How an RCFE or ARF Can Become an Assisted Living Waiver Provider in California
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Assisted Living Waiver (ALW) provider enrollment is a separate California Department of Health Care Services process layered on top of the facility’s CDSS license; it is not automatic and does not guarantee residents or reimbursement.
Before you commit time or money
RCCS can help owners and aspiring operators organize licensing-readiness questions, documents, site concerns, and next steps before they rely on an outdated checklist or make a costly commitment.
Call RCCS: (888) 272-3301, option 2 | Website: rosenthalcommunitycare.com | Email: marky.pascua@rosenthalcommunitycare.com
What the ALW pathway is
The ALW is a Medi-Cal home- and community-based alternative for eligible people who would otherwise need nursing-facility-level care and can safely receive services in an assisted-living setting. DHCS currently describes the waiver term as March 1, 2024 through February 28, 2029 and accepts provider applications in 15 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.
DHCS says qualifying RCFE and ARF providers must be licensed by CDSS and work with a Care Coordination Agency (CCA). Confirm the current status and county rules on DHCS’s ALW provider-enrollment page and ALW program page.
Do not confuse the approvals
| Approval | Role | Not guaranteed by it |
|---|---|---|
| CDSS RCFE or ARF license | Authorizes the licensed residential operation within its scope. | ALW enrollment or Medi-Cal payment. |
| ALW provider enrollment | Allows the provider to participate in the waiver subject to DHCS rules, agreement, site review, and authorization. | A resident, referral volume, occupied bed, rate, or guaranteed revenue. |
| CCA coordination | Develops and coordinates the participant’s individualized service plan and monitors services. | A promise that every applicant will be placed in your facility. |
| Medi-Cal enrollment | The provider-enrollment and billing side of the program, using the applicable DHCS forms and identifiers. | Approval to exceed the facility’s license, fire clearance, staffing, or resident-care scope. |
Need help separating CDSS, ALW, and Medi-Cal steps?
RCCS can help you organize the facility license, ALW program checklist, HCBS materials, Medi-Cal enrollment documents, and approval sequence.
Talk with RCCS: (888) 272-3301, option 2 or rosenthalcommunitycare.com.
Step-by-step enrollment roadmap
- Confirm the facility and county. Maintain the applicable CDSS license, verify the site is in a current ALW county, and confirm the facility type is within DHCS’s accepted provider categories.
- Read the current DHCS provider resources. Start at the ALW provider-resources page, not an old saved PDF. Requirements, forms, and fees can change.
- Prepare the ALW program checklist. DHCS’s posted checklist currently asks for items including a signed initial provider application, NPI/NPPES information, a labeled facility floor plan, resident admission agreement, the last two CDSS licensing reports, a full month of planned meals/snacks, activity schedule, staff training topics, CDSS facility license, signed provider agreement, HCBS setting attestation, brochure or public website, lease or ownership evidence, and policies/manuals mapped to applicable federal requirements.
- Prepare the Medi-Cal enrollment checklist where required. The current posted checklist includes DHCS 6204, DHCS 6207, DHCS 6208, NPI, federal tax ID, business email, city business license or exemption, facility license, identification, DBA information where applicable, general-liability insurance, workers’ compensation or exemption, surety bond, and a $730 cashier’s check or money order. The posted fee is subject to annual change; confirm the current checklist and whether this track applies to your enrollment.
- Use category-specific emergency documentation. The posted DHCS checklist refers to RCFE emergency plan LIC 610E. An ARF’s current CDSS emergency form is LIC 610D. Follow the current DHCS checklist and the category-specific CDSS form; confirm the correct form with DHCS/CDSS before submitting an ARF packet.
- Submit to the correct DHCS unit. DHCS directs ALW applications to the Provider and Facility Site Review Unit, Integrated Systems of Care Division, Department of Health Care Services, 1501 Capitol Avenue, MS 4502, P.O. Box 997437, Sacramento, CA 95899-7437. DHCS specifically says not to send these applications to the Provider Enrollment Division.
- Complete review, site and HCBS requirements, and agreement. Respond to DHCS requests, complete required site/setting review, and submit the signed ALW Provider Agreement. The agreement must be signed, submitted, and approved before claims are considered for payment.
- Operate only after approval and authorization. Work with the CCA, follow the participant’s written individualized service plan, maintain records, and bill only for authorized services within the agreement and facility scope.
HCBS and person-centered expectations
DHCS’s ALW Individual Service Plan Desk Guide describes person-centered planning and home- and community-based setting characteristics. Depending on the setting and arrangement, the materials address community integration, access to the broader community, choice, privacy, dignity, rights, autonomy, lockable doors, privacy, roommate choice, control over schedules and food, visitors, and physical accessibility. Your policies and actual resident experience should match the applicable requirements.
Participant eligibility is not provider demand
DHCS describes participant criteria that can include age 21 or older, full-scope Medi-Cal with zero share of cost, nursing-facility-level care, safe assisted living, residence in an available county, and the ability to pay room and board. The program has limited slots and can have a waitlist. A facility’s enrollment does not guarantee that a particular applicant is eligible, that a CCA will select the facility, or that a bed will be filled.
ALW enrollment is not Regional Center vendorization
An ARF that also wants Regional Center business must follow DDS’s separate vendorization process. Conversely, ALW enrollment does not create a Regional Center vendor number. Keep the licenses, agreements, service populations, rates, and billing records distinct.
For a licensing foundation, read How to Start an RCFE or How to Start an ARF. For financial planning, read RCFE Startup Cost Breakdown.