Home Services Long-Term Care Alternatives (Home and Community-Based Service Options) Assisted Living Waiver

Assisted Living Waiver

The Assisted Living Waiver (ALW) helps eligible Medi Cal members who need a high level of daily support receive care in licensed assisted living settings instead of nursing facilities. It is a Home and Community-Based Services (HCBS) waiver approved by the federal Centers for Medicare and Medicaid Services. Waivers operate in five-year cycles, and the current ALW term is approved from March 1, 2024, through February 28, 2029. The program is available in 15 counties in California.

Eligibility

To receive services as an ALW participant, an individual must meet the following ALW eligibility criteria :

Age 21 or older.
Have full-scope Medi-Cal eligibility with no share of cost.
Have care needs equal to those of Medi-Cal-funded residents living and receiving care in nursing facilities.
Be 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: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma.

ALW participants must pay the facility directly for their room and board, with some funds remaining to meet personal and incidental needs. In determining Medi-Cal eligibility for individuals who are applying for enrollment into ALW, institutional and spousal impoverishment prevention rules are applied.

Goals

The ALW helps members:

Transition from a nursing facility to a community home-like setting in a Residential Care Facility for the Elderly (RCFE), Adult Residential Care Facility (ARF), or subsidized public housing, utilizing ALW services, when safe and appropriate.
Stay in the community with support if they are at risk of being institutionalized.

ALW Program Integrity

DHCS routinely monitors ALW claiming to confirm proper payments, safeguard federal and State funds, and ensure compliance with waiver requirements. As part of this oversight, DHCS has identified issues requiring CCAs and ALW facilities to take corrective action to avoid claim denials. For more information, review the latest policy letter.

ALW Grievances

If you have concerns about your ALW services or facility, you can file a grievance:

About your ALW services: Contact your Care Coordination Agency (CCA) via email, mail, or telephone. Find your CCA’s contact information.
About the coordination of care by your CCA: Email DHCS at ALWGrievances@dhcs.ca.gov.
All other grievances: Contact the California Department of Social Services:
- Phone: (844) LET-US-NO (538-8766)
- Email: letusno@dss.ca.gov
- Online: CDSS’ Community Care Licensing Division webpage.

For more information, see the ALW Grievance Fact Sheet.

HCBS Provider Minimum Wage Increase

Due to the enactment of Senate Bill 3, California’s statewide minimum wage will increase from $16.50 to $16.90 for all employers on January 1, 2026. As a result of California’s minimum wage increase, the 2026 Home and Community-Based Services reimbursement rates for specific provider types and procedure codes will also increase. Below is a list of the increased 2026 maximum payable rates that are applicable to the ALW.

Service Description	Service Code and Modifier	Maximum Payable Rate 2026	Unit	Waiver
Tier 1- Assisted Living Services – Homemaker; Home Health Aid; Personal Care	T2031 U1	$95.69	Per Diem	ALW
Tier 2- Assisted Living Services – Homemaker; Home Health Aid; Personal Care	T2031 U2	$114.33	Per Diem	ALW
Tier 3- Assisted Living Services – Homemaker; Home Health Aid; Personal Care	T2031 U3	$132.97	Per Diem	ALW
Tier 4- Assisted Living Services – Homemaker; Home Health Aid; Personal Care	T2031 U4	$179.58	Per Diem	ALW
Tier 5- Assisted Living Services – Homemaker; Home Health Aid; Personal Care	T2031 U5	$270.80	Per Diem	ALW

In order to be reimbursed at the new rate, agencies will need to submit claims using the higher rates listed above for all services provided effective January 1, 2026. This will allow your agency to be reimbursed at the new rates immediately, as opposed to having to resubmit claims.

Please email ALWP.IR@dhcs.ca.gov with any additional questions.

Current Waiver

Current Approved ALW Amendments

ALW Slot Expansion Amendment WY 2-5 (Effective March 1, 2025), CMS approved DHCS’ amendment to the ALW to increase the waiver capacity for waiver years 2-5 of the 2024-2029 ALW.

Emergency Amendments (Appendix Ks)

Appendix K Orange County Chemical Spill (Effective May 21, 2026), CMS approved DHCS’ request to amend the ALW in order to add an App K in response to the Orange County chemical spill. The Appendix K amendments authorize temporary flexibilities for Assisted Living Waiver participants and applicants impacted by the Orange County chemical leak state of emergency. These changes allow the state to extend the re-enrollment period from 30 to 60 days for participants unable to return to their assisted living facility, ensure Assisted Living and Residential Habilitation services can be provided in alternative settings, and temporarily suspend the 60day enrollment period for applicants who cannot complete required steps or secure placement due to the emergency. Additionally, applicants who are assigned waiver slots but cannot yet secure a facility placement may retain their slot until conditions allow completion of enrollment requirements.

Expired Amendments

Assisted Living Waiver Expired Amendments

ALW Current Enrollment

Current ALW enrollment and waitlist information is available on the enrollment dashboard, which is updated monthly. New applicants to the ALW should know that the number of available slots is limited, and there is currently a waitlist. Open waiver slots are released to Care Coordination Agencies on a regular basis. Please contact the Care Coordination Agency of your choice for more information.

Current Policy Letters and Memorandums

Additional Program Resources:

Please submit your ALW comments and questions to: ALWP.IR@dhcs.ca.gov