What Is the Assisted Living Waiver Program in California?

Medi-cal, California’s Medicaid program, provides the Assisted Living Waiver (ALW) to adults over 65 years of age — and those who are between 21 and 64 years of age and have a disability — who are eligible for Medicaid. The ALW enables recipients to receive the same level of care in an assisted living community as they would in a nursing home.^[01]

How much does the ALW program pay?

The amount the ALW will pay for services varies from person to person and depends on what kind of care is needed and how often. This is typically defined by a personalized care plan.

For California residents enrolled in the ALW program, Medi-Cal will reimburse their health care providers for certain home and community-based services (HCBS) they provide.

What services are covered by the Medi-Cal ALW?

Covered services must be provided by staff in a Medi-Cal-certified assisted living community or by a licensed home health agency and include:^[02]

• Assistance with activities of daily living, or ADLs
• Meal services
• Medication administration
• Social activities
• Housekeeping
• Skilled nursing care, as needed

Read more:Assisted Living Medicaid Waivers: A State-by-State Guide

Can you afford assisted living?

To participate, seniors must be eligible for Medi-Cal, live in one of the 15 California counties listed below that offer the ALW, and meet certain financial and medical criteria. ^[01]

Medical criteria

To be eligible for the ALW program, elderly and disabled California residents must:

• Meet requirements for skilled nursing care
• Be able to reside safely in an assisted living community or in public subsidized housing

Financial criteria

Residents must:

• Be able to pay for their own room and board
• Have full-scope Medi-Cal eligibility with zero share of the cost – in 2025, the monthly income limits for residents with a zero share of cost are $1,801 for an individual and $2,433 for a couple.^[02]

Seniors whose Medi-Cal benefits provide partial Medicaid coverage and who share in the cost of their care aren’t eligible for the ALW program.

California counties that offer the ALW

Not all counties in California offer the ALW program. Those that do are:

• Alameda
• Contra Costa
• Fresno
• Kern
• Los Angeles
• Orange
• Riverside
• Sacramento
• San Bernardino
• San Diego
• San Francisco
• San Joaquin
• San Mateo
• Santa Clara
• Sonoma

If your loved one isn’t already covered by California Medicaid, the first step is apply for Medi-Cal coverage. If they are covered by Medi-Cal, the next steps are:

1. Contact a local Care Coordination Agency.
2. Arrange with the agency for a nurse to assess your loved one.
3. Complete this form to add your loved one to the waitlist for one of California’s assisted living communities that accept the ALW.

Because the Medi-Cal ALW program is not considered an entitlement, it’s not automatically available to all state residents. Those who aren’t eligible for immediate placement are added to the waitlist.

How long is the ALW waitlist?

As of April 2025, there were nearly 12,000 residents on the ALW waitlist.^[03] The time it takes to move to the top of the waitlist varies, ranging from two months to two years.^[04]

Expert advice for affordable assisted living

Finding the right assisted living community can take time. While A Place for Mom doesn’t refer families who are using public pay options like Medicaid to cover senior living services, a Senior Living Advisor can explain more about how Medicaid works for long-term care. They can also recommend a short-term stay at an assisted living facility or temporary home care to help your loved one through a Medicaid spend-down period.