Does Medicaid pay for assisted living in California?

3/22/2019: The California Assisted Living waiver has a wait list of approximately 2,500-3,000 individuals.

From the Department of Health California Assisted Living Waiver Website.

The California Assisted Living Waiver (ALW) is a Home and Community-Based Services (HCBS) waiver that was created by legislation that directed the California Department of Health Care Services (DHCS) to develop and implement the project to test the efficacy of assisted living as a Medi-Cal benefit.

The pilot program was determined to be successful during the first three years in a limited trial in three counties.  In March 2009, the Centers for Medicare and Medicaid Services approved a waiver renewal for an additional five years and expansion of the program into additional counties.  A five year waiver renewal was effective March 1, 2014.

To be eligible to receive services as an ALW Participant, an individual must meet all of the following ALW eligibility criteria:

  • Age 21 or older;

  • Have full-scope Medi-Cal eligibility with zero share of cost;

  • Have care needs equal to those of Medi-Cal-funded residents living and receiving care in Nursing Facilities;

  • Willing to live in an assisted living setting as an alternative to a Nursing Facility;

  • Able to reside safely in an assisted living facility or public subsidized housing;

  • Willing to live in an assisted living setting located in one of the following counties providing ALW services: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma counties.

The goal of the assisted living waiver is to:

1) facilitate a safe and timely transition of Medi-Cal eligible seniors and persons with disabilities from a nursing facility to a community home-like setting in a Residential Care Facility (RCF), an Adult Residential Care Facility (ARF), or public subsidized housing, utilizing ALW services; and

2) offer eligible seniors and persons with disabilities, who reside in the community, but are at risk of being institutionalized, the option of utilizing assisted living waiver services to develop a program that will safely meet his/her care needs while continuing to reside in a RCF, ARF, or public subsidized housing.

California Assisted Living Waiver fact sheet.

California Assisted Living Waiver list of care coordination agencies.

The California Assisted Living Waiver Waitlist Form is here.