The ALWP is hiding the reality of its disaster

Under Social Security Act §1915(c) an assisted living waiver (ALW) allows states to use Medicaid dollars to pay for home-based community services. It allows low-income, Medicaid eligible seniors and persons with disabilities to avert nursing home placement and receive care at home or in a community care setting i.e., RCFEs and ARFs.

          California’s ALW, implemented in 2006, allows Medi-Cal to pay for assisted living or public subsidized housing. Several websites claim the program is “experimental,” despite the passage of 20 years, and the current state budget does not cover a state-wide expansion to more counties and is limited to just 15 counties. The program came under serious scrutiny when it ran out of money in September 2025, resulting in a suspension of new placements. The number of persons awaiting placement—the waitlist—swelled, but the actual number on the state’s waitlist is now suspicious.

          The waitlist was at 18,365 in December 2025, but in March it was over 19,000. Those numbers were drastically reduced by the Department of Health Care Services (DHCS) to 6,588, meaning nearly 13,000 persons were placed shortly after the state’s budget went into effect on July 1. However, the waitlist is vague and avoids providing identical information previously online. It appears the numbers have been “adjusted, revised” so Mr. Newsom appears to be effectively managing the state as he seeks the 2028 presidential nomination. Leaving the truth in the dark does not change the truth. DCHS states, “Please be advised that there are currently very significant wait times, due to the existing backlog of applications.” Delays. Backlogs, but 13,000 people were placed in one month?

          Justice in Aging recently wrote that the ALW had 18,847 persons currently enrolled in the program, but just as many on a waitlist.

          ALW qualifies low-income persons on the SSI or Supplemental Security Income grant of $1444.07 (2026) and eligible for nursing home care but they prefer community-based care. The SSI grant is in addition to a daily, ALW rate for care and services, up to $264 a day, or $9367 per month if the person’s care needs are at “Tier 5,” the highest level of care.

          DHCS has nearly 1300 care facilities that can admit ALW-dependent persons. The where a resident goes is “brokered” by one of the state’s 41 designated Care Coordination Agencies (CCA), and placement is determined by registered nurses employed by CCAs. Paying those nurses strains the ALW budget and some facilities are paying “kickbacks” to the CCAs.

          In California, there are about 14 million persons on welfare, 35% of the state’s population! Over 50% of Medi-Cal recipients are between 21 and 64 years old, and over 50% are Hispanic. Many recipients are illegally in the country because California allows illegals to get federally-paid placements and housing, a violation of federal law, and that has not gone unnoticed. The federal government has withdrawn nearly $1 billion in state payments.

          Illegals do not pay social security taxes because they cannot be legally employed. Yet, California allows illegals to collect US taxpayer-paid social security benefits. The state’s philosophy is:

“The transformation of Medi-Cal is a key building block of California’s broader commitment to building a healthier and more equitable state for all Californians, regardless of their ethnicity, gender, sexual orientation, disability, age, immigration status, health needs, or where they live (emphasis added).”

The administration of the ALW program is complicated because state law allows CCAs to subcontract some of its programs’ activities:

“Each participating local governmental agency or local educational consortium may subcontract with private or public entities to assist with the performance of administrative activities necessary for the proper and efficient administration of the Medi-Cal program” (emphasis added).

How this ends is unknown, but under current California governance, the program will end because of fiscal mismanagement.