay under specific conditions. Verify your own coverage with Medicare or your plan.
• Regular Medi-Cal. It covers health care and can cover long term skilled nursing care under its own rules, but it generally does not pay assisted living room and board.
• Housing vouchers and subsidized senior apartments. Those are housing programs. They do not provide care.
• A facility saying it accepts Medi-Cal. Ask instead whether it is an approved Assisted Living Waiver provider with an available slot.
• In Home Supportive Services. IHSS supports care at home and is a separate program from the waiver.
• VA Aid and Attendance. That is a VA pension increase paid to the beneficiary, not a Medi-Cal program, and the two interact in ways worth asking about directly.

Get the current rules before you decide

Program details, county participation, financial rules, and payment rates all change. Anything you read about a benefit program, here or anywhere else, should be confirmed against the current rules before your family relies on it.

This page is general information and not medical, legal, or benefits advice. Confirm current details with the Department of Health Care Services, with a Care Coordination Agency, or with us, and get anything a facility promises in writing.

Keep reading

• Does Medicare pay for assisted living, and what does it cover?
• How much assisted living costs in Los Angeles
• VA Aid and Attendance and paying for assisted living
• Low income assisted living options in Los Angeles
• Board and care vs assisted living in Los Angeles
• How senior placement agencies get paid
• Does Medicaid pay for assisted living in California?

Questions families ask us

What is the Assisted Living Waiver program?

The Assisted Living Waiver, usually shortened to ALW, is a Medi-Cal home and community based services waiver administered by the California Department of Health Care Services. It pays for care services delivered in participating licensed assisted living settings for eligible Medi-Cal members who would otherwise need nursing facility level care, so that they can live in a residential setting instead. It is not standard Medi-Cal, it does not operate in every county, and it does not pay rent.

What does the Assisted Living Waiver cover?

It covers the care side rather than the housing side. That generally means personal care and supervision delivered in a participating facility, care coordination, and a nurse led care plan, with the exact service package set by the program. Room and board stays with the resident and is generally paid from their own monthly income. Program details change over time, so confirm what is currently covered with the Department of Health Care Services or a Care Coordination Agency.

Does Medi-Cal pay for assisted living in California?

Generally not for room and board. Standard Medi-Cal does not cover assisted living rent. The Assisted Living Waiver can cover assisted living care services for eligible Medi-Cal enrollees living in participating facilities, in a limited set of counties that includes Los Angeles, while the resident remains responsible for room and board. Program rules change, so confirm current details with the program.

Which counties have the Assisted Living Waiver?

The waiver operates in a limited set of California counties rather than statewide, and Los Angeles County is one of them. The participating county list has changed over the life of the program, so if your family is weighing a move to another county, confirm the current list with the Department of Health Care Services before you plan around it.

Is the Assisted Living Waiver available in Los Angeles County?

Yes. As of now, Los Angeles is one of the participating counties. The waiver does not operate statewide, so if your family is considering a move to another county, confirm current county participation before you plan around it.

How long is the Assisted Living Waiver waiting list?

It varies and it changes with funding and demand. There is typically a wait, and families often wait months rather than weeks. Ask a Care Coordination Agency serving Los Angeles County for the current picture instead of relying on a number from an article, including this one.

Who pays for room and board if my mother is on the waiver?

The resident does. Room and board is generally paid from the person's own monthly income, which for many enrollees means SSI, up to a limit tied to the SSI board and care rate. The waiver is designed to cover the care services side rather than the housing side. Confirm the current rate and what the facility will accept before anyone moves.

How do we apply for the Assisted Living Waiver?

Enrollment generally runs through a designated Care Coordination Agency rather than through the facility. That agency handles intake, verifies Medi-Cal eligibility, arranges the nurse assessment that establishes level of care, helps identify a participating facility, and builds the care plan. Start there rather than at a community's sales office.

How do I find a facility that accepts the Assisted Living Waiver?

Ask a Care Coordination Agency for currently participating facilities with an open waiver slot, because the list changes and no public directory stays accurate for long. Do not rely on a facility telling you it accepts Medi-Cal. Ask specifically whether it is an approved Assisted Living Waiver provider, whether a waiver slot is open right now, and whether the room being offered is covered under that arrangement.

Can my parent stay in their current assisted living community using the waiver?

Only if that community is an approved Assisted Living Waiver provider and has an available waiver slot. Most Los Angeles RCFEs do not participate. A facility saying it accepts Medi-Cal is not the same thing, so ask specifically whether it is an approved waiver provider and whether a slot is open right now.

Does the waiver cover memory care?

The waiver covers care services rather than a marketing category. What matters is whether the facility is an approved waiver provider, whether it is licensed and staffed to serve someone with dementia including a secured setting if that is needed, and whether it has a slot. Some participating facilities do serve residents with memory loss.

Is there an income or asset limit for the Assisted Living Waiver?

Eligibility runs through Medi-Cal, which applies its own financial rules, and those rules have changed in recent years. We do not publish a figure here on purpose, because an out of date number is worse than none. Apply for or confirm Medi-Cal eligibility directly with the Department of Health Care Services or your county office, and ask specifically about share of cost, since a share of cost can affect waiver participation.