Medicaid waiver for assisted living
A Medicaid waiver can pay for the care your parent gets in assisted living. It can't pay the rent or the meals. Federal law bars it from paying room and board, so your parent still pays that part from their own income.
To get it, your parent must qualify for Medicaid, need the level of care a nursing home gives and live in a facility that takes the waiver. Florida's and California's waivers both have a waitlist.
What a Medicaid waiver is
Medicaid normally pays for long-term care in a nursing home. A waiver lets a state spend that money on care at home or in the community instead.
These are called home and community-based services (HCBS) waivers. They began in 1983, when Congress added section 1915(c) to the Social Security Act. Medicaid.gov says 47 states and DC run at least one 1915(c) waiver.
Each state designs its own within federal rules. A state can run as many waivers as it wants. So the name, the rules and the list of facilities change from state to state.
What it pays and what it does not
The rule comes straight from the Social Security Act, section 1915. A waiver may pay for home or community-based services "other than room and board". Those services follow a written plan of care.
| A waiver can pay for | A waiver can't pay for |
|---|---|
| Personal care, such as help with bathing and dressing | Rent for the room or apartment |
| Homemaker and home health aide services | Meals, the "board" in room and board |
| Other services in your parent's written plan of care | Anything outside that plan |
So the bill splits in two. Medicaid pays the facility for care. Your parent pays the facility for room and board, usually from Social Security or a pension. States leave your parent some income to cover it.
In Florida, DCF lets a resident on the waiver keep enough for the ALF's basic room and board rate plus 20% of the federal poverty level. Anything above that goes toward the cost of care.
Who qualifies
Every state checks 3 things:
- Medicaid eligibility. Your parent's income and assets must fit the state's Medicaid limits. Each state sets its own figures.
- Level of care. They must need the care a nursing home would give. A waiver is the alternative to a nursing home, so this is the bar.
- A place that takes it. They must live in, or move to, a facility enrolled in the waiver.
Age rules vary. Florida's program is for people 65 and over, or 18 and over with a disability. California's is for people 21 and over.
Florida also looks back at gifts. DCF reviews assets transferred in the 60 months before the application month for its long-term care programs.
Waitlists
Waivers have a limited number of places, so a waitlist is common. Florida and California both have one. It's the hardest part for families, and it's worth getting on the list early.
How the list moves depends on the state. Florida doesn't go by who applied first. Each month the Department of Elder Affairs releases people by their screening score and frailty level. California's Department of Health Care Services releases open places to local care coordination agencies on a regular basis.
While you wait, keep paying privately if you can. Ask the facility whether it takes the waiver so your parent won't have to move once a place opens.
Florida: the SMMC long-term care program
Florida's waiver is the Statewide Medicaid Managed Care (SMMC) Long-Term Care program. AHCA says your parent can qualify if they're:
- 65 or older and eligible for Medicaid, or
- 18 or older and eligible for Medicaid because of a disability, and
- Found by the Department of Elder Affairs CARES program to need nursing facility level of care
The Department of Elder Affairs decides the medical side. The Department of Children and Families (DCF) decides the financial side.
To start, call the Elder Helpline at 1-800-96-ELDER or your local Aging and Disability Resource Center for a screening. You apply for Medicaid itself through DCF, online at MyACCESS.
If income is too high, a Qualified Income Trust can still make your parent eligible. DCF's SSI-Related Medicaid fact sheet explains it. Income goes into a special account each month, and anything left at death goes to the state, up to what Medicaid paid.
407 Florida ALFs are on the state's Medicaid assisted living waiver list. Our cost of assisted living in Florida guide shows what the rest of the bill looks like.
California: the Assisted Living Waiver
California runs the Assisted Living Waiver (ALW) through the Department of Health Care Services. Its current term runs from March 2024 to February 2029.
To qualify, your parent must:
- Be 21 or older
- Have full-scope Medi-Cal with no share of cost
- Have care needs equal to Medi-Cal residents in nursing facilities
- Be able to live safely in assisted living or public subsidised housing
- Be willing to live in one of 15 counties
The 15 counties are Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara and Sonoma.
Participants pay the facility directly for room and board. DHCS pays the facility a daily rate for care in 5 tiers. In 2026 those rates run from $95.69 to $270.80 a day. There's a waitlist, and you join it through a care coordination agency.
1,045 licensed California homes on our list are on the ALW facility list.
Other states
Outside Florida and California, start with your state's Medicaid agency. Ask 3 questions:
- Which waiver covers assisted living, and what is it called here?
- Is there a waitlist, and how are places released?
- Where's the list of facilities that take it?
In Florida the screening is done by the local Aging and Disability Resource Center. Elsewhere, ask the Medicaid agency who does it. Have your parent's income, assets and medical details ready.
Find facilities on a waiver list
- Florida ALFs that accept Medicaid: 407 on the state waiver list, by city
- Assisted living in California: 8,508 licensed homes, with each one's ALW status
- Assisted living near me: search by city or ZIP and see which facilities are on a waiver list
A facility saying it "takes Medicaid" isn't the same as being on the waiver list. Check the list, then ask the facility how many waiver places it has open.
Sources: Social Security Act section 1915; Medicaid.gov; Florida AHCA; Florida DOEA; Florida DCF; California DHCS.
Questions families ask about Medicaid
Will Medicaid pay for assisted living?
It pays for the care part through a waiver, in states that have one for assisted living. It doesn't pay room and board. Your parent must qualify and the facility must take the waiver.
Does Medicaid cover room and board in assisted living?
No. Section 1915 of the Social Security Act bars waivers from paying room and board. Your parent pays that from their own income, and the state leaves them enough to do it.
What are the income limits for Medicaid assisted living?
Each state sets its own. In Florida, DCF publishes the limits in its SSI-related Medicaid charts, and a Qualified Income Trust helps if income is over. In California, your parent needs full-scope Medi-Cal with no share of cost.
Is there a waiting list for the assisted living waiver?
Usually, yes. Florida and California both have one. Florida releases people each month by score and frailty level, not by date of application.
More guides for the decision
- Cost of assisted living, state by stateAssisted living costs a median $6,200 a month in the US (CareScout 2025). See every state, what the fee covers, what costs extra and the ways to pay.
- Cost of assisted living in FloridaAssisted living in Florida costs a median $5,610 a month (CareScout 2025). What it covers, nursing home and memory care costs, and the Medicaid waiver.
- Does Medicare pay for assisted living?Medicare does not pay for assisted living rent or personal care. What it does cover, the nursing home 100-day rule, and what pays instead.
- How to pay for assisted living with no moneyNo savings for assisted living? How Medicaid waivers, Florida's OSS, VA Aid and Attendance and a nursing home on Medicaid work, and where to ask first.
- Assisted living vs nursing homeAssisted living helps with daily tasks; a nursing home gives 24-hour nursing care. Compare the care, the median cost, who pays and how to choose.
- Florida assisted living regulationsFlorida ALF rules in plain words: the licence types, staff training, help with medication, discharge notice, resident rights and how to complain.
Or search assisted living near you.