California Medi-Cal Assisted Living Waiver (ALW)

The Assisted Living Waiver (ALW) is a Medi-Cal waiver that pays for care services for people who need a nursing home level of care but can live in a participating assisted living setting (a residential care facility for the elderly or adult residential facility) or in certain public subsidized housing with home health support. This page is part of our California Long-Term Care Medicaid guide.

Figures change periodically. Double-check current amounts before relying on them.

At a glance

Item	Details
Type of program	Medicaid waiver for care in assisted living
Who runs it	California Department of Health Care Services (DHCS)
Age	21 and older
Care need	Nursing facility level of care
California 2026 income rule (long-term care)	No fixed cap for nursing home care (income above allowances goes toward the cost of care)
California 2026 asset limit (single applicant)	$130,000 in countable (nonexempt) property
Waiting list	Yes. The ALW has a statewide waitlist

The Assisted Living Waiver in brief

Put simply, responsibility for the Assisted Living Waiver sits with California Department of Health Care Services (DHCS). Who it is for: 21 and older. Care need required: Nursing facility level of care. Waiting list status in 2026: Yes. The ALW has a statewide waitlist. The sections below repeat these points with more detail, and our state guide covers the California rules that apply to every long-term care program. Other California programs, and general guides on care at home, are linked at the end of this page for comparison with the Assisted Living Waiver.

What the program is

DHCS runs the ALW in 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. Care coordination agencies assess applicants, write a service plan and work with the participating facility. Medi-Cal pays the facility a daily rate for care, and the resident pays room and board.

Room and board in assisted living is never a Medicaid expense. The Assisted Living Waiver pays for the care side of assisted living, such as personal care, medication help and supervision. The resident pays for room and board from their own income, often Social Security and any pension. See Assisted living and Medicaid and Room and board.

Who qualifies in 2026

Eligibility for the Assisted Living Waiver comes down to these points. The person:

Is 21 or older and has full-scope Medi-Cal with no share of cost (a share of cost bars enrollment)
Needs a nursing facility level of care
Lives in, or will move to, a participating assisted living setting or public subsidized housing in one of the 15 ALW counties
Can be served safely in that setting

Financial eligibility. The person must have full Medi-Cal. Medi-Cal’s income and asset rules are explained in our California guide. The income and asset figures in the table above are California’s 2026 Long-Term Care Medicaid figures from our state guide. Medi-Cal’s countable assets do not usually include the home (within the equity limit, if the applicant or a spouse lives there or intends to return), one car, personal belongings and a small burial fund. When one spouse applies for the Assisted Living Waiver and the other stays at home, the spouse at home keeps a protected share of the couple’s assets and may receive part of the applicant’s income. See Spousal impoverishment rules.

About the level-of-care assessment. For the Assisted Living Waiver, an assessor checks how much help the person needs with bathing, dressing, eating, toileting, mobility and medications, and whether memory loss calls for supervision. A nurse or social worker working with Medi-Cal usually does it in person, wherever the person is living. Before a the Assisted Living Waiver assessment, it helps to line up a family member who can describe a typical bad day, and to have a list of diagnoses and medications ready. See Nursing home level of care and Activities of daily living.

What services it can pay for

The plan of care decides which services are used. The Assisted Living Waiver can cover:

Assisted living services: help with personal care, medication oversight and supervision
Care coordination
Nursing oversight
Home health aide services in public subsidized housing
Transition help for people leaving a nursing home

No program pays for everything. The Assisted Living Waiver services are based on assessed need, and a family caregiver who is already helping is usually counted when the plan is written. When needs grow, request an updated assessment.

How to apply

Applying usually involves two decisions: one about money (financial eligibility for Medicaid) and one about care needs. In plain terms, the steps are:

Contact a care coordination agency in a county where the ALW operates (DHCS publishes the list).
Get on the ALW waitlist through the care coordination agency.
When a slot is offered, the agency assesses the level of care.
Choose a participating facility and complete Medi-Cal eligibility.
Move in; the facility provides care under the plan.

Before contacting Medi-Cal, see Applying for a waiver and the documents checklist for what to gather.

Waiting lists

The ALW keeps a statewide waitlist, and more people are waiting than are enrolled. Openings go first to people living in an institution, such as a nursing facility, and to people referred by Adult Protective Services or the Long-Term Care Ombudsman. People applying from the community are offered openings after those groups. A nursing home resident may therefore enter faster than someone applying from home.

General advice is in Waiver waiting lists.

How it relates to nursing home Medicaid

The ALW serves people at the nursing home level of care, so it is a direct alternative to a nursing home. The financial rules are those of Medi-Cal (see our California guide). The key difference is room and board: the resident pays it from income, at an amount capped for ALW residents, while in a nursing home Medi-Cal pays almost everything and the resident keeps a personal needs allowance.

What is the same as nursing home Medicaid. California’s financial rules for the Assisted Living Waiver track the nursing home rules closely. Gifts and below-value transfers in the five-year look-back can trigger a penalty period for home care as well as nursing home care. Estate recovery also applies: the state can seek repayment from the estate of a person who received long-term care services after age 55. People who keep income above a set allowance may have to pay part of it toward their care each month.

Personal needs allowance. If the person does move to a nursing home, California’s 2026 personal needs allowance is $35 a month. Most of the rest of their income goes toward the cost of care. Details are in our state guide.

Tips for families

Do not wait for a crisis. Lists and assessments for the Assisted Living Waiver take time, and the start date is usually when you first request help.
Keep copies of every the Assisted Living Waiver form, notice and letter, and write down the name of each person you speak with and the date.
Watch the deadlines on notices. A denial or cut can be appealed through a fair hearing, and a timely request can keep services going meanwhile.
Report changes in income, assets, address or living situation to Medi-Cal when they happen.
Expect yearly reviews of both Medicaid eligibility and the care assessment. See Renewals.
Protect a spouse at home. Spousal protections must be claimed; a certified Medicaid planner or legal aid office can explain them for your family.

Common questions

Does the ALW pay rent? No. The resident pays room and board, which is limited for ALW residents.

Is the ALW in every county? No. It operates in 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.

Is there a faster way in? People living in a nursing facility, and people referred by Adult Protective Services or the Long-Term Care Ombudsman, have priority for openings.

Can I enroll if I have a Medi-Cal share of cost? No. The ALW requires full-scope Medi-Cal with no share of cost.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.