How to apply for Assisted Living Waiver (ALW) in California

Who it's for

The Assisted Living Waiver pays the care portion of a stay at a participating Residential Care Facility for the Elderly (RCFE) or publicly subsidized senior housing for Medi-Cal beneficiaries who would otherwise need nursing home placement. The waiver covers personal care, assistance with activities of daily living, medication management, social services, and care coordination at the facility; the participant pays only the residency cost (room and board), which for SSI-eligible seniors is capped at the SSI/SSP non-medical out-of-home care rate (roughly $1,300 per month). ALW operates in 15 California counties and has limited slots; new applicants typically join a waiting list. The waiver is one of the few Medi-Cal pathways that pays for assisted living rather than only home-based care. Questions go to the DHCS ALW unit by email at ALWP.IR@dhcs.ca.gov, or apply through one of the ALW Care Coordination Agencies listed on the DHCS page.

What you'll need

• Medi-Cal card or Medi-Cal application confirmation showing full-scope coverage
• Recent medical records or a physician statement documenting nursing-facility-level care need
• Care needs assessment from a state-contracted Care Coordination Agency (typically scheduled after the application is submitted)
• Documentation of preferred ALW-participating facility, if known (or willingness to consider available facilities in the service area)

Where to apply

Step by step

1. Confirm that you are enrolled in full-scope Medi-Cal, since the Assisted Living Waiver (ALW) is only available to Medi-Cal beneficiaries who would otherwise need nursing home placement.
2. Gather your required documents: your Medi-Cal card or Medi-Cal application confirmation showing full-scope coverage, and recent medical records or a physician statement documenting a nursing-facility-level care need.
3. Check whether you live in one of the 15 California counties where ALW operates, and identify any ALW-participating Residential Care Facility for the Elderly (RCFE) or publicly subsidized senior housing you prefer, if known.
4. Apply online through the California Department of Health Care Services (DHCS) ALW page, or contact one of the ALW Care Coordination Agencies listed on the DHCS page to start your application.
5. After submitting your application, complete a care needs assessment scheduled by a state-contracted Care Coordination Agency — this step is typically arranged once your application is received.
6. If you have questions at any point, contact the DHCS ALW unit by email at ALWP.IR@dhcs.ca.gov.

What to expect: After submitting your application, a state-contracted Care Coordination Agency will reach out to schedule a care needs assessment to confirm nursing-facility-level need. Because ALW has a limited number of slots, many applicants are placed on a waiting list — processing times vary, so contact the DHCS ALW unit or your Care Coordination Agency for an estimate of current wait times. If approved, you will pay only the residency cost (room and board) at your participating facility; the waiver covers personal care, medication management, social services, and care coordination. Enrollment is reviewed every year, and you will need to show continued nursing-facility-level care need and active Medi-Cal eligibility to stay enrolled.

Renewals

annual (re-assessment of nursing-facility-level certification and Medi-Cal eligibility)