Medi-Cal Assisted Living Waiver in San Diego: Eligibility, Waitlist and Homes

For San Diego families with limited savings, the biggest question about senior care is often how to pay for it. Medi-Cal’s Assisted Living Waiver (ALW) is one of the few programs that helps cover care in a licensed assisted living community or board and care home instead of a nursing home. The assisted living waiver San Diego families hear about is real and valuable, but it comes with strict eligibility rules, a statewide waitlist and a limited number of participating homes.

This guide is a deep dive on the ALW only: who qualifies, what it pays for and what the resident still pays, how to apply through a Care Coordination Agency, how the waitlist and priority work, and how to find participating homes in San Diego County. For a broader overview of Medi-Cal rules, including income and asset limits, see our guide to Medi-Cal eligibility.

What Is the Medi-Cal Assisted Living Waiver?

The Medi-Cal Assisted Living Waiver is a California program run by the Department of Health Care Services (DHCS) that pays for care services in licensed assisted living settings for Medi-Cal members who would otherwise need a nursing home. It covers the care, not the rent: residents pay their own room and board.

The ALW is a federally approved Home and Community-Based Services (HCBS) waiver. Its purpose is to let people with nursing-home-level needs live in a more home-like community setting. According to DHCS, the current waiver term runs from March 1, 2024 through February 28, 2029.

ALW participants can live in:

• Residential Care Facilities for the Elderly (RCFEs), which include both large assisted living communities and small board and care homes
• Adult Residential Facilities (ARFs) for adults under 60
• Publicly subsidized housing, with services brought in by a home health agency

The program is available in 15 California counties, and San Diego County is one of them. That makes the assisted living waiver San Diego residents can access one of the most important tools for paying for residential senior care on a low income.

Assisted Living Waiver San Diego Eligibility: Who Qualifies?

To qualify for the assisted living waiver in San Diego, a person must be 21 or older, have full-scope Medi-Cal with no share of cost, need a nursing facility level of care, be able to live safely in an assisted living setting, and be willing to live in a participating setting in one of the ALW counties.

DHCS lists these eligibility requirements:

• Age 21 or older
• Full-scope Medi-Cal with zero share of cost. If your parent has a share of cost, they do not qualify until that is resolved.
• Nursing facility level of care. Care needs must be similar to Medi-Cal residents in nursing homes, such as needing hands-on help with several daily activities or significant supervision for dementia.
• Able to live safely in an assisted living facility or subsidized housing with services
• Willing to live in an ALW setting in a participating county

A practical requirement is often overlooked: the person needs enough monthly income to pay the home’s room and board, but low enough income to have no Medi-Cal share of cost. Many ALW residents receive SSI.

Medi-Cal’s financial rules also apply. In 2026, California reinstated an asset limit for most non-MAGI Medi-Cal programs, which cover older adults: $130,000 for a single person, plus $65,000 for each additional household member, with a primary residence generally exempt. Our article on Medi-Cal countable vs. exempt assets in 2026 explains what counts.

What Does the ALW Pay For, and What Does the Resident Pay?

The ALW pays the home for care services such as personal care, supervision, medication help, nursing oversight, care coordination and transportation to medical appointments. The resident pays room and board to the home each month, usually from SSI or other income, and keeps a small amount for personal needs.

Services the waiver can cover, according to DHCS and Justice in Aging, include:

• Care coordination by a Care Coordination Agency
• Assisted living services: personal care, help with bathing, dressing and toileting, and 24-hour supervision
• Medication help and nursing oversight
• Housekeeping, laundry and meals as part of the service plan
• Nursing facility transition coordination for people moving out of a nursing home
• Non-emergency transportation to medical appointments

What the resident pays:

• Room and board. For residents on SSI, this amount is set by the state and tied to the SSI/SSP board and care rate. For 2026, DHCS lists the SSI/SSP payment standard for an aged individual in a licensed board and care facility as $1,626.07 per month. The resident keeps a portion for personal and incidental needs, and the rest goes to the home.
• Personal items. Clothing, toiletries, phone and any extras not in the service plan.

For residents who do not receive SSI, room and board may be set by the provider, so ask the home in writing what it will charge and whether it can change.

How Do You Apply for the Assisted Living Waiver?

You apply for the assisted living waiver San Diego program by contacting a Care Coordination Agency (CCA) that serves San Diego County. The CCA screens your parent, schedules an in-person assessment, places them on the waitlist if no slot is open, and later builds a service plan and helps choose a participating home.

The application process step by step:

• Step 1: Confirm Medi-Cal status. Your parent needs full-scope Medi-Cal with no share of cost. If they are not yet enrolled, apply through San Diego County first.
• Step 2: Contact a Care Coordination Agency. DHCS publishes the list of CCAs by county on its ALW page. You may contact more than one to ask about their waitlist size.
• Step 3: Screening. The CCA asks about your parent’s needs, income and current living situation.
• Step 4: Assessment. A nurse or care coordinator assesses your parent in person to confirm nursing facility level of care.
• Step 5: Waitlist or enrollment. If no slot is available, your parent is placed on the waitlist. When a slot opens, enrollment proceeds.
• Step 6: Service plan and home selection. The CCA writes an individual service plan and helps you choose a participating RCFE or housing option.

Alzheimer’s San Diego notes that each CCA keeps its own waitlist and that some lists are shorter than others, which is a good reason to ask more than one agency.

How Long Is the ALW Waitlist and Who Gets Priority?

The Assisted Living Waiver has a limited number of slots and a statewide waitlist, so most applicants wait. DHCS releases open slots to CCAs on a regular basis and publishes enrollment and waitlist data on a monthly dashboard. Priority generally goes to people moving out of a nursing facility.

What to know about the wait:

• Demand exceeds supply. Justice in Aging reports roughly 18,000 people on the waitlist statewide, more than the number enrolled. Wait times vary and can be long.
• Priority groups. According to Justice in Aging, priority goes to people transitioning from a nursing facility, people referred by Adult Protective Services or the Long-Term Care Ombudsman, and people transferring from another waiver.
• Slot expansion. DHCS added slots through an amendment effective March 1, 2025, but the waitlist remains.

Because nursing facility residents get priority, some families find that the fastest route into an ALW-funded home is from a SNF after a hospital stay. Our guide to moving from skilled nursing to board and care covers that transition. Never move a parent into a nursing home only to gain priority without talking with a CCA, social worker or elder law attorney first.

Assisted Living Waiver San Diego Homes: Do Board and Care Homes Participate?

Some do, but many do not, whether the setting is a large community or a small senior care home or elder care home. Under the assisted living waiver, San Diego homes must first enroll as ALW providers and accept the waiver’s payment rates. In San Diego, participating settings include some larger assisted living communities and a smaller number of board and care homes, each a licensed home for elderly residents. Availability changes, so confirm directly with the CCA and each home.

Why participation is limited:

• Waiver payments plus SSI room and board are typically well below private-pay rates. Private-pay board and care homes in San Diego cost about $5,500 to $9,500 per month in 2026.
• ALW homes must meet extra program requirements, including resident rights such as a lease and community access.
• Small homes have few beds and often fill them with private-pay residents.

Questions to ask a home that says it accepts ALW:

• How many ALW residents do you have now, and do you have an open ALW bed?
• Will my parent have a private or shared room?
• What will the monthly room and board payment be?
• Are there any extra charges outside the service plan?
• What happens if my parent’s care needs increase?

Our main board and care homes in San Diego page and our assisted living in San Diego page explain the settings in more detail.

What Are the Alternatives While You Wait?

While waiting for an ALW slot, families in San Diego often combine other resources: In-Home Supportive Services (IHSS) for Medi-Cal members living at home, adult day health care, PACE programs, private pay for a period, VA benefits for veterans and surviving spouses, or a Medi-Cal nursing home if needs are high.

Options to explore:

• IHSS. San Diego County’s Aging and Independence Services runs In-Home Supportive Services for eligible Medi-Cal members who live at home. The AIS call center is 800-339-4661.
• PACE. Programs of All-Inclusive Care for the Elderly operate in parts of San Diego County and coordinate medical care, day center services and in-home help.
• VA Aid and Attendance. For wartime veterans and surviving spouses, the pension can help pay for board and care. Our veterans assisted living guide explains it.
• Medi-Cal managed care Community Supports. Some Medi-Cal health plans offer Community Supports related to transitions to assisted living. Ask your parent’s plan what is available.
• Private pay bridge. Some families pay privately for a period, then transition to Medi-Cal-funded care when savings run low.

Our guide to low-income senior care options in San Diego County covers each of these in more detail.

Common Mistakes to Avoid With the ALW

The most common assisted living waiver San Diego mistakes are waiting too long to apply, not fixing a Medi-Cal share of cost, assuming every assisted living or board and care home accepts the waiver, and not getting room and board terms in writing. Planning ahead avoids most of them.

• Applying late. Get on the waitlist as soon as your parent is likely to qualify.
• Ignoring share of cost. A share of cost blocks ALW eligibility. Ask a benefits counselor or elder law attorney how it can be addressed.
• Not tracking the application. Keep notes of who you spoke with at each CCA and when. Update the CCA if your parent’s address or needs change.
• Assuming acceptance. Confirm ALW participation and bed availability directly with each home.
• Skipping the agreement review. Read the admission agreement closely. Our guide to board and care admission agreements lists clauses to check.

For example, a daughter in Chula Vista caring for her mother at home might apply for the ALW while her mother still lives with her and receives IHSS, so that when her mother’s needs grow, she is already on the waitlist. This is an illustration, not a specific client story.

How Elder Answers Helps Medi-Cal Families

The assisted living waiver San Diego families rely on can be confusing, and finding a participating home with an open bed is harder still. Elder Answers has helped San Diego families for well over a decade, and our advisors personally visit the homes we recommend.

Our help is free to families, because homes pay us after move-in, and your rate does not change. We share information only with the homes you choose. Our guide to working with a placement agency when your parent has Medi-Cal explains what we can and cannot do for Medi-Cal families. Contact Elder Answers to talk with a local advisor.

Frequently Asked Questions About the Assisted Living Waiver San Diego Families Use

Is the Assisted Living Waiver available in San Diego County?

Yes. According to DHCS, San Diego is one of 15 California counties where the Assisted Living Waiver is offered. Participants must live in a participating setting in one of those counties.

Does the Assisted Living Waiver pay for room and board?

No. The ALW pays for care services. The resident pays room and board to the home, usually from SSI or other income. For SSI recipients, the room and board amount is set by the state based on the SSI/SSP board and care rate.

How long is the waitlist for the Assisted Living Waiver?

Wait times vary and can be long, because demand exceeds available slots statewide. DHCS publishes monthly enrollment and waitlist data. People moving out of nursing facilities generally receive priority, and each Care Coordination Agency keeps its own list.

Can my parent use the ALW in a small board and care home?

Yes, if the home is enrolled as an ALW provider and has an open bed. Many San Diego board and care homes do not participate because waiver rates are lower than private-pay rates, so confirm with the Care Coordination Agency and each home.

What if my parent has a Medi-Cal share of cost?

A share of cost makes a person ineligible for the ALW. Talk with a Medi-Cal benefits counselor or elder law attorney about whether the share of cost can be addressed before applying.

Does my parent need to be in a nursing home to qualify?

No. People living at home or elsewhere in the community can apply if they meet the nursing facility level of care and other requirements. However, people transitioning out of a nursing facility generally receive priority for open slots.

Who decides whether my parent meets the level of care?

The Care Coordination Agency assesses your parent in person to determine whether their needs match a nursing facility level of care. The assessment looks at help needed with daily activities, health conditions and cognition.

Can Elder Answers help us find an ALW home?

We can help you understand options and identify homes that may accept the waiver, and we work with families on Medi-Cal. Because ALW beds are limited, we also help families plan realistic alternatives while they wait.