What the Assisted Living Waiver is
The Assisted Living Waiver, or ALW, is a Medi-Cal program. It helps people who need nursing home level care get that care in assisted living instead. The goal is simple: keep people out of a nursing home when a care home can safely meet their needs.
Good news for local families: Fresno County is one of the 15 California counties where the ALW is offered. Others include Kern, Sacramento, San Joaquin and Los Angeles.
What it pays, and what it does not
The ALW pays for care services. That includes help with bathing, dressing, medications and other personal care, plus care coordination. Medi-Cal pays the home directly, at a daily rate based on how much care your parent needs.
The ALW does not pay for room and board. Your parent pays that part, usually from Social Security or SSI. For 2026, when a resident's SSI income is $1,626.07 a month, the room and board rate is $1,444.07, according to California Advocates for Nursing Home Reform (CANHR). The small amount left over is for personal needs.
Who qualifies
- Age 21 or older
- Full-scope Medi-Cal with zero share of cost
- Care needs equal to someone on Medi-Cal in a nursing home
- Willing and able to live safely in assisted living
- Enough income to pay room and board
"Nursing home level of care" is a real bar. Your mom would need a lot of daily help, not just reminders. A care coordinator does an assessment to decide.
The 2026 Medi-Cal asset limit
On January 1, 2026, California brought back an asset limit for Medi-Cal for older adults. The limit is $130,000 for one person and $195,000 for a couple, plus $65,000 for each added household member. The home your parent lives in is not counted.
A look-back on transfers also started for long-term care Medi-Cal. Transfers made in 2024 and 2025 are not included, but gifts made on or after January 1, 2026, can be reviewed. Talk with an elder law attorney before moving money. CANHR's 2026 asset limit FAQ is a good plain language source.
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The waitlist: the honest truth
The ALW has a limited number of slots, and there is a waitlist. The state says so on its own ALW page. Open slots are released to care coordination agencies over time, and some new slots have gone first to people moving out of nursing homes.
What this means for you: get on the list early, and have a plan for the months in between. If your dad is at home, that may mean family help or in-home care. If he is in a nursing home now, ask the social worker about the ALW right away.
Not every home takes the ALW
Only care homes that enroll in the program can accept ALW residents, and many have just a few ALW spots. The state lists participating facilities on the DHCS website. Some are larger assisted living communities. Many are small board and care homes.
How to apply in Fresno County
- Make sure your parent has full-scope Medi-Cal with no share of cost. If not, apply through the Fresno County Department of Social Services.
- Pick a Care Coordination Agency that serves Fresno County. DHCS keeps the list of approved agencies.
- The agency assesses your parent, adds them to the waitlist, and helps with the move when a slot opens.
- Choose a participating home. The DHCS ALW page has the program details.
Other options while you wait
- In-Home Supportive Services (IHSS). This Medi-Cal program can pay a caregiver, even a family member, to help at home.
- CBAS adult day health care. Medi-Cal can cover a day program with nursing and therapy. See our adult day care page.
- VA benefits. Wartime veterans and surviving spouses may qualify for Aid and Attendance.
- Private pay for a while. Some families use savings or a home sale to pay privately, then apply for Medi-Cal later. Get legal advice first.
How we help Medi-Cal families
We work with Medi-Cal families too, and our help is free. Families pay us nothing. The licensed homes we work with pay us a referral fee. We will be honest about which homes can take an ALW resident, what the wait may look like, and what private pay costs in the meantime. Assisted living in Fresno runs about $5,100 to $6,600 a month privately, and board and care starts around $3,700.
Call or text (559) 550-4533, 8am to 8pm every day. Our paying for senior care guide covers the other ways families pay.
Updated September 2026 by Shaun and Nick, co-founders of CalValley Senior Living Advisors.