If your parent qualifies for Medi-Cal, you may be able to place them in a licensed board and care home for little or no out-of-pocket cost. For many Bay Area families, this is a life-changing piece of information — but navigating the system to get there is genuinely complex.
This guide explains exactly how California's Medi-Cal board and care coverage works, who qualifies, and what the application process looks like step by step.
The bottom line upfront
What Is the Assisted Living Waiver?
The Assisted Living Waiver (ALW) is a California Medicaid program (administered by the Department of Health Care Services) that pays for residential care — room, board, and personal care assistance — in participating residential care facilities for the elderly (RCFEs).
Without the ALW, Medi-Cal only covers medical services. The ALW is what bridges the gap to cover the room and care portion that Medi-Cal normally doesn't pay.
Think of it this way: regular Medi-Cal might pay for your parent's doctor visits and medications. The ALW pays for the place where they live and the daily personal care they receive.
Who Qualifies for the ALW?
To qualify for the Assisted Living Waiver, a person must:
- 1.Be 21 years of age or older
- 2.Be eligible for Medi-Cal (income and asset limits apply)
- 3.Require nursing facility level of care (assessed by a doctor or DHCS)
- 4.Choose to live in a community setting rather than a skilled nursing facility
- 5.Reside in an ALW-participating county
The nursing facility level of care requirement sounds intimidating, but it simply means your loved one needs significant help with activities of daily living — bathing, dressing, mobility, medication management. Most seniors who are ready for board and care will meet this threshold.
Medi-Cal Income and Asset Limits (2025)
Medi-Cal eligibility for long-term care is complex and changes regularly. General thresholds for a single person in California:
- ›Monthly income limit: approximately $1,677 (Supplemental Security Income / SSI level). Income above this may require a spend-down.
- ›Asset limit: $130,000 in 2025 (California raised the asset limit significantly in recent years — many seniors who were previously ineligible may now qualify).
- ›Your home is generally not counted as an asset if you or a spouse lives there.
Important
Which Bay Area Counties Participate in the ALW?
The ALW program is available in most California counties, including all 9 Bay Area counties. However, participation by individual facilities varies — not every RCFE has enrolled in the program.
Based on our database, approximately one-third of Bay Area board and care homes accept Medi-Cal through the ALW or other programs. The best way to find participating homes is to ask directly or use our Medi-Cal search filter.
The Step-by-Step Application Process
- 1.Apply for Medi-Cal. If your parent isn't already enrolled, apply through BenefitsCal.com or your county social services office. The application can be submitted online, by mail, or in person. Processing takes 45 days (or 90 days if a disability is involved).
- 2.Get a Level of Care assessment. Once on Medi-Cal, contact your county's Home and Community Based Services (HCBS) coordinator to request an ALW functional assessment. A DHCS nurse or social worker will evaluate your loved one's care needs.
- 3.Get an ALW slot. If approved, your loved one is assigned to the ALW program. In some counties, there's a waitlist — starting early is critical.
- 4.Find a participating RCFE. Not all board and care homes are ALW-certified. You need to find one that is enrolled and has an available bed. Use our search tool to filter for Medi-Cal homes.
- 5.Complete the admission agreement. The home, the resident, and DHCS coordinate to finalize placement. The ALW then pays the facility directly for the residential care portion.
What the ALW Actually Pays For
The Assisted Living Waiver covers:
- ›Room and board (the base monthly fee)
- ›Personal care assistance (bathing, dressing, grooming, mobility)
- ›Medication management
- ›Basic supervision and safety monitoring
- ›Protective supervision for residents with cognitive impairment
What it does not cover:
- ›Incontinence supplies beyond a standard monthly allowance
- ›Telephone, cable, or internet
- ›Clothing, personal toiletries, and grooming supplies
- ›Transportation to non-medical appointments
- ›Any service not related to residential care
Medi-Cal continues to cover medical services separately — doctor visits, medications through the Part D benefit, hospitalizations, and medically necessary therapies.
What If There's a Waitlist?
In competitive counties like San Francisco, Alameda, and Santa Clara, ALW slots can have significant waitlists. Here's what to do while you wait:
- ›Apply early — don't wait until there's a crisis.
- ›Place your loved one in a care home while on the waitlist and self-pay in the interim.
- ›Ask the care home if they'll honor the ALW rate once you're approved — many will, especially if they like the resident and family.
- ›Work with a Medi-Cal planner who specializes in long-term care placements.
- ›Contact your county's HCBS coordinator every 60–90 days to keep your name active.
Other Medi-Cal Programs to Know About
CBAS (Community-Based Adult Services)
If your loved one attends an adult day health program, CBAS may cover that separately from the ALW. Some families use CBAS plus a board and care home to get comprehensive daytime programming plus safe overnight care.
MSSP (Multipurpose Senior Services Program)
MSSP provides intensive case management and services for Medi-Cal seniors at risk of nursing home placement. An MSSP case manager can be invaluable in navigating the ALW application.
Free help is available
Finding a Medi-Cal Board and Care Home Near You
Once you have (or expect to receive) an ALW slot, here are the highest-volume cities to search in our database: