​​​​​HCBS Provider Minimum Wage Increase

The 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 program to test the efficacy of assisted living as a Medi-Cal benefit. The Centers for Medicare and Medicaid Services (CMS) approves waiver renewals in five-year increments, and expansion of the program into additional counties.  Currently, the ALW ​is available in 15 counties and the current five-year waiver term is approved for March 1, 2024 – February 28, 2029.

To be eligibl​​e​ 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 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.
  

​​ALW is limited to individuals eligible for Medi-Cal, without a Medi-Cal share of cost, who require a nursing facility level of care and wish to live in a residential care setting or in publicly funded senior and/or disabled housing. ALW participants must have sufficient funds to pay 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.

The goals of the ALW are 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 for the Elderly (RCFE), an Adult Residential Care Facility (ARF), or subsidized public 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 ALW services to develop a program that will safely meet his/her care needs while continuing to reside in a RCFE, ARF, or public subsidized housing.

ALW Grievances

If you are an ALW participant and dissatisfied with your ALW facility, Care Coordination Agency (CCA), or the ALW services you receive, you may file an ALW grievance in the following ways:​

• Grievances regarding the quality or receipt of ALW services must be submitted to your CCA via email, mail, or telephone. Find your CCA's contact information.
  
• Grievances regarding the coordination of care by your CCA must be submitted to the Department of Health Care Services via email at: ALWGrievances@dhcs.ca.gov
• All other grievances not listed above must be submitted to the California Department of Social Services, which will direct your grievance to your local ombudsman. Grievances can be submitted via telephone at (844) LET-US-NO ((844) 538-8766), via email at letusno@dss.ca.gov, or online.
  

For more information about ALW grievances, please review the ALW Grievance Fact Sheet​.

Current Waiver

• ​ALW Approval Letter​
  
• 2024 - 2029 ALW​​​
  

​Approved ALW Amendments​​

• ALW Slot Expansion Amendment WY 1​ (Effective October 1, 2024​), CMS approved DHCS' amendment to the ALW to increase the waiver capacity for waiver year 1 of the 2024-2029 ALW.​
  
• ​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.
• ALW Slot Expansion Amendment​ (Effective January 1, 2024​)​, CMS approved DHCS' amendment to the ALW to add 1,800 slots to year 5 of the 2019-2024 ALW.
• Telehealth Amendme​​nt​​​ (Effective November 12, 2023​, this amendment adds telehealth as a permanent service delivery option for the following: Care Coordination, Augmented Plan of Care Development and Follow-Up, NF Transition Care Coordination.)
• ALW Slot Expansion Amendment​​ (Effective July 1, 2021, CMS approved DHCS' amendment to the ALW to add 7,000 slots to eliminate the current waitlist and expand waiver capacity.) ​
• ALW Policy Letter #24-002 ALW Slots and Waitlist Management​

• ​DHCS obtained approval for flexibilities accepted under the federal 1135 waiver authority which will expire January 7, 2026, for Los Angeles and Ventura Counties. The following flexibilities are available immediately. 
  
• Permit evacuating facilities (such as ICF-DDs, SNFs) to be fully reimbursed for services rendered to affected beneficiaries in alternative physical settings, such as temporary shelters or other care facilities. 
• Permit some services to continue to be provided without a requirement for a new or renewed prior authorization. 
• Temporarily allow services to be provided in settings that have not been determined to meet the HCBS Settings Rule criteria. 
• Temporarily extend the timeframe to reinstate services and benefits to an individual who files a fair hearing request.