The Assisted Living Waiver in Sacramento County
Sacramento County is one of the counties where California’s Medi-Cal Assisted Living Waiver (ALW) program currently operates — but participation doesn’t mean easy or immediate access. Here’s what the program covers, and an honest look at current demand.
What ALW covers
ALW lets Medi-Cal pay for the care portion — not room and board — of assisted living in a participating facility, as an alternative to nursing-home placement. It’s meant for people who qualify for nursing-facility-level care but could safely live in an assisted living setting with the right support.
Confirmed current participating counties include: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma.
Be honest about the wait
Sacramento County families can apply for ALW, but statewide demand for this program has grown much faster than enrollment. Per DHCS’s own statewide ALW enrollment/waitlist dashboard (data through December 2025), the statewide waitlist — 18,365 people — now exceeds total statewide enrollment of 14,847 people, and the waitlist has grown roughly 6x since January 2024.
That figure is statewide, not broken out by county — so we can’t tell you a Sacramento-specific wait time. But it means you shouldn’t assume easy, immediate access just because the county participates. Ask about current wait times when you apply, and consider the options below in parallel rather than waiting on ALW alone.
Other avenues to pursue in parallel
- CalAIM Community Supports — ask your Medi-Cal managed care plan directly whether they offer relevant services, especially while you’re on the ALW waitlist.
- MSSP (Multipurpose Senior Services Program) — care management as an alternative to nursing-home placement, through a local site serving Sacramento County.
- In-Home Supportive Services (IHSS) — help paying for in-home caregiving so someone can stay at home while other options are pending.
This is general information, not financial or legal advice. Program availability, wait times, and eligibility change — confirm current details with DHCS or the ALW program directly before you rely on them.
Want this checked against your specific numbers? Our free Care Financing Roadmap asks a few questions about your assets, income, veteran status, and insurance, then tells you exactly which paths apply to you.