Hospice and the Assisted Living Waiver

How the two programs differ

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 the waiver is worth asking about

Where to go next

For the waiver: alwbeta.com (opens in a new tab) covers eligibility, the waitlist, costs, participating facilities and how to ask for an assessment. Until that site is live, the sections below carry the same information and the ALW team's contact details.

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.

Who the waiver is for

The Department of Health Care Services (DHCS) sets the rules. In general, a person can be considered for the waiver when all of these are true:

• They are 21 or older.
• They have full-scope Medi-Cal with no share of cost, or will have it by the time services start.
• An assessment finds they need a nursing-facility level of care.
• They can live safely in a participating assisted living home or in public subsidized housing with waiver services.
• They live, or will live, in one of the 15 waiver counties. San Bernardino, Riverside, Los Angeles and Orange counties are waiver counties. Ventura County is not.

How enrollment works

Enrollment is limited by the state and most people start on the waitlist. These are the usual steps.

1. Step 1

   Waitlist request

   A DHCS waitlist request form is completed and submitted. DHCS gives priority to people leaving a nursing facility or hospital and to referrals from Adult Protective Services or the Long-Term Care Ombudsman. Others wait in the community tier, which can take years.

2. Step 2

   Slot release

   When DHCS releases a slot, the care coordination agency contacts the person or their representative and confirms Medi-Cal status and current needs.

3. Step 3

   Assessment

   A nurse from the care coordination agency completes the assessment that documents level of care and the services the person needs.

4. Step 4

   Individual service plan and facility match

   The agency writes the service plan with the person and helps find a participating facility, or arranges services in subsidized housing.

5. Step 5

   DHCS approval and move

   DHCS reviews the enrollment package. After approval, services and care coordination begin.

What the waiver pays for, and what the resident pays

Medi-Cal pays the participating facility for care services under the waiver at rates set by DHCS. The resident pays room and board from their own income, at a monthly amount DHCS sets each year for people on SSI or with similar income. The amount changes, so check the current DHCS notice in the sources below or ask the ALW team.

Neither the waiver nor hospice pays rent. Families planning for assisted living should budget for room and board under either program.

How to reach Beta's ALW team

Waiver questions, waitlist requests and assessments are handled by Beta's Care Coordination Agency, a separate team from hospice. Reach them directly:

Phone (747) 293-5777 or email alw@betahospice.com. The team can send the current DHCS waitlist request form, explain the priority tiers and confirm whether a facility participates.

The DHCS waitlist request form and the list of participating facilities are published by DHCS; see the sources below. Only DHCS decides eligibility and enrollment.

Already on the waiver with another agency?

A participant can change care coordination agencies. DHCS has a change-of-agency form for this, and the new agency helps complete it. Ask the ALW team for the current form and the steps.

Waiver resources

Official documents and pages from the state:

• DHCS: Assisted Living Waiver program page (opens in a new tab), the authority on rules, forms and rates
• DHCS: ALW participating facilities and care coordination agencies (opens in a new tab)
• Covered California and Medi-Cal application (opens in a new tab) for people who do not yet have Medi-Cal

Common questions