Assisted Living Waiver (ALW) Program
Helping Medi-Cal Beneficiaries Access Assisted Living Instead of Nursing Homes
The Assisted Living Waiver (ALW) is a critical program for California seniors who need help with daily living but prefer a homelike setting over institutional care. Administered by the California Department of Health Care Services, the ALW enables eligible Medi-Cal recipients to receive long-term care services in assisted living environments, rather than being limited to Skilled Nursing Facilities (SNFs).
Why Was the ALW Created?
Before 2006, Medi-Cal only covered long-term care for individuals in nursing homes — even if their care needs could be met in less restrictive settings. That approach was not only costly but also limited the personal independence of many elderly and disabled individuals.
To address this, the Assisted Living Waiver Pilot Project (ALWPP) launched in 2006 in Los Angeles, Sacramento, and San Joaquin counties. It allowed qualified seniors and adults with disabilities to receive care in licensed Residential Care Facilities for the Elderly (RCFEs) or publicly subsidized housing with services. The pilot proved successful: for the cost of supporting one person in a nursing home, two people could receive care in assisted living under the ALW.
By 2009, the program was officially recognized and expanded to include up to 1,000 waiver slots. Since then, its reach and impact have continued to grow.
Who Is Eligible for the ALW Program?
To qualify for the Assisted Living Waiver, an individual must:
- Be Medi-Cal eligible (without a share of cost)
- Require a nursing facility level of care
- Be willing to live in an ALW-participating facility
- Be able to live safely in an assisted living environment with services and support
- Reside in or be willing to move to one of the approved counties
Assistance must be needed with three or more activities of daily living, such as:
- Bathing
- Dressing
- Eating
- Medication management
- Mobility
- Personal hygiene
Services Provided Through the ALW
Under the ALW, participants receive a customized package of care services that may include:
- Personal care and supervision
- Assistance with daily living activities
- Medication management
- Housekeeping and laundry
- Social and recreational activities
- Meals and snacks
Where Is the ALW Currently Available?
As of the most recent update, the ALW program operates in the following participating California counties:
- Los Angeles
- Sacramento
- San Joaquin
- Fresno
- Sonoma
- San Bernardino
- Riverside
- Contra Costa
- Alameda
- San Diego
- Kern
- Placer
- Shasta
⚠️ Please note: Availability can vary by facility, and slots may be limited. Enrollment is ongoing, but there may be a waiting list.
Benefits of the ALW Program
- Greater independence for seniors who don’t require 24/7 nursing supervision
- More affordable care options than traditional nursing homes
- Improved quality of life in a more homelike, social environment
- Increased flexibility in housing and care settings
How to Apply
To begin the process, individuals must be assessed by a Care Coordination Agency (CCA) that is authorized to help with ALW eligibility, enrollment, and placement. These agencies work directly with Medi-Cal, licensed facilities, and case managers to coordinate the care plan.
📞 Need help with ALW enrollment or eligibility?
Call us toll-free at (800) 777-7575 — our counselors are available 24/7 to walk you through the process and help you find a participating facility in your county.
Stay Updated
We are continuously monitoring policy changes, county expansions, and facility enrollments. For the most current information on ALW availability in your area, check back regularly or speak to one of our expert senior care advisors.
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