What the ALW is, in plain language
The Assisted Living Waiver (ALW) is a California Medi-Cal program. It exists for one practical reason: some seniors who otherwise would have to move into a skilled nursing facility could live safely in a residential assisted living setting instead — and Medi-Cal saves money when they do.
For families, the ALW means a loved one with Medi-Cal can receive assisted living care at a participating RCFE (Residential Care Facility for the Elderly) — like Ivory Crest Care in Loma Linda — without paying private-pay rates out of pocket.
Who qualifies
To be eligible for the California ALW, a person must:
- Be at least 21 years old
- Have full-scope Medi-Cal with zero share of cost
- Require the level of care provided in a nursing facility (medically necessary)
- Be able to live safely in an assisted living setting
- Live in a county where the ALW operates — San Bernardino, Riverside, Los Angeles, and Orange counties all participate
What it pays for — and what it doesn't
The ALW covers care coordination and assisted living services: personal care, medication management, supervision, and the day-to-day support that defines assisted living.
It does not cover room and board. That portion is paid separately at roughly the SSI rate — currently around $1,300/month in California. For most Medi-Cal residents, that's already covered by their SSI payment, so out-of-pocket costs are low or zero.
How to apply
Applications go through a Care Coordination Agency in your county. The steps usually look like this:
- Confirm full-scope Medi-Cal with zero share of cost
- Connect with a Care Coordination Agency in your county
- Complete a level-of-care assessment (medical documentation required)
- Match with a participating RCFE that has availability
- Move in once enrollment is approved
We help families with steps 2–5, especially when there's a hospital discharge or skilled nursing transition that puts the application on a faster track.
Frequently asked questions
What is the California Assisted Living Waiver?
The Assisted Living Waiver (ALW) is a Medi-Cal program that lets eligible seniors receive assisted living care at a participating Residential Care Facility for the Elderly (RCFE) instead of moving to a skilled nursing facility. It exists because most people prefer to age in a homelike setting, and it costs Medi-Cal less than nursing-home care.
Who is eligible for the ALW?
To qualify for the California ALW, a person must (1) be full-scope Medi-Cal eligible with no share of cost, (2) be age 21 or older, (3) require the level of care provided in a nursing facility, (4) be able to live safely in an assisted living setting, and (5) live in a county where the waiver operates. San Bernardino, Riverside, Los Angeles, and Orange counties are all participating counties.
What does the ALW cover?
The ALW covers care coordination and assisted living services — personal care, medication management, and supervision. It does not cover room and board, which is paid separately at the SSI rate (currently around $1,300/month in California, subject to change).
How long does it take to get on the ALW?
It varies. Some counties have wait lists; others can enroll within a few weeks. The faster path is usually a hospital discharge or skilled-nursing transition — those cases are often expedited. We help families navigate the timeline.
Does Ivory Crest Care accept the ALW?
Yes. Ivory Crest Care is an ALW-participating six-bed RCFE in Loma Linda. We accept Medi-Cal ALW residents alongside private pay and IEHP residents.
What if I have Medi-Cal but a share of cost?
ALW requires zero share of cost. If your loved one currently has Medi-Cal with a share of cost, there are sometimes ways to restructure income or assets to qualify — but that's an elder-law-attorney conversation, not one we can give legal advice on. We can refer you to attorneys who do this work.
How do I apply for the ALW?
The application starts with a Care Coordination Agency in your county. We help families connect to the right agency, gather the medical documentation needed for the level-of-care assessment, and move things along. Start by calling us.