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​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Assisted Living Waiver

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 project to test the efficacy of assisted living as a Medi-Cal benefit.​

ALW Amendment for Participant Slot Expansion

On January 7, the Centers for Medicare and Medicaid Services (CMS) approved DHCS' amendment to the ALW to add 7,000 slots to eliminate the current waitlist and expand waiver capacity. This amendment is retroactive to July 1, 2021. The purpose of the ALW is to keep eligible seniors and persons with disabilities in their communities and out of institutional care settings.

​On July 12, 2021, DHCS submitted Medi-Cal's Home and Community-Based Services (HCBS) Spending Plan authorized by Section 9817 of the American Rescue Plan Act (ARPA). ARPA includes an additional 10 percent Federal Medical Assistance Percentage (FMAP) on certain HCBS services, which can then be reinvested to expand and improve HCBS. CMS conditionally approved California's Spending Plan on January 4, 2022. DHCS intends to fund the ALW slot expansion through the enhanced FMAP available through ARPA.

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COVID-19 Hotspot Enrollment

On September 17, 2020, the Centers for Medicare and Medicaid Services (CMS) authorized California’s request to temporarily modify 1915(c) Waiver enrollment policy for the Assisted Living Waiver (ALW) to prioritize intake processing of waiver applicants residing in hospitals and skilled nursing facilities in areas of the state identified as “hotspots.” The temporary enrollment flexibility is available waiver-wide but only applies to individuals within counties with the highest rates of new COVID-19 infections. For more information on the Appendix K temporary authorization of prioritized enrollment of applicants in COVID-19 “hotspots,” please visit DHCS’ COVID-19 Information for Providers & Partners webpage.
 
​County​Designated COVID-19 "hotspot: as of ​Care Coordination Agency
​Alameda​12/01/2020
  1. ​Blossom Ridge
  2. NorCal Care
  3. Star Nursing
​Contra Costa​11/16/2020
  1. NorCal Care
  2. Rehab Services of CA
  3. Star Nursing
​Fresno​10/13/2020
  1. ​All Hours
  2. Libertana
  3. Star Nursing
​Kern​10/13/2020
  1. ​All Hours
  2. Star Nursing
​Los Angeles​10/27/2020
  1. ​A-Biz Health Systems
  2. Access TLC
  3. All Hours Adult Care
  4. Archangel Home Health
  5. Castro Hospice
  6. Concise Home Health
  7. Guidant Care Management
  8. Home Health Service of CA
  9. Huntington Home Care
  10. Huntington Hospital Senior Care
  11. Jewish Family Services
  12. Libertana
  13. Matrix Home Health
  14. Media Home Health
  15. Partners in Care
  16. Star Nursing
  17. Steward Hospice Care
  18. The Caring Connection
  19. True Care Home Health
  20. Universal Home Care
  21. Vigilans Home Health Services
​Orange​11/17/2020
  1. Access TLC
  2. All Hours Adult Care
  3. Castro Hospice
  4. Concise Home Health
  5. Home Health Service of CA
  6. Huntington Home Care
  7. Libertana
  8. Media Home Health
  9. Star Nursing
  10. The Caring Connection
  11. True Care Home Health
  12. Universal Home Care
  13. Vigilans Home Health Services
​Riverside​10/13/2020
  1. ​All Hours Adult Care
  2. Archangel Home Health
  3. Castro Hospice
  4. Home Health Service of CA
  5. Huntington Home Care
  6. Libertana
  7. Partners in Care
  8. Star Nursing
  9. Steward Hospice Care
  10. The Caring Connection
  11. Vigilans Home Health Services
​Sacramento​11/10/2020
  1. ​Blossom Ridge
  2. Guidant Care Management
  3. Elder Options
  4. HHCM
  5. NorCal Care
  6. Senior Care Solutions
  7. Star Nursing
​San Bernardino1​0/13/2020
  1. All Hours Adult Care
  2. Archangel Home Health
  3. Castro Hospice
  4. Concise Home Health Services
  5. Home Health Service of CA
  6. Libertana
  7. Media Home Health
  8. Partners in Care
  9. Star Nursing
  10. Steward Hospice Care
  11. Vigilans Home Health Services
​San Diego​11/10/2020
  1. All Hours Adult Care
  2. Huntington Home Care
  3. Institute on Aging
  4. Libertana Home Health
  5. Star Nursing
​San Francisco​12/15/2020
  1. ​NorCal Care
  2. Star Nursing
​San Joaquin​10/13/2020
  1. Guidant Care Management
  2. HHCM
  3. Infinity Care Services
  4. NorCal Care
  5. Star Nursing
​San Mateo​12/01/2020
  1. ​Institute on Aging
  2. NorCal Care
  3. Star Nursing
​Santa Clara​12/01/2020
  1. ​​Institute on Aging
  2. NorCal Care
  3. Star Nursing
​Sonoma
​10/13/2020​
  1. ​NorCal Care
  2. Star Nursing​
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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.  The current, five-year waiver term is approved for March 1, 2019 – February 28, 2024.

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 ALW 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 ALW 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.

Provider Enrollment Information

Provider Resources, Forms, and Memorandums ​

Assisted Living Waiver Current Enrollment

Current enrollment and waitlist information for the Assisted Living Waiver can be found on the enrollment dashboar​d​, which is updated monthly. New applicants to the ALW should be aware the number of available slots is limited and there is a waitlist. Open waiver slots are release to Care Coordination Agencies on a regular basis. Please contact the Care Coordination Agency of your choice for the information. A current listing of Care Coordination Agencies can be found here.

Additional Program Resources:

Last modified date: 3/22/2023 3:27 PM