The ALW pays for assisted living care in San Diego for Medi-Cal recipients — but the waitlist is long, and the mistakes families make in month one cost them a year.
By Diane Whitfield, CSA · August 06, 2026
Most San Diego families discover the Assisted Living Waiver the same way: they learn that regular Medi-Cal does not pay for assisted living, then someone mentions there's an exception. The exception is real. The Assisted Living Waiver (ALW) is a federal 1915(c) home- and community-based services waiver run by the California Department of Health Care Services. It exists so that people who would otherwise be placed in a nursing home can live in a Residential Care Facility for the Elderly (RCFE) or in publicly subsidized senior housing instead. San Diego is one of only 15 California counties where it operates, and the current waiver term runs March 1, 2024 through February 28, 2029.
The split matters more than anything else in this article: Medi-Cal pays the facility for care and services. The resident pays room and board out of their own income. In 2026, a participant whose only income is SSI at $1,626.07 per month pays $1,444.07 to the facility for room and board and keeps a $182 personal needs allowance. If the resident has income beyond SSI, the facility may charge an additional $20 per month, but only if that is written into the admission agreement (CDSS PIN 25-19-CCLD).
On the care side, DHCS pays participating facilities a per-diem rate set by assessed tier. For 2026 the maximum payable rates run from $95.69 per day at Tier 1 to $270.80 per day at Tier 5. Facilities cannot negotiate those rates or trim the service package — the services covered include personal care and help with activities of daily living, meals, housekeeping and laundry, medication assistance, intermittent skilled nursing, transportation coordination, and recreational and social services.
To enroll, a person must be 21 or older; have full-scope Medi-Cal with zero share of cost; have care needs equal to those of a Medi-Cal resident in a nursing facility; be willing and able to live safely in an assisted living setting instead of a nursing home; and be willing to live in one of the 15 participating counties, San Diego among them.
The gate that stops the most applications is the second one. Full-scope Medi-Cal with a zero share of cost is not the same as "having Medi-Cal." A share of cost is the amount a beneficiary must spend on medical care each month before Medi-Cal picks up the rest, and any share of cost above zero disqualifies an ALW applicant. If your parent has one, that is the problem to solve first, before anything else — often through a Medi-Cal redetermination, or by applying institutional rules. For married couples, spousal impoverishment protections apply when DHCS determines eligibility for ALW enrollment, which can change the math considerably. This is worth an hour with an elder law attorney or a benefits counselor; CANHR maintains a free lawyer referral service at canhr.org.
The level-of-care requirement is assessed, not self-declared. A contracted Care Coordination Agency uses a standardized assessment tool to determine whether the applicant needs nursing-facility-level care and which of the five tiers applies. Families who are unsure whether a parent qualifies often do, particularly where dementia, incontinence, transfer assistance, or multiple daily medication administrations are involved.
The ALW hit capacity in 2017 and has had a waitlist ever since. As of December 2025, roughly 14,847 people were enrolled statewide and about 18,365 were waiting. DHCS releases open slots to Care Coordination Agencies on a rolling monthly basis, with priority given to people currently institutionalized in a nursing facility.
Here is the practical part: you do not apply to DHCS. You contact a Care Coordination Agency (CCA) serving San Diego County and ask them to submit a one-page Waitlist Request Form on your behalf. It is free, it holds your place, and you do not need to have chosen a facility yet. Agencies currently serving San Diego include All Hours Adult Care at (844) 657-4748, Libertana Home Health Care at (800) 750-1444, A-Biz Health Systems at (818) 654-6874, GrandCare Assisted Living Services at (877) 405-6990, Star Nursing at (916) 542-1445, and The Caring Connection at (818) 368-5007. DHCS keeps the current list at dhcs.ca.gov, and the roster changes — verify before you call. The ALW program hotline is (916) 552-9322.
Three tips that save time. First, submit the form now even if a move is a year away; wait times are long and the list is the only way in. Second, when a slot is released you have a limited window to complete enrollment and secure a placement, so do your facility research while you wait, not after the call comes. Third, confirm any facility you are considering is on the DHCS list of approved ALW RCFEs — that list changes month to month, and a community that took waiver residents two years ago may not today. A facility is also allowed to decline an applicant, but once it admits someone, it must provide the necessary services and adapt as needs change.
County of San Diego Aging & Independence Services is the Area Agency on Aging and the right first call for anything long-term-care related: (800) 339-4661. If a parent is currently in a nursing facility and you are trying to move them out, ask about transition assistance — the ALW includes Nursing Facility Transition Care Coordination specifically for that path.
Before you commit to any RCFE, pull its licensing record yourself at ccld.dss.ca.gov. Citations, complaint investigations, and inspection reports are public, and a facility's willingness to take waiver residents says nothing about its compliance history. The San Diego County Long-Term Care Ombudsman, at (800) 640-4661, will also talk through a specific community with you at no cost.
If something goes wrong after enrollment, the complaint routing is split by subject. Problems with the services you're receiving go to your CCA. Problems with the CCA itself go to DHCS at [email protected]. Problems with the facility — care quality, safety, staffing, conditions — go to Community Care Licensing at (844) 538-8766 or [email protected]. Sending a complaint to the wrong office is the most common reason families feel ignored.
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