If you already operate a licensed Residential Care Facility for the Elderly in California, you may be wondering whether the Assisted Living Waiver Program is a good fit. The program is designed to help eligible Medi-Cal beneficiaries remain in a community setting, such as a participating RCFE, as an alternative to long-term placement in a nursing facility.
This article is for existing facility owners and explains what official Department of Health Care Services (DHCS) materials say about becoming a participating provider. It is general information, not legal, enrollment, or billing advice. DHCS and the other agencies involved decide whether a facility may participate and whether any resident may enroll. Nothing here is a promise of approval, a slot, a tier, a claim payment, or a timeline.
What the program does and does not pay for
Official DHCS materials describe the waiver as a way for eligible seniors and people with disabilities to receive covered care services in a participating assisted living setting. Medi-Cal reimburses those waiver services. The resident is responsible for room and board. Joining the program does not mean Medi-Cal will pay the resident’s rent. You will still need a clear admission agreement and a practical way for the resident to pay room and board.
The program is available only in designated counties. A DHCS fact sheet effective January 1, 2024, listed Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma. County participation can change, so confirm the current list on the official DHCS Assisted Living Waiver pages before you invest time in an application.
Residents also have their own eligibility rules. Official materials state that eligible individuals must be enrolled in Medi-Cal and meet a nursing facility level of care because of their medical needs. People with a Medi-Cal share of cost may not be enrolled. Having Medi-Cal coverage is not the same thing as being enrolled in the waiver. Those decisions are handled through a Care Coordination Agency and DHCS, not by the facility alone.
You need an existing CDSS license
The official ALW Program and Medi-Cal Application Checklists start from the premise that you are already a licensed facility. The program checklist asks for a copy of the CDSS facility license and the last two CDSS facility licensing reports, along with a signed ALW Program Initial Provider Application and a signed ALW Program Provider Agreement. This is not a substitute for RCFE licensure. If you are still in the licensing process, finish that work first.
There are two related applications
DHCS publishes two checklists: one for the ALW program application and one for the Medi-Cal provider application. Both have to be complete before DHCS will review them, according to those checklists.
At a high level, the program checklist also asks for National Provider Identifier confirmation, a labeled facility floor plan, the admission agreement for waiver participants, a sample month of meals and snacks, a sample activity schedule, a list of staff training topics, an evacuation plan on CDSS form LIC 610E, and a signed Home and Community-Based Setting Characteristics Provider Attestation with supporting documents.
The Medi-Cal application checklist asks for a signed and notarized Medi-Cal Provider Application, Disclosure Statement, and Provider Agreement, plus business documentation such as proof of your federal taxpayer identification number, a city business license or a documented exemption, identification for each person listed on the forms, insurance documents, and, where applicable, Secretary of State and formation documents.
The same checklist lists an application fee, described as a cashier’s check or money order for $730.00 made payable to the Department of Health Care Services. It also says the fee amount is subject to change each year, so confirm the current amount on the official DHCS materials before you send payment. Use the current official checklists, not a copied summary, when you assemble a packet.
After enrollment, the compliance work continues
If DHCS approves your facility to participate, official claiming rules still apply. A September 2026 DHCS policy letter reminds providers that services must be billed appropriately, provided only to waiver participants, and documented in line with program requirements. Providers must confirm a participant’s enrollment before rendering services, using the Informing Notice sent by the Care Coordination Agency. Claims that do not meet program standards can be denied, and DHCS may recover overpayments.
The waiver also uses five tier levels to set the daily rate for Assisted Living services. The Care Coordination Agency completes the assessment, and DHCS makes the final determination. Your facility does not assign the tier. Some residents may later be considered for Residential Habilitation, a separate waiver service that requires prior approval from DHCS Nurse Evaluators.
How to approach the decision as an owner
These are practical planning tips, not DHCS rules. Read the official provider checklists and rate sheet yourself before you spend money on an application. Look honestly at your last licensing reports, staffing, admission agreement, and layout. Talk with a Care Coordination Agency that serves your county. Build a budget that separates waiver service rates from room-and-board income, and that does not assume a particular number of enrolled residents. Official documents do not promise a review or approval date. And protect resident privacy throughout: do not send names, diagnoses, Medi-Cal numbers, or other health information through ordinary email or a website contact form.
How RJ-RCFE Consulting can help
I am RJ Diaz, a California RCFE owner and operator in San Diego and a 21-year U.S. Navy veteran. RJ-RCFE Consulting is a Veteran-Owned business. I work remotely with licensed facilities across California, and I operate an Assisted Living Waiver Program-approved RCFE myself.
Assisted Living Waiver Program Consulting is $2,000 and is designed to help you understand the process and organize provider enrollment preparation. If a current waiver resident may need a Residential Habilitation package, package preparation is $1,000 per resident; your facility submits the completed package to your Care Coordination Agency, which submits it to DHCS. Ongoing ALWP Medi-Cal billing support is $199 per resident per month. None of these services can guarantee participation, resident enrollment, a tier, package approval, a claim, or a payment amount.
A 60-minute Zoom Strategy Consultation is $250. You can book a time here:
calendly.com/rjrcfeconsulting
Please do not send resident health information or personal identifiers through our contact form or ordinary email.