California’s Assisted Living Waiver vs. CalAIM: What’s Changed — and How They’re Different
What Is the Assisted Living Waiver (ALW)?
The Assisted Living Waiver is a specific Medi-Cal waiver program that helps eligible adults receive assisted living services in licensed facilities such as Residential Care Facilities for the Elderly (RCFEs) or Adult Residential Facilities (ARFs) instead of institutional care. It was created under a Home and Community-Based Services (HCBS) waiver authority and renewed for a five-year term through February 28, 2029.
Key Features
Who it serves: Adults 21+ (including seniors), with full-scope Medi-Cal and a nursing facility-level of care, who choose assisted living over a nursing home.
Where it’s available: Only in about 15 California counties, including Los Angeles, Orange, San Diego, Sacramento, and others.
What it covers: Medi-Cal pays for care services (personal care, homemaker, home health aide, care coordination, etc.), but does not pay for “room and board” — residents must cover that cost (often using SSI/SSP).
Capacity limits: There are a capped number of slots and typically waitlists — meaning not everyone who qualifies can get a space immediately.
Program improvements: Expansion of slots and telehealth delivery options are part of ongoing amendments, and reimbursement rates will increase starting Jan. 1, 2026, tied in part to state minimum wage changes.
Recent Law Affecting ALW Participants
In 2025, California lawmakers advanced Senate Bill 433, aimed at protecting consumers in ALW (and related assisted-living settings) from unreasonable room-and-board increases. The bill would establish income-based caps on what facilities can charge help prevent displacement and ensure participants retain a personal needs allowance. It also cross-references CalAIM’s assisted-living transition supports to align protections.
This reflects an important focus on financial security and stability for seniors participating in long-term care programs.
What Is CalAIM?
CalAIM (California Advancing and Innovating Medi-Cal) is not a single benefit but a broad Medi-Cal reform initiative designed to transform how California provides coordinated, whole-person care through managed care plans (MCPs). It includes Enhanced Care Management (ECM) and 14 Community Supports (sometimes called In-Lieu-Of Services).
Role in Assisted Living Support
Under CalAIM, certain Community Supports aim to help Medi-Cal members transition into assisted living or avoid nursing home placement:
Nursing Facility Transition/Diversion to Assisted Living Facilities: A Community Support that helps eligible people move from a nursing facility to an assisted living setting, or avoid nursing facility placement altogether.
This support is part of a managed care plan’s offerings, so it varies by county and plan, and participation is not guaranteed statewide. It’s plan-elected, not entitlement-based like a federally approved waiver.
Key Differences: Assisted Living Waiver vs. CalAIM
Here’s a side-by-side comparison of what makes ALW and CalAIM’s assisted-living supports distinct:
Program Type
Assisted Living Waiver (ALW): A 1915(c HCBS waiver with defined funding from federal Medicaid.
CalAIM Community Supports: State + managed care initiative; part of Medi-Cal managed care plans’ optional services.
Availability
ALW: Only in specific counties and limited by number of slots (waitlists possible).
CalAIM supports: Potentially available wherever a managed care plan chooses to offer them — but not all plans/counties offer every support.
Service Scope
ALW: Primarily ongoing assisted living care with defined service tiers and care coordination.
CalAIM: Supports transitions (like moving from a nursing facility to assisted living) and one-time or supplemental services (e.g., housing setup, environmental modifications).
Participant Costs
Both: Participants are responsible for room and board; Medi-Cal does not cover room and board in either program.
Financial protections: Recent policy efforts (like SB 433) seek to cap these charges for waiver and CalAIM transition participants.
Care Coordination
ALW: Enrollment includes care coordination via Care Coordination Agencies.
CalAIM: Managed care plans provide Enhanced Care Management and Community Supports, which coordinate services across transitions and community supports.
Why This Matters for Seniors
Understanding your options can make a huge difference:
ALW may offer more structured, long-term assisted living support but is limited by geography and slot availability.
CalAIM support may help you transition into assisted living without a lengthy waitlist, but offerings depend on your Managed Care Plan and county.
Recent laws like SB 433 aim to protect older adults’ financial well-being by capping room and board, a key out-of-pocket cost.
Tips for Seniors & Caregivers
Check your county and MCP’s CalAIM elections — not all plans offer the same Community Supports.
Contact a Care Coordination Agency early if interested in ALW — waiting lists can be long.
Review SB 433 progress and related protections with your provider or legal advisor to understand financial limits that may affect your care setting.
Plan ahead for room and board costs — neither Medi-Cal program pays these directly.
Final Thought
California’s long-term care landscape is changing — with dual pathways like the Assisted Living Waiver’s structured care and CalAIM’s flexible, managed care-driven supports. Knowing the difference and how they complement each other can help seniors and their families make the best care decisions.
Would you like a step-by-step guide to applying for the Assisted Living Waiver or checking CalAIM supports in your county? I can help with that next.
For further assistance in seeing if you qualify for the Assisted Living Waiver(ALW) program or CalAIM, please reach out to our contact page and we will guide you to an agency for a free consultation to seek qualification. Always happy to help.
