18,365 Californians are on the waiting list for a Medi-Cal benefit built for exactly this kind of care — and the slots exist. They’re just held back by budget rules.
18,365 People Are Waiting for a Program That Could Keep Them Out of a Nursing Home. Orange County Is One of Only 15 Counties Where It Exists.
On August 12, the Senate Budget and Fiscal Review Subcommittee No. 3 published a hearing agenda with a number that has not appeared in any AHVA article, any competitor’s blog, or, as far as we can find, any Orange County news coverage: as of December 2025, California’s Assisted Living Waiver had a waitlist of 18,365 people. A companion program, the Home- and Community-Based Alternatives Waiver, had 6,091 more waiting. The agenda’s own words for why: the slots exist, but they’re “held back in service of cost neutrality requirements.”
That is a strange thing to sit with. This isn’t a program that ran out of money to build capacity. It’s a program with room, sitting empty on paper, while more than 18,000 people who qualify for it wait. And Orange County is one of only fifteen counties in the entire state where the Assisted Living Waiver (ALW) is even offered.
What the Assisted Living Waiver Actually Covers
The ALW is a Medi-Cal 1915(c) home- and community-based services waiver, which is bureaucratic language for a fairly simple idea: instead of paying for a nursing home, Medi-Cal pays for a similar level of hands-on care inside a licensed residential care facility for the elderly (RCFE) or publicly subsidized senior housing. It’s built for people who need nursing-facility-level care but don’t need to be in an actual nursing facility to get it safely.
To qualify, an applicant must be 21 or older, have full-scope Medi-Cal with no share of cost, meet a nursing facility level of care determination, and be willing and able to live safely in an assisted living or subsidized housing setting. Once enrolled, the waiver pays for care coordination, help transitioning out of a nursing facility if that’s where someone is coming from, personal care and 24-hour protective supervision, homemaker and laundry services, meals, licensed nursing staff, and transportation to medical appointments.
Checking waitlist status, confirming Medi-Cal eligibility, and asking your county’s waiver agency the right questions all start with a phone call — before a crisis, not after.
What it doesn’t cover is room and board. That part still comes out of the participant’s own income. If someone receives Supplemental Security Income, the room-and-board rate they pay is set annually by the state. If they don’t receive SSI, the facility itself sets that rate, and the state’s own budget agenda notes it “can be adjusted at any time, potentially leading to eviction.” That gap is one of several the Be Home Soon proposal specifically tries to close, which we’ll get to below.
| What the ALW Pays For | What Families Still Pay |
|---|---|
| 24-hour care and supervision in a licensed assisted living facility | Room and board at the facility (set by CDSS for SSI recipients, by the facility for everyone else) |
| Care coordination and nursing facility transition support | Any services outside the approved care plan |
| Personal care, protective supervision, and behavioral support plans | Costs incurred during the waitlist period, if care is needed before a slot opens |
| Licensed nursing staff, meals, and transportation to medical appointments | Facility-set rate increases for non-SSI participants, which can happen at any time |
Why the Waitlist Exists When the Slots Don’t Have To
Every state Medicaid waiver operates under a federal rule called cost neutrality: the average cost of serving people in the waiver can’t exceed what it would have cost to serve the same group in an institution. California has interpreted that rule, in practice, as a hard enrollment cap on the ALW and the HCBA Waiver. New applicants go on a waitlist not because the state lacks money to serve them today, but because letting more people in at once could tip the average cost calculation.
The August 12 hearing agenda is blunt about the result: 18,365 people waiting for ALW, 6,091 for HCBA, “despite waiver slots being available but held back.” For a family in Anaheim or Mission Viejo trying to keep a parent out of a nursing home, that’s small comfort. The eligibility is real, the need is real, and the wait is real too.
Be Home Soon California: The Proposed Fix, Still Held Open
The same hearing considered a Legislature-backed package called Be Home Soon California, which would restructure the ALW, HCBA Waiver, and Multipurpose Senior Services Program into a different kind of federal waiver authority — a 1915(i) benefit — specifically to eliminate the enrollment caps and the waitlists that come with them. The proposal’s own estimate is that it would save the state $625.7 million a year in General Fund costs once fully phased in, by keeping roughly 15,000 more people a year out of skilled nursing facilities and hospitals in the first place.
Other Pieces of the Be Home Soon Proposal That Would Affect ALW Directly
- Room and board rate protection for ALW participants, addressing the “can be adjusted at any time” gap noted above
- Raising the income limit used to determine Medi-Cal share of cost to 138% of the federal poverty level, so families qualify for stabilizing care before a crisis forces institutionalization
- Presumptive Medi-Cal eligibility, so waiver agencies could start provisional services immediately instead of waiting on a full eligibility determination
- Incentive payments to Medi-Cal managed care plans for successfully transitioning members out of institutional care and into settings like ALW
None of this is law. The subcommittee’s own recommendation on August 12 was “Hold Open,” which in budget-process terms means exactly what it sounds like: still being negotiated, no funding locked in, no effective date. It also isn’t the first time California has floated waiver reform only to have it stall in budget negotiations, so families shouldn’t plan around a repeal of the waitlist happening on any particular timeline. We’ll be tracking this through the rest of the 2026 legislative session and will update this article if the subcommittee reconvenes on it.
Why This Lands Differently in Orange County
The ALW is available in exactly fifteen California counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma. That’s a little over a quarter of the state’s 58 counties. If you live in Orange County, the waiver is at least an option on the table — which is not true for a Medi-Cal member in, say, Ventura or San Luis Obispo County, where it isn’t offered at all. That makes the waitlist news cut two ways locally: frustrating, because the wait is real, but also worth knowing about precisely because so few California families have access to this benefit in the first place.
Getting your name on the ALW waitlist doesn’t cost anything and doesn’t lock you into anything — it just starts the clock while you sort out care in the meantime.
If cost is part of your family’s care planning right now, our honest pricing guide to home care in Orange County breaks down what private-pay and Medi-Cal-funded options actually run. And if a parent or spouse doesn’t yet have a Medi-Cal-funded personal care benefit in place, it’s worth reading how CalAIM’s in-home personal care benefit works alongside programs like the ALW, since the two are not mutually exclusive.
What to Do While You’re on the Waitlist
An 18,365-person statewide waitlist doesn’t mean a family has to do nothing until a slot opens. A few things are worth doing in parallel, not instead of applying for ALW:
Options That Can Run Alongside an ALW Application
- In-Home Supportive Services (IHSS). IHSS isn’t capped the way ALW is, and it can fund personal care hours in a family’s own home while an ALW application sits on the waitlist. Our coverage of the federal IHSS funding freeze covers where that program currently stands.
- Community-Based Adult Services (CBAS). Orange County has dozens of licensed adult day health centers offering this related Medi-Cal benefit, which provides daytime nursing, therapy, and social support so a family caregiver can keep working while a loved one stays out of a facility.
- Private-pay assisted living or board and care, as a bridge. Not every family can absorb this cost, but for some, a shorter private-pay stretch while the ALW application processes is more workable than waiting at home without enough support.
- Ask your waiver agency for your position and estimated timeline. The wait isn’t published per-applicant, but the local agency administering ALW enrollment for Orange County can tell you where a specific application stands.
ALW Waitlist Action Checklist
Click each item as you complete it.
- Confirm your family member has full-scope Medi-Cal with no share of cost — this is required before an ALW application can even be submitted
- Request a nursing facility level of care determination if one hasn’t been completed yet, since ALW eligibility depends on it
- Submit the ALW application even if you expect a wait — the waitlist clock starts at application, not at a later “convenient” date
- Ask the waiver agency directly where your application stands and what the estimated wait looks like right now
- Apply for IHSS in parallel if your family member isn’t already receiving it — it isn’t capped like ALW and can help bridge the wait
- Ask about CBAS adult day health centers near you as a daytime-support option while waiting
- If considering a residential care facility now, ask upfront whether the room-and-board rate can change and how much notice you’d get
- Keep a copy of your application date and any correspondence — if Be Home Soon California passes, this paperwork may matter for transition planning
- Track the Senate Budget Subcommittee No. 3 hearing schedule if you want to follow whether Be Home Soon California moves out of “Hold Open” status
- Talk to a home care agency about bridging support at home while an ALW or IHSS application processes
Test What You Know
1. As of December 2025, how many people were on California’s Assisted Living Waiver waitlist?
2. Why does the ALW waitlist exist, according to the state’s own budget agenda?
3. In how many California counties is the Assisted Living Waiver offered?
4. What does the ALW NOT pay for?
5. As of the August 12, 2026 hearing, what is the status of the Be Home Soon California proposal to eliminate the ALW waitlist?
Frequently Asked Questions
The One Thing to Take From This
The Assisted Living Waiver is one of the few Medi-Cal benefits built specifically to keep someone out of a nursing home while covering real, 24-hour care — and Orange County is lucky, relatively speaking, to be one of just fifteen counties where it exists at all. But 18,365 people are proof that access on paper and access in practice are two different things right now. Applying doesn’t cost anything, the wait doesn’t disqualify anyone from other Medi-Cal-funded support in the meantime, and the state itself is actively negotiating a fix. None of that shortens the wait today, but none of it is a reason to stay off the list either.
Waiting on a Waiver Shouldn’t Mean Waiting on Care
Whether your family is on the ALW waitlist, weighing IHSS, or just trying to figure out what’s actually available in Orange County right now, we’re happy to walk through the options with you at no cost or obligation.
This article is provided for general informational purposes and reflects publicly available California Senate Budget and Fiscal Review Subcommittee No. 3 hearing documents published August 12, 2026, along with public program information from the California Department of Health Care Services. It is not legal, medical, or eligibility advice. The Be Home Soon California proposal discussed in this article had not been enacted as of publication and its final terms, funding, or effective date could change or fail to advance. Waitlist figures reflect a statewide snapshot as of December 2025 and may not reflect current conditions. This article is not a substitute for guidance from the Department of Health Care Services, your county’s ALW waiver agency, or a qualified benefits counselor. At Home VA Staffing does not administer Medi-Cal waiver enrollment or determine eligibility.
