Care Coordinating Agency (to be confirmed)
Pending operator confirmation
Find a CCA via DHCS →
Medi-Cal · San Francisco
The California Assisted Living Waiver,
at Portola Gardens.
Full assisted living for eligible Medi-Cal residents. Care covered by Medi-Cal; room and board starts at $4,500/month.
We are one of three facilities in San Francisco County participating in the ALW program.
Definition
What is the Assisted Living Waiver?
The Assisted Living Waiver (ALW) is a California Medi-Cal program that pays for assisted living care for eligible low-income seniors. Medi-Cal covers the care; residents and families pay only room and board.
The program operates in 15 California counties, including San Francisco. It serves people who would otherwise need nursing facility placement but can be safely cared for in an assisted living community.
At Portola Gardens, room and board starts at $4,500/month. The remainder of the cost is covered by Medi-Cal through ALW.
Eligibility
You may be eligible for ALW if you:
- Age 21 or older
- Eligible for full-scope Medi-Cal with zero share of cost
- Need a Nursing Facility Level of Care assessment
- Could safely live in assisted living (do not require a Skilled Nursing Facility)
- Reside in or willing to move to a participating county (San Francisco is participating)
Not sure? Talk to a case manager →
Application
How to apply, in five steps.
Total time from first contact to move-in is usually 60 to 120 days.
- 1
Contact a Care Coordinating Agency (CCA)
A CCA is a state-contracted agency that handles ALW enrollment in your county. They are your guide through the process.
- 2
Level of Care Assessment by a Registered Nurse
An RN visits to confirm you need a Nursing Facility Level of Care but could safely live in assisted living.
- 3
Care plan and waiver enrollment with DHCS
Your CCA submits the care plan to the California Department of Health Care Services for waiver approval.
- 4
Facility placement
Once approved, you choose a participating facility. We coordinate move-in details directly with your CCA.
- 5
Move-in and care begins
Daily care is covered by Medi-Cal through ALW. Room and board is paid by the resident, starting at $4,500/month at Portola Gardens.
Get started
Care Coordinating Agencies serving San Francisco.
Your first call. A CCA handles your enrollment, RN assessment, and ongoing coordination.
Care Coordinating Agency (to be confirmed)
Pending operator confirmation
Find a CCA via DHCS →Care Coordinating Agency (to be confirmed)
Pending operator confirmation
Find a CCA via DHCS →Names will be published as Portola Gardens confirms current SF CCA partners. In the meantime, the DHCS ALW directory and CANHR consumer guide are authoritative.
What your money buys
What room and board covers at Portola Gardens.
Included in room and board
$4,500+/mo, paid by resident
- Private or shared suite
- Three meals daily plus snacks
- Weekly housekeeping
- Laundry and linen
- Utilities
- Activities and outings
Covered by Medi-Cal through ALW
No cost to resident
- Personal care and ADL assistance
- Medication management
- Nursing oversight
- Care plan and assessments
Apply
ALW Intake Form
Tell us about your loved one. We will respond within one business day.
For social workers and discharge planners
Are you placing a client? We have a separate track for you.
Bed availability, ALW intake form for clients and and a 15-minute Calendly walkthrough with admissions.
Frequently asked
Questions families and case managers ask.
What is the California Assisted Living Waiver?
The Assisted Living Waiver (ALW) is a California Medi-Cal program that pays for assisted living care for eligible low-income seniors. Medi-Cal covers the care; residents and families pay only room and board. The program operates in 15 California counties including San Francisco.
Who is eligible for ALW in California?
You may be eligible if you are 21 or older, qualify for full-scope Medi-Cal with zero share of cost, need a Nursing Facility Level of Care, could safely live in assisted living (not requiring a Skilled Nursing Facility), and reside in or are willing to move to a participating county.
How do I apply for ALW in San Francisco?
Start by contacting a Care Coordinating Agency (CCA) that serves San Francisco County. The CCA will arrange a Level of Care assessment by a Registered Nurse, build your care plan, and submit your enrollment to DHCS. Total time is typically 60 to 120 days depending on assessment availability and waitlist status.
How long is the ALW waitlist in San Francisco?
Statewide ALW demand exceeds available slots. Waitlist length in San Francisco varies and depends on county allocation and facility capacity. Portola Gardens is one of only three SF facilities participating in ALW, which can affect placement timelines depending on the level of care needed.
What does ALW cover and what does it NOT cover?
ALW (Medi-Cal) covers personal care, ADL assistance, medication management, nursing oversight, and care planning. ALW does NOT cover room and board: that is the resident's responsibility. At Portola Gardens, room and board starts at $4,500/month.
What is room and board under ALW?
Room and board covers your physical place to live and meals: your suite (private or shared), three meals daily plus snacks, weekly housekeeping, laundry and linen service, utilities, and access to activities and outings. It does not include personal care, which is covered separately by Medi-Cal through the waiver.
How much is room and board at Portola Gardens?
Room and board starts at $4,500 per month at Portola Gardens. Final pricing depends on suite type (shared or private) and is confirmed during the admissions conversation.
What is a Care Coordinating Agency (CCA)?
A CCA is a state-contracted nonprofit or agency that manages ALW enrollment, care planning, and ongoing coordination for residents in the program. Every ALW resident has a CCA. Your CCA is your primary point of contact for benefit questions.
What is a Nursing Facility Level of Care assessment?
It is a Registered Nurse evaluation that determines whether your daily care needs would qualify you for nursing facility (SNF) care. ALW eligibility requires this level of need, but you must also be safe in an assisted living setting rather than requiring SNF placement.
How long does the ALW application take?
From CCA contact to move-in, the process typically takes 60 to 120 days. Faster timelines are possible when a participating facility has immediate availability and the resident already has full Medi-Cal eligibility confirmed.
What if I am denied?
Denials are usually due to one of three reasons: Medi-Cal status, level of care assessment result, or county allocation. Your CCA will explain the specific reason and help with appeals or alternative pathways such as IHSS or PACE.
Can I switch facilities after ALW placement?
Yes. If your needs change or you want to move, your CCA helps coordinate a transition to another participating facility. ALW eligibility moves with the resident.
How does ALW compare to IHSS?
IHSS (In-Home Supportive Services) provides paid caregiver hours in your own home. ALW pays for assisted living care in a participating facility. The two serve different settings: IHSS if you want to stay home, ALW if you need or want a community setting with 24/7 staff.
How does ALW compare to PACE?
PACE (Program of All-Inclusive Care for the Elderly) bundles medical, social, and long-term services for seniors who need nursing-home-level care but want to live in the community. ALW is more focused on the assisted living facility itself. PACE eligibility requires age 55+ and nursing-home-level care; ALW starts at 21+ and requires NF-level care.
What if my Medi-Cal status changes?
Notify your CCA immediately. ALW eligibility requires continuous Medi-Cal with zero share of cost. Status changes can trigger eligibility review.
What if my care needs increase past ALW scope?
If you need a Skilled Nursing Facility level of care that cannot be safely provided in assisted living, your CCA helps transition you to SNF placement and Medi-Cal coverage continues.
Authoritative sources
Learn more from primary sources.
We cite the agencies and advocates who define the program. They are the source of truth on policy; we are the source of truth on what placement actually looks like at Portola Gardens.
California Department of Health Care Services
DHCS, ALW program page
Primary authority on ALW program operations and county participation
Open in new tab ↗California Advocates for Nursing Home Reform
CANHR, ALW consumer guide
Independent consumer advocacy on long-term care in California
Open in new tab ↗California Health Care Foundation
CHCF, ALW & CalAIM Community Supports (2025 report)
Research on California long-term services and supports policy
Open in new tab ↗Two next steps.
See the community in person, or submit the ALW intake and we will get back within a business day.