Understanding the Changes Between Health Net, CalAIM, and the Assisted Living Waiver (ALW) in Los Angeles County: What Providers, Families, and Seniors Need to Know in 2026
California's long-term care system continues to evolve, and nowhere are the changes more noticeable than in Los Angeles County. Assisted living providers, hospitals, discharge planners, care coordinators, and families are navigating significant updates involving Health Net Medi-Cal, CalAIM Community Supports, and the Assisted Living Waiver (ALW) program.
Although these programs share the common goal of helping seniors remain in community-based settings rather than nursing homes, they are not interchangeable. Recent policy updates have created new requirements that providers must understand to ensure successful placements and continued reimbursement.
The Goal Remains the Same: Keep Seniors Out of Nursing Homes
California's Department of Health Care Services (DHCS) continues expanding its California Advancing and Innovating Medi-Cal (CalAIM) initiative, designed to shift healthcare away from institutional care and toward coordinated, community-based services.
The Assisted Living Waiver (ALW) has become one of the state's most important tools for accomplishing that mission by allowing eligible Medi-Cal beneficiaries who meet a nursing facility level of care to receive services in participating assisted living communities instead of remaining in skilled nursing facilities. The waiver is currently authorized through February 2029 and continues to operate in 15 California counties, including Los Angeles.
Understanding the Difference Between ALW and CalAIM
One of the biggest misconceptions is that ALW and CalAIM are the same program.
They are not.
Assisted Living Waiver (ALW)
The ALW is a Home and Community-Based Services (HCBS) waiver administered by DHCS. It is specifically intended for individuals who:
Qualify for full-scope Medi-Cal
Require a nursing facility level of care
Can safely reside in an approved assisted living setting
Live in or are willing to relocate to a county where ALW operates
Under the waiver:
Medi-Cal pays for the care services.
The resident pays room and board.
Services are delivered only through DHCS-approved ALW facilities and participating providers.
CalAIM Community Supports
CalAIM Community Supports are optional services offered through Medi-Cal managed care plans such as Health Net.
Community Supports include services like:
Housing transition assistance
Recuperative care
Home modifications
Meals
Nursing Facility Transition/Diversion services
Assisted Living Facility Transition services
Unlike ALW, these services are managed through the individual's health plan and vary by county and participating health plan. Health Net currently offers multiple Community Supports to eligible Medi-Cal members.
