The Medi-Cal Assisted Living Waiver in Los Angeles County

Medi-Cal does not normally pay for assisted living. California Advocates for Nursing Home Reform (CANHR), a nonprofit that publishes consumer fact sheets on long-term care, explains that the Assisted Living Waiver is the exception. Under it, Medi-Cal pays for eligible people who need a nursing home level of care to live in a participating residential care home or in publicly subsidized housing.

The program is run by the California Department of Health Care Services (DHCS). According to CANHR, it began in 2006 in Los Angeles, Sacramento and San Joaquin counties, became a federal waiver program in 2009, and is renewed by the federal government five years at a time. The current approval runs from March 1, 2024 through February 28, 2029.

Program rules, counties and waitlist practice can change. Everything in this guide reflects CANHR's fact sheet as we read it in October 2026. Confirm the current rules with DHCS or a Care Coordination Agency before you rely on them.

Yes. As of October 2026, CANHR lists 15 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.

Being in a participating county is not the same as finding an opening. CANHR notes that the list of participating homes changes from month to month, and that a home is allowed to turn down a waiver participant. Once a home admits someone, it must provide the services that person needs and adjust them as needs change.

DHCS publishes the list of participating facilities. Any home on it is still a state-licensed home, so it is worth reading its record first. Our guide on how to check an RCFE license shows how.

CANHR's fact sheet gives three requirements as of October 2026:

• Full-scope Medi-Cal with no share of cost.
• A need for a nursing facility level of care. A Care Coordination Agency decides this with a standardized assessment tool.
• Age 21 or older.

The level of care requirement is the heart of the program. The waiver is meant for people who would otherwise be in a nursing home, so a person who only needs light help may not meet it.

This guide does not cover Medi-Cal's income or asset rules. Whether your parent qualifies is a question for the county Medi-Cal office, DHCS or an elder law attorney. A placement agency cannot decide it.

CANHR adds that a person living in another county may still receive waiver services if he or she is otherwise qualified, is willing to move to a participating county and works with an enrolled Care Coordination Agency.

CANHR puts it in one line: participants pay for their room and board, and Medi-Cal pays for their care and services. The covered services it lists include an individual care plan, personal care and help with daily activities, meals and snacks, housekeeping and laundry, help with self-administered medications, intermittent skilled nursing care, transportation, and recreational activities. Care coordination is covered too, including help moving from a nursing home back to the community.

Room and board comes from the resident's own income. CANHR gives a 2026 example: for a participant whose monthly SSI income is $1,626.07, the room and board rate is $1,444.07. Its fact sheet says residents use their income to pay the home each month, apart from a personal needs allowance.

Medi-Cal pays the home a daily rate for care, set by the participant's assessed level. CANHR notes that homes cannot negotiate the services or the payment rate. For how private-pay pricing works by comparison, see our guide to board and care costs in California.

You do not apply at a care home. Enrollment runs through Care Coordination Agencies that contract with the state.

1. 1

   Confirm Medi-Cal first

   The waiver requires full-scope Medi-Cal with no share of cost. If your relative is not on Medi-Cal yet, start with the county Medi-Cal office.

2. 2

   Contact a Care Coordination Agency that serves your county

   DHCS publishes the list of approved agencies. CANHR's fact sheet says this is how the application process begins.

3. 3

   Ask to be placed on the waitlist

   CANHR reports that the program reached capacity in 2017 and DHCS started a waitlist. You complete a one-page Waitlist Request Form through the agency.

4. 4

   Wait for a slot and an assessment

   Open slots are released to the agencies on a monthly basis. The agency assesses the level of care, writes an individual service plan and tells you which participating homes have openings. You choose the home.

Hamssa Benrekia is a senior living placement specialist in Torrance. She does not enroll anyone in the waiver or decide Medi-Cal eligibility: that work belongs to the Care Coordination Agencies and the state. She can talk through your relative's care needs and monthly budget and which kinds of homes may fit, including a board and care home, and she has coordinated with case workers and social workers when a relative was leaving a hospital or skilled nursing facility. To talk it through, contact Hamssa.