Two separate programs
Hospice and the Assisted Living Waiver
California's Assisted Living Waiver (ALW) is a Medi-Cal program that helps eligible people live in an assisted living home instead of a nursing facility. Hospice is comfort care near the end of life. They answer different questions, a person can have both at once, and neither one decides the other. Beta runs its ALW care coordination as a separate program with its own team and website.
Reviewed by Jack Demirchyan, Chief Operating Officer, September 24, 2026
On this page (5 sections)
How is hospice different from the Assisted Living Waiver?
Hospice is comfort-focused medical care for people with a serious illness when a doctor certifies a life expectancy of six months or less, paid by Medicare, Medi-Cal or private insurance. The Assisted Living Waiver is a Medi-Cal program that pays for care services in participating assisted living homes for adults who need a nursing-facility level of care. Neither one covers room and board.
| Hospice | Assisted Living Waiver | |
|---|---|---|
| What it is | Comfort-focused medical care from a nurse, doctor, aide, social worker and chaplain | Medi-Cal funded care services and care coordination in a participating assisted living home or public subsidized housing |
| Who it is for | People with a serious illness when a doctor certifies a life expectancy of six months or less if the illness runs its usual course | Adults 21 or older with full-scope Medi-Cal and no share of cost who need a nursing-facility level of care and can live safely in assisted living |
| Who pays | Medicare, Medi-Cal or private insurance | Medi-Cal |
| Room and board | Not covered | Not covered. The resident pays room and board from their own income |
| Where | Wherever the person lives | Participating facilities in 15 California counties, including San Bernardino, Riverside, Los Angeles and Orange. Ventura County is not a waiver county |
| Waiting | Care can usually start soon after eligibility is confirmed | Enrollment is limited and there is a waitlist |
| Who runs it at Beta | Beta Hospice, this website | Beta's Care Coordination Agency, on its own website, alwbeta.com |
Program rules change. The Department of Health Care Services page in the sources below is the authority on the waiver.
Can someone have both?
Yes. A person enrolled in the Assisted Living Waiver can choose hospice when the time comes, and it can work well. It is not automatic. The hospice leads the plan of care for the terminal illness. The waiver's care coordination agency keeps its own assessments and service plan. The facility keeps its licensed responsibilities and must hold a hospice care waiver from the state to keep a resident on hospice. The three need to agree, for this person, who supplies which medicines and equipment and who is called first when something changes.
Being on hospice does not make someone eligible for the waiver, and being on the waiver does not make someone eligible for hospice. Each program has its own rules and its own review.
When is the Assisted Living Waiver worth asking about?
The Assisted Living Waiver is worth asking about when assisted living costs are the worry, when it is not time for hospice but home is no longer safe, when someone is leaving a nursing facility, or after someone has left hospice.
Assisted living costs are the worry
The person has Medi-Cal, needs a lot of daily help, and the family cannot keep paying privately. The waiver can pay for care services, though not room and board.
It is not time for hospice
The person is not near the end of life but can no longer manage safely at home, and a nursing facility is the only other option on the table.
Leaving a nursing facility
The person is in a nursing facility, has Medi-Cal, and could live in assisted living with support. The waiver gives priority to people leaving institutions.
After hospice
The person stabilized and left hospice, and still needs a nursing-facility level of daily help.
Where to go next
For the waiver, Beta's ALW website explains who qualifies for the Assisted Living Waiver (opens in a new tab), how to apply for the waiver, step by step (opens in a new tab) and what the waiver pays and what residents pay for room and board (opens in a new tab).
For hospice in an assisted living home: families can read hospice in assisted living and paying for care. Facility staff can read hospice for assisted living and RCFE residents.
Common questions
Does hospice pay for assisted living?
No. Hospice covers the hospice care itself. Room and board in assisted living stays the resident's responsibility, with or without hospice and with or without the waiver.
Is the hospice care waiver the same as the Assisted Living Waiver?
No. The names are confusing. A hospice care waiver is a state permission that lets a licensed assisted living home keep a resident who is on hospice. The Assisted Living Waiver is a Medi-Cal program that pays for care services for eligible residents.
If I am on the waiver and choose hospice, do I lose my waiver services?
Electing hospice does not end waiver care coordination. Which services continue under which program is worked out for each person by the hospice, the care coordination agency and the facility. Beta's Assisted Living Waiver care coordination and hospice services are distinct programs: eligibility, services and payment are evaluated separately, so contact the relevant program to discuss your needs.
Can the hospice team help me apply for the waiver?
No. The hospice team can point you to Beta's ALW team, who handle waiver questions on their own website, alwbeta.com. The two teams coordinate when a person is served by both.
About this page
- Written by
- Beta Hospice care team
- Reviewed by
- Jack Demirchyan, Chief Operating Officer
- Last reviewed
- September 24, 2026
- Next review
- September 24, 2027
How we write and review this site
Sources
- DHCS: Assisted Living Waiver (opens in a new tab)
- Medicare.gov: Hospice care coverage (opens in a new tab)
- DHCS: Medi-Cal hospice care (opens in a new tab)
These sources support the general information on this page. For one personās care and coverage, talk with the hospice team.
You do not have to decide alone.
Call (877) 258-7129 any time, or leave your number and someone from Beta's hospice team will call you. No decision is needed to call. Most families start with a question.
Only a hospice doctor, together with the personās own doctor, can confirm hospice eligibility. A website cannot.
- A nurse answers 24 hours a day, 7 days a week
- You can stop hospice at any time
- You have the right to choose your hospice