Overview of the Medi-Cal Assisted Living Waiver
The Medi-Cal Assisted Living Waiver (ALW) provides assisted living services for California residents who are elderly or disabled and require a Nursing Home Level of Care, but prefer to reside in an assisted living environment instead of a nursing home. The ALW provides personal care assistance, homemaker services, and home health aides in Adult Residential Facilities (ARFs), Residential Care Facilities for the Elderly (RCFE), and limited to Los Angeles, also Public Subsidized Housing (PSH).
Many waiver programs offer a participant-directed option, allowing program beneficiaries to select their own caregivers, including friends and relatives. The ALW does not. Assisted Living Waiver services are provided by licensed home health agency providers or staff employed by the residential care facility.
The ALW is not available statewide, and currently, is available in 15 CA counties. However, persons can move to an assisted living setting within a county that offers the program.
The Assisted Living Waiver is not an entitlement program. There are a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms. Currently, there is a significant waiting list. As of December 2025, there were 18,365 persons on the waiting list.
The Assisted Living Waiver is a 1915(c) Medicaid Waiver. In California, the Medicaid program is called Medi-Cal.
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers, also known as Home and Community Based Services Waivers, allow states to offer benefits outside of these institutions. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers target specific groups of persons who require a Nursing Home Level of Care and are at risk of institutionalization, such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. Instead, there are a limited number of program participant slots, and when they are full, a waitlist is established.
Benefits of the Medi-Cal Assisted Living Waiver
Follows is a list of the benefits available via the Assisted Living Medi-Cal Waiver. An individualized service plan determines which services a program participant will receive, and the frequency with which they are received.
– Activities – recreational, therapeutic, and social
– Care Coordination / Management
– Homemaker Services – housekeeping and laundry
– Medication Oversight
– Personal Care – non-medical assistance with daily living activities (i.e., bathing, dressing, toileting, and eating)
– Prepared Meals and Snacks
– Residential Habilitation – one-on-one care assistance with a focus on improving socialization, self-help, and adaptive skills in regards to behavioral issues
– Skilled Nursing / Home Health Aides – on an as-needed basis
– Transitional Assistance – from nursing facility to assisted living
– Transportation / Coordination of Transportation
The ALW does not cover the cost of room and board in assisted living settings, but other options can help.
Eligibility Requirements for California’s Assisted Living Waiver
The ALW is for California residents who are elderly (aged 65+) or between the ages of 21 and 64 if disabled. Applicants who are nursing home residents must have been there a minimum of 60 days. Applicants must be willing to reside in a CA county that has an assisted living residence that participates in the ALW program. Currently, ALW services are available in the following California counties:
Alameda
Contra Costa
Fresno
Kern
Los Angeles
Orange
Riverside
Sacramento
San Bernardino
San Diego
San Francisco
San Joaquin
San Mateo
Santa Clara
Sonoma
Financial Criteria: Income, Assets & Home Ownership
Income
While the Assisted Living Waiver itself has no income limits, one must be eligible for full-scope Medi-Cal without a Share of Cost. This income limit is equivalent to 138% of the Federal Poverty Level (FPL). While this figure increases annually in January, Medi-Cal’s income limits increase each April. Effective 4/1/26 – 3/31/27, a single applicant can have income up to $1,836 / month. When both spouses are applicants, the income limit for the couple is $2,490 / month. When only one spouse is an applicant, the income of the non-applicant spouse is disregarded. Only the applicant spouse’s income is considered, which is limited to $1,836 / month. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a Spousal Income Allowance, also called a Monthly Maintenance Needs Allowance. The maximum amount that can be transferred in 2026 is $4,066.50 / month and is intended to ensure the non-applicant spouse has a minimum monthly income of this amount. Non-applicant spouses who have their own income equal to or greater than $4,066.50 / month are not entitled to a Spousal Income Allowance.
ALW participants must contribute towards their room and board costs. The amount is based on their income. In CA, in 2026, state residents who receive SSI and live in an assisted living setting receive a monthly payment of $1,626.07. Of this amount, an individual can retain $182 / month as a Personal Needs Allowance (PNA), while the remaining $1,444.07 / month must be paid to the residence for room and board. If an applicant has income aside from SSI, the residence can charge an extra $20 / month for room and board. In other words, a resident may be required to pay $1,464.07 / month. With the exception of a PNA of $182 / month, any additional income must go towards assisted living costs.
Assets
The asset limit is $130,000 for an individual and $195,000 for a couple (with both spouses as applicants). When only one spouse is an applicant, the couples’ assets are considered jointly owned. However, the applicant spouse can keep up to $130,000 in assets and the non-applicant spouse is allocated a larger portion of the assets to prevent spousal impoverishment. This is called a Community Spouse Resource Allowance, and in 2026, allows the non-applicant spouse to keep up to $162,660 in assets.
Some assets are not counted towards Medicaid’s asset limit. This generally includes one’s primary home, household furnishings and appliances, personal effects, and a vehicle.
There is a Look-Back Period, during which Medi-Cal scrutinizes past asset transfers of persons applying for nursing home care, but it is not applicable to persons applying for the Assisted Living Waiver. However, if one requires Nursing Home Medicaid in the near future, it is applicable. Learn more about CA’s “look-back”.
Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that Medicaid will take it. Fortunately, for Medi-Cal eligibility purposes, the home is considered exempt (non-countable) in the following circumstances.
– The applicant lives in the home or has Intent to Return home and indicates it in writing. California is set apart from the other states in that there is no home equity interest limit.
– The applicant has a spouse living in the home.
– The applicant has a dependent relative, such as a disabled child (of any age) living in the home.
– The applicant has a child under 21 years old living in the home.
While one’s home is generally safe from Medicaid’s asset limit, it is not necessarily safe from Medicaid’s Estate Recovery Program. Learn more about when Medicaid can and cannot take one’s home.
Medical Criteria: Functional Need
An applicant must require a Nursing Facility Level of Care (NFLOC). For the Assisted Living Waiver, a specialized, electronically scored assessment tool is administered by a registered nurse to determine if this level of care need is met. As part of the assessment, an applicant’s care needs are further determined on a tier level of one to five. Tier one indicates an applicant requires the minimal amount of support provided by the ALW, while a determination of tier five indicates one requires the highest level of support available. An applicant’s ability to independently complete Activities of Daily Living (i.e., transferring from the bed to a chair, mobility, eating, toileting) is one area that is considered during the assessment. Relevant to some persons with Alzheimer’s disease or a related dementia, behavioral problems, such as regular attempts to leave the facility or removal of one’s clothes, are also considered. A diagnosis of dementia in and of itself does not mean one will meet a NFLOC.
Qualifying When Over the Limits
Having income and / or assets over Medicaid’s limit does not necessarily mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others exceeding complex. Below are the most common.
While Medi-Cal has a Share of Cost program, the Assisted Living Waiver does not allow applicants to qualify via this program. With “Share of Cost”, an applicant with income over Medi-Cal’s income limit has a set amount of income, a “Share of Cost”, that must be spent on medical expenses and supplies before qualifying for program benefits. However, in some situations, it may be possible to eliminate one’s Share of Cost, allowing them to be eligible for the ALW.
When persons have assets over the limit, Irrevocable Funeral Trusts (IFTs) are an option. IFTs are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Another option are Medicaid-Compliant Annuities, which turn countable assets into a stream of income. There are many other options when the applicant has assets exceeding the limit.
Inadequate planning or improperly implementing a Medicaid planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid Planners are educated in the planning strategies available in California to meet Medi-Cal’s financial eligibility criteria without jeopardizing Medicaid eligibility. Furthermore, there are additional planning strategies that not only help one meet Medicaid’s financial eligibility criteria, but can also protect assets for family as inheritance.
While these strategies often violate Medi-Cal’s Look-Back Period, the Look-Back Rule does not apply to the HCBA Waiver. Some persons, however, will go on to require Nursing Home Medicaid, and if this is the case, the Look-Back Period is relevant. Due to this, it is best to implement Medicaid planning strategies with careful planning and well in advance of the need for nursing home care. There are, however, some workarounds, and Medicaid Planners are aware of them. For these reasons, it is highly suggested one consult a Medicaid Planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Certified Medicaid Planner.
How to Apply for the Medi-Cal Assisted Living Waiver
Before You Apply
Prior to submitting an application for the Assisted Living Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) may be cause for denial of benefits. The American Council on Aging offers a free Medicaid Eligibility Test to determine if one might meet Medicaid’s eligibility criteria.
As part of the application process, applicants need to gather documentation for submission. Examples include copies of Social Security cards, Medicare cards, life insurance policies, property deeds, pre-need burial contracts, prior bank statements, and proof of income. A common reason applications are held up is required documentation is missing or not submitted in a timely manner.
The Assisted Living Waiver is approved for a maximum of approximately 18,762 program participants, and currently, there is a statewide waitlist. Priority is given to nursing home residents who have been residents 60+ days and are transitioning back into the community, as well as persons who have a referral from Adult Protective Services. Persons can contact an Assisted Living Waiver Care Coordination Agency to inquire as to the current average waiting period.
Application Process
In order to be eligible for the Assisted Living Waiver, an applicant must be a Medi-Cal recipient with zero Share of Cost. To apply for Medi-Cal, one must complete an Application for Health Insurance. Persons can also apply online at Covered California or over the phone / in person at one’s Department of Health Care Services county office.
To apply for the ALW, applicants must contact a participating Care Coordination Agency in their county, or the county to which they would like to relocate, to fill out and submit a program application to CA’s Department of Health Care Services. See a list of participating RCFE’s and ARF’s by city and county and a list of participating PSH facilities by city. As part of the application process, a care needs assessment is completed by a registered nurse hired by the Care Coordination Agency. An over-the-phone prescreening is completed first to determine if the individual qualifies for the actual assessment.
There are currently no available assisted living beds via the Assisted Living Waiver. Applicants should complete a Waitlist Request Form (via a Care Coordination Agency) to be put on a statewide waitlist. The Care Coordination Agency will be contacted by CA’s Department of Health Care Services (DCHS) when a participant slot becomes available. The applicant will have 60 days to submit a completed application to DHCS. An applicant who currently receives Medi-Cal benefits, but who does not yet meet the functional need for care, can still be placed on the ALW waiting list.
Learn more about the Assisted Living Waiver. Alternatively, persons can contact their local DHCS county office.
The Assisted Living Waiver is administered by the California Department of Health Care Services (DHCS).
Approval Process & Timing
The Medi-Cal application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed. Based on federal law, Medicaid offices have up to 45 days to review and approve or deny one’s application (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as a waitlist currently exists for the Assisted Living Waiver, approved applicants may spend years waiting to receive benefits.