Medi-Cal's Assisted Living Waiver (ALW): How it Works
California's primary program for assisting with assisted living costs is the Medi-Cal Assisted Living Waiver (ALW). This waiver is not an entitlement, meaning availability is limited, and waitlists may exist. The ALW covers the services a resident receives, but individuals are responsible for their room and board costs. This allows eligible low-income seniors and people with disabilities requiring a nursing facility level of care to reside in community settings.
Program Expansion and Availability
Initially launched in 2009 in a few counties, the ALW has expanded but remains limited to 15 counties. While the program's capacity increased in 2022, applicants should still anticipate a potentially lengthy process involving coordination with a Care Coordination Agency (CCA).
Eligibility Requirements for the ALW
Strict criteria for age, medical need, and financial status must be met to qualify for the ALW. Eligibility requires being aged 65 or older or aged 21 or older with a qualifying disability, needing a level of care equivalent to a skilled nursing facility, and being able to live safely in a community setting. Financially, applicants must have full-scope Medi-Cal with zero share of cost and meet income limits. Although asset limits were eliminated as of 2024, residents must be able to pay for their room and board, possibly using SSI.
Covered Services vs. Excluded Costs
The ALW covers care services like assistance with daily living activities, medication management, and meals, but does not cover room, board, or personal expenses.
Other California Programs and Funding Alternatives
Other options for long-term care support in California include In-Home Supportive Services (IHSS), aspects of the CalAIM initiative through Medi-Cal Managed Care Plans, the PACE program, Veterans' Benefits, and private Long-Term Care Insurance.
Comparison of Assisted Living Funding Options
| Feature | Medi-Cal Assisted Living Waiver (ALW) | Veterans' Aid & Attendance | Private Long-Term Care Insurance |
|---|---|---|---|
| Payer | State of California (Medi-Cal) | Department of Veterans Affairs (VA) | Private Insurance Company |
| What it Covers | Care and services provided in the facility | Long-term care costs, including assisted living | Benefits depend on the specific policy |
| What it Excludes | Room and board portion of costs | N/A | Varies widely by policy |
| Eligibility | Low-income Medi-Cal beneficiaries needing nursing home level of care | Eligible veterans and their spouses | Based on insurance policy terms and premiums |
| Availability | Limited to 15 counties, with waitlists possible | All states, based on local VA offices | Based on private market availability and premium costs |
| Primary Goal | Defray costs for services to avoid institutionalization | Financial support for veterans' care needs | Comprehensive coverage for pre-planned LTC expenses |
Conclusion: State Assistance is Limited and Conditional
In summary, does the state of California pay for assisted living? The state provides limited, conditional assistance through the Medi-Cal Assisted Living Waiver (ALW), primarily covering care services for eligible low-income individuals meeting nursing home level of care criteria. However, residents are responsible for room and board costs. The ALW is a waiver program with capacity limits, is restricted to 15 counties, and may have waitlists.
Most residents rely on private funds, long-term care insurance, or veterans' benefits for assisted living costs. Even ALW recipients may need supplemental income, such as SSI, for room and board. Given these complexities, families exploring assisted living in California should thoroughly review all potential funding options.
