Medicaid Assisted Living Waivers | Helping Persons with Dementia Afford Residential Memory Care

Last Updated: January 21, 2022


What is an Assisted Living Waiver?

 An assisted living waiver is a state-specific Medicaid program that helps persons who need a nursing facility level of care (NFLOC) live in assisted living residences as an alternative to moving into nursing homes.

Medicaid is a state-run health insurance program for financially needy persons, covering children, families, pregnant women, disabled persons, and seniors. For the purposes of this article, we will focus on persons with Alzheimer’s disease and related dementias—such as Parkinson’s disease dementia, frontotemporal dementia, and Lewy body dementia—and the Medicaid programs that help pay for assisted living.

The terms “Memory Care”, “Special Care Unit”, and “Alzheimer’s Care” all refer to assisted living for persons with dementia, where staff is specially trained and extra design elements and security measures make the residence safer for people with dementia.

While a few state Medicaid plans cover personal care assistance in assisted living residences, long-term services and supports are mostly provided via Home and Community Based Services (HCBS) Medicaid waivers. Also called 1915(c) Medicaid waivers, these waiver programs are intended to prevent, or at the very least delay, the move into a nursing home.

Via these waivers, long-term care benefits are provided for the disabled and elderly, and often persons with dementia, in a variety of settings, including the following:
– one’s own home
– the home of a relative
– an adult foster care home
– an adult day care center
– group residential living
– assisted living / memory care

This article will focus on the last of those: assisted living and assisted living with memory care. Via assisted living waivers, a variety of benefits are provided in assisted living / memory care, allowing persons who otherwise would not be able to live independently to remain in the community.

 Assisted living waivers do not cover room and board in memory care, they only pay for care costs.

Assisted living waivers DO NOT cover the cost of room and board. Rather, they cover the cost of benefits. This usually includes assistance with activities of daily living (ADLS). These are examples of ADLs:
– bathing
– dressing
– grooming
– mobility (getting from room to room)
– going to the bathroom
– eating

Personal care assistance, attendant care, and custodial care are all common terms used for this type of care. Homemaker services, medication management, transportation, and activities (social, recreational, and educational) are also frequently provided. The exact benefits available are based on the specific state’s assisted living waiver.

The HCBS waivers providing care assistance in assisted living residences may be called something other than an “Assisted Living Waiver”. For instance, in Alaska, the “Alaskans Living Independently Waiver” provides such care, and in Minnesota, the “Minnesota Elderly Waiver” does. Not all states offer assisted living waivers.

HCBS Medicaid waivers, unlike state Medicaid programs, are not entitlements. This means even if an assisted living waiver applicant meets all eligibility requirements, he / she may not be able to receive benefits immediately through the program. This is because these waivers limit enrollment, which means once all of the participant slots have been filled, waitlists are formed.


Relevance for Persons with Alzheimer’s / Dementia

In order to be eligible for an assisted living waiver, regardless if one has Alzheimer’s disease or another form of dementia, there are certain requirements (functional and financial) that must be met. This means, unfortunately, a diagnosis of Alzheimer’s disease does not make one automatically eligible. When a person with dementia does meet the criterion, a Medicaid waiver can be the difference between moving to a nursing home facility and continuing to live in the community.

Change can be particularly difficult for persons with dementia. The ability to live in a home-like setting (assisted living) and receive supervision and required care in this setting, rather than in an institution, can be beneficial. Residing in an assisted living residence also allows persons to maintain a greater degree of independence than does skilled nursing homes.

Some assisted living waivers offer dementia care, also called “memory care”, in which staff is specifically trained and equipped to handle the needs of persons with dementia. Specific activities, such as music and art, may be organized to stimulate memory and cognitive functioning.


Eligibility Requirements

Financial Criteria

In order to be financially eligible for a Medicaid assisted living waiver, there are both income and asset limits. While these limits vary slightly by state, the following guidelines generally hold true for the majority of the states and waivers:
– In 2022, a single applicant must not have income greater than 300% of the Federal Benefit Rate, which is $2,523 / month.
– The asset limit is $2,000 for an individual. Some assets are exempt, which means they do not count towards the limit. In most cases, primary homes are exempt. See state specific eligibility requirements here.

For married couples in which only one spouse is applying for the assisted living waiver, spousal impoverishment rules are in place to prevent the non-applicant (community) spouse from having too little income and assets to live comfortably. These rules include a Community Spouse Resource Allowance and a Minimum Monthly Maintenance Needs Allowance that not only ensure non-applicant spouses are financially stable but also help to lower the countable income and assets of applicant spouses. As of 2022, in most states, up to $3,260 / month in income can be transferred from the applicant spouse to the non-applicant spouse. Furthermore, the non-applicant spouse is able to retain up to $137,400 of the couple’s joint assets.


Level of Care Requirements

In addition to the financial criterion, applicants of Assisted Living Waivers must demonstrate a functional need for the assistance provided via these programs. In most cases, an applicant must demonstrate a level of care consistent to that which is provided in a nursing home residence. Often, an assessment is made by a health care professional working for Medicaid, who visits the applicant and uses a state-specific checklist to determine care needs.

What nursing facility level of care (NFLOC) means is not easily definable. This is because each state, and even various programs within a state, define this designation differently. For instance, NFLOC could mean that an applicant requires assistance with three ADLs, such as bathing, putting on / taking off clothing, personal hygiene, mobility, transitioning, and using the toilet / cleaning up after oneself. On the other hand, NFLOC could also be determined as such because a person with dementia is cognitively impaired and requires significant supervision. Learn more about nursing home level of care.


Becoming Eligible If You Exceed Requirements

Persons with dementia who have income and / or assets over the Medicaid eligibility limit(s) are not automatically disqualified from an assisted living waiver or Medicaid in general. Rather, there are several planning techniques that can be implemented in order to meet the financial eligibility requirements in any state.

 Did You Know? Medicaid planning professionals are available to help persons with Alzheimer’s or dementia become Medicaid eligible. Learn more about Medicaid planning.

Excess Income

The two main ways an applicant with income above the Medicaid limit can still be approved for Medicaid are Qualified Income Trusts and the Medically Needy Pathway.

Qualified Income Trusts (QITs) allow persons to deposit their “excess” income (the income over Medicaid’s income limit) into an irrevocable trust, which is managed by someone other than the Medicaid applicant (commonly an adult child of the applicant). The money deposited in the trust is no longer thought of as the applicant’s income, and therefore does not count toward the income limit. The money in the trust can only be used for very specific purposes, such as paying for the care recipient’s uncovered medical expenses and long-term care costs. This is an oversimplified explanation of QITs, which are also called Miller Trusts. Learn more here.

The Medically Needy Pathway enables Medicaid applicants to “spend down” their income that is over Medicaid’s income limit on medical bills. The Medically Needy Pathway, in other words, is for applicants who make more than the income limit but spend a significant amount on medical expenses. The spend down period varies based on the state in which one resides, but may be 1 month, 3 months, or even 6 months. Once the Medicaid applicant has spent their income down to the medically needy income limit for the spend down period, he / she is eligible to receive benefits for the remainder of the spend down period.

Excess Assets

There are a variety of ways to lower one’s countable assets. A simple and straightforward way to do so is to spend excess assets on assets that are not counted towards the limit. Examples include paying off debt, purchasing an irrevocable funeral trust, buying medical equipment not covered by insurance, and even fixing up one’s personal vehicle or taking a vacation. Learn more about asset spend down here.

It is important to mention that Medicaid has a 60-month look back period (30 months in California and New York), in which Medicaid examines all past transfers preceding one’s application for benefits. Simply stated, if an applicant gave away assets or sold them for less than market value during the “look-back” period, the applicant will be punished with a period of Medicaid eligibility. This rule is in place to prevent persons from giving away their “excess” assets in order to meet the asset limit.

Other ways to get one’s assets below the limits include Irrevocable Funeral Trusts—prepaying for funeral and burial costs for the applicant or a family member—and Medicaid-exempt Annuities, in which a lump sum of assets (cash in bank accounts) are converted into a regular income stream.


How Medicaid Planning Can Help

Medicaid planners are instrumental to the Medicaid application process in a number of ways:
– Explaining Medicaid benefits
– Assisting with the application
– Collecting required supporting documentation
– Restructuring finances to meet financial requirements

Medicaid planners can be particularly invaluable when an applicant is over the income and / or asset limit(s). Remember that allowable planning strategies vary by state, and as mentioned above, not all states allow qualifying income trusts, nor do all states permit a medically needy pathway.

If one is over the financial eligibility limit(s), it is highly suggested one seek the counsel of an experienced Medicaid planner. In addition to helping Medicaid applicants meet the income and / or asset limit(s), professional planners also assist families in saving financial resources from Medicaid’s estate recovery program and preserve them as inheritance instead.

Some of these techniques are complicated and time-consuming, and incorrectly implementing a planning strategy to meet Medicaid’s income and / or asset limit(s) can cause one to be ineligible for Medicaid. Learn about the different types of Medicaid planners here.


Which States Have Assisted Living Waivers

Below is a list of assisted living waivers relevant to persons with Alzheimer’s disease and related dementias, with links for additional details and how to apply.

Not all states offer assisted living waivers, and those that do may not offer identical services. In other words, a benefit offered by one assisted living waiver may not be available via another waiver. Remember, room and board IS NOT covered under assisted living waivers. However, a variety of supportive benefits may be provided, including assistance with activities of daily living (ADLs), supervision, medication reminders, activities (therapeutic, recreational, social), meal preparation, transportation, companionship, and some health related services. In addition, some of the following waivers offer specific supports (dementia care) for persons with Alzheimer’s care and related dementias. Recall that not all assisted living waivers are called “assisted living waivers”.

Medicaid Assisted Living Waivers for Alzheimer’s / Dementia (Updated June 2021)
Alaska Alaskans Living Independently Waiver (ALI)

One of the benefits under the ALI waiver is assisted living home services (formally called residential supported living in Alaska) for persons 21+ years old who require a nursing home level of care. This includes 24-hour supervision and security, assistance with ADLs, medication management, social and recreational activities, and transportation as determined by one’s care plan.

Arizona Arizona Long Term Care System (ALTCS)
Through ALTCS, seniors and disabled individuals who require a nursing home level of care are able to receive supportive long-term care services in assisted living residences. This may include personal care assistance, homemaker services, home health care, and in-home nursing. Certain conditions, such as Alzheimer’s disease and related dementias, are considered when assessing an applicant’s functional ability and the need for assistance with daily living activities.
Arkansas Living Choices Assisted Living

The Living Choices Assisted Living Waiver allows eligible applicants (physically disabled adults 21-64 years old and all adults 65 and over who meet the financial criteria) to live in private apartments within an assisted living facility. Around-the-clock supervision, attendant care, nursing evaluations, limited nursing services, non-medical transportation, medication oversight, and activities (therapeutic, recreational, and social) are provided.

California Medi-Cal Assisted Living Waiver (ALW)

Medi-Cal’s (California’s Medicaid program) ALW is intended for adults 21 years and older who require the level of care provided in a nursing home. This waiver provides a variety of supportive assistance, such as personal care, health related services, and housekeeping, in three types of assisted living facilities: Residential Care Facilities for the Elderly (RCFE), Adult Residential Facilities (ARF), and Public Subsidized Housing (PSH). Some of these settings offer home-like memory care for persons with dementia. In some instances, even a memory care facility adjacent to an assisted living facility is an option. Unfortunately, this program is currently only available in 15 counties within the state. More info.

Colorado Colorado Elderly, Blind and Disabled Waiver

The Elderly, Blind, & Disabled Waiver (EBD) offers a variety of long-term care services and supports, and receiving such benefits in an alternative care facility (ACF) is one such support. While this waiver does not offer services that are specific to Alzheimer’s disease or related dementias, persons with these neurological diseases are eligible to live in ACFs. Based on the alternative care facility, special programming may be offered for persons with these conditions.

Connecticut Assisted Living Program under CHCPE

Assisted living services are provided in “Managed Residential Communities” (MRC) under the Connecticut Home Care Program for the Elderly (CHCPE) for persons who require assistance with daily living activities. Intended for persons 65 years of age and over, this waiver program is unique in that persons not eligible for Medicaid may also be program participants (though some financial limits still apply). For persons with Alzheimer’s disease or a related dementia, memory care is an option.

Delaware Diamond State Health Plan Plus
DSHP Plus, a long-term managed care program, provides a variety of supportive services for elderly and disabled persons who are at risk of nursing home admission. Although it is unclear if specific dementia-related benefits are provided, cognitive services are included, and one setting in which program participants can reside and receive care assistance is in assisted living.
District of Columbia DC Elderly and Persons with Physical Disabilities (EPD) Waiver

In addition to providing home based services and supports, the EPD Waiver Program also provides benefits in assisted living facilities for elderly and disabled individuals who need assistance with activities of daily living (ADLs). Given persons with Alzheimer’s disease or related dementias meet the functional and financial requirements, they are eligible for assisted living services. It is not specifically stated if assisted living services can be provided in a memory care unit, but this could be a possibility.

Florida Statewide Medicaid Managed Care Long Term Care Program (SMMC LTC)

Florida previously had an Assisted Living for the Elderly Waiver, but it has been incorporated into the SMMC-LTC Program. The current program provides a variety of long term care services for physically disabled adults and frail elderly residents who require a nursing home level of care. This is demonstrated as a need for assistance with ADLs. For persons who have dementia, but are not physically limited, cognitive issues resulting in the need for supervision are considered. One of the benefits of SMMC LTC is assisted living facility services. This includes personal care assistance, homemaker and chore services, and medication management. More info.

Georgia CCSP and SOURCE Programs

The Community Care Services Program and the Service Options Using Resources in a Community Environment Program operate under Georgia’s Elderly and Disabled Waiver. Both programs offer alternative living services, also known as assisted living services, and these services are provided in personal care homes, also known as assisted living residences. Both programs have a level of care requirement that is lower than needing full-time Nursing Facility Level of Care while considering both cognitive and physical limitations that can result from dementia. The difference between the two programs is that SOURCE is strictly for persons receiving SSI. Both CCSP and SOURCE program participants pay a monthly share of cost. More info on CCSP and more on SOURCE.

Hawaii Med-QUEST Integration Program

Med QUEST (Quality Care, Universal access, Efficient utilization, Stabilizing costs, and to Transform how health care is provided) is a managed care program for elderly, blind and disabled HI residents. This program offers a variety of benefits, including home and community based services and supports in assisted living. In these home-like assisted living facilities, residents are provided with attendant care, light house cleaning, laundry, and preparation of meals. While a diagnosis of Alzheimer’s disease or related dementia, such as Lewy Body dementia or Parkinson’s disease dementia, does not meet the functional eligibility requirement by itself, persons with these diseases can qualify based on their level of care need.

Idaho Aged and Disabled Waiver
Via the Idaho HCBS waiver, a variety of benefits are available for the frail elderly and disabled that promote independent living with the goal of preventing and / or delaying nursing home placement. One such benefit is residential care services, of which assisted living facilities are an appropriate setting. In assisted living, assistance with daily living activities, medication management, housekeeping, laundry, meals, and social and recreational activities are provided. Program participants must require a nursing home level of care. Cognitive functioning level is considered when determining if an applicant requires this level of care.
Illinois HCBS Waiver for Supportive Living Facilities

The Supportive Living Program (SLP) provides “supportive living” benefits, such as personal care assistance and homemaker services, for physically disabled adults and seniors who require a nursing home level of care. Program participants can reside in board and care homes, assisted living residences, or residential memory care, the latter specifically for Illinois residents diagnosed with Alzheimer’s disease and similar dementias. More info.

Indiana Aged and Disabled (A&D) Waiver

The A&D Waiver offers a variety of home and community based services, including assisted living services, for elderly and disabled Indiana residents who require a nursing home level of care. Persons with dementia are eligible to receive benefits, which include attendant care, homemaker and chore services, recreational activities, and onsite staff 24-hours / day in assisted living.

Iowa Home and Community Based Services (HCBS) Elderly Waiver
The HCBS Elderly Waiver is intended for aged Iowa residents (65 and over) who without appropriate care assistance and supportive services would have to relocate to a nursing home facility. While a number of benefits allow program participants to live independently in their homes, assisted living services is also an option, allowing them access to 24-hour care.
Kentucky Home and Community Based Waiver

Individuals who are 65 and older and meet the financial requirements, as well as requirements for care in a nursing facility, are eligible to receive support in a community under the Kentucky Home and Community Based Waiver. Intellectual disabilities are among the qualifications listed under Kentucky’s waiver program, and Alzheimer’s disease and related dementia may apply.

Kansas Frail Elderly Waiver Program
The FE Medicaid Waiver, also called the Home and Community Based Services for the Frail Elderly Waiver, is for seniors 65 and over who require nursing home level care. Services via this waiver can be provided in a variety of settings, including one’s home, a residential health care facility, a boarding care home, or an assisted living residence.
Louisiana Community Choices Waiver
While primarily designed to assisted nursing home eligible persons remain living at home.  Louisiana’s Community Choices Waiver (CCW) defines “home” broadly and can include persons living in assisted living or memory care residences.
Maryland Community Options Waiver
The Community Options Waiver is also referred to as the Home and Community Based Options Waiver (HCBOW). This waiver provides assisted living facility services for adults 18 and over, including those with Alzheimer’s disease, who need assistance with their daily living activities and require a nursing home level of care. Memory care, specific to persons with dementia, is also a possibility, given there is a facility that provides this type of care on the approved provider list. Applicants may be placed on a waitlist.
Michigan Choice Waiver Program

Via the MI Choice Waiver, previously called the Home and Community Based Services for the Elderly and Disabled Waiver Program, “community living supports” are available to physically disabled state residents a minimum of 18 years old and frail elderly persons 65 and over. Provided in one’s home or a community setting, such as an assisted living residence, dementia care is offered in addition to assistance with personal care, managing finances, shopping for groceries, and preparing meals. More info.


MI Health Link HCBS Waiver
The MI Health Link HCBS Waiver is a managed care program through which “dual eligible” elderly and disabled state residents who require a nursing home level of care receive long-term services and supports. “Dual eligible” is a term used for persons who are eligible for both Medicaid and Medicare. Program participants can receive care assistance in a variety of settings, including a home for the aged, which is similar to assisted living. This program is limited to 25 counties within Michigan. More info.

Minnesota Elderly Waiver (EW) & CADI Waiver

The Elderly Waiver and the Community Access for Disability Inclusion Waiver (CADI), also called the Community Alternatives for Disabled Individuals Waiver, offer “customized living services”, which can include services in assisted living residences. One important distinction between the two waivers is that CADI is intended for persons under 65 years old at the time of enrollment, while the EW is for persons age 65 and over. In addition to “customized living services”, there is also the option of “24-hour customized living services”, which includes around the clock supervision. For 24-hour customized living services, the level of care need is greater than for customized living services. With this option, services can be provided in memory care units.

Mississippi Assisted Living (AL) Waiver

The AL Waiver provides assistive services in personal care home-assisted living facilities, abbreviated as PCH-AL, for disabled adults and frail seniors who meet the level of care need that is provided in nursing homes. When considering functional eligibility, cognitive deficits and behavioral issues, which are commonly seen in persons with Alzheimer’s disease, are considered. Safety needs of persons with dementia are taken into account when creating one’s care plan.

Montana Big Sky Medicaid Waiver
This home and community based services Medicaid waiver is for elderly and disabled Montana residents. Residential habilitation is one of many benefits. A variety of services are provided in assisted living residences, including personal care assistance, homemaker services, medication management, 24-hour supervision, and medical escort. Both physical and cognitive functioning is considered when determining functional need for waiver services.
Nebraska Aged and Disabled Medicaid Waiver

Formally called the HCBS Waiver for Aged and Adults and Children with Disabilities, assisted living services (housecleaning and laundry, personal care assistance, shopping for essentials, medication management, etc.) is one benefit available via this waiver. A person with Alzheimer’s disease who meets the level of care need (nursing facility) may be functionally eligible, given no one’s safety, health, and welfare are jeopardized. Assisted living facilities with a memory care unit may be enrolled as Medicaid providers, which means it is possible for eligible waiver recipients to receive dementia specific care.

Nevada HCBS Waiver for the Frail Elderly (HCBS-FE)

The Nevada Home and Community Based Waiver for the Frail Elderly (HCBW-FE), formally called the Waiver for the Frail Elderly, offers an Augmented Personal Care (Assisted Living) benefit with four levels of care. Supportive services may include companionship, medication management, personal care assistance, homemaker services, and 24-hour supervision. Staff providing care for persons with dementia are required to be trained accordingly.

New Hampshire Choices for Independence (CFI) Waiver

The CFI Waiver, previously called the Home and Community Based Care Program for the Elderly and Chronically Ill (HCBC-ECI), offers residential care facility services, which includes supportive services (personal care assistance and supervision) in assisted living residences. Intended for New Hampshire residents who require a nursing home level of care, dementia care and services can also be provided in this setting.

New Jersey Managed Long Term Services and Supports (MLTSS)
In the state of New Jersey, the Medicaid program is known as NJ FamilyCare, and assisted living services are made available through the Managed Long Term Services and Supports (MLTSS) program. MLTSS is for persons of all ages who meet the eligibility criteria. When determining functional need, cognitive deficits, which are commonly seen in persons with dementia, are considered. More info.
New Mexico Centennial Care Community Benefit

In New Mexico, Medicaid is called Centennial Care, and long-term home and community based services and supports are made available through what is called Community Benefit (CB). While program participants must require a nursing facility level of care (NFLOC), assisted living services are available via CB. Dementias are stated as conditions that might be cause for a determination of NFLOC and include Alzheimer’s disease, Lewy Body, and Multi-Infarct.

New York Assisted Living Program
The Assisted Living Program (ALP) is open to adults 21+ years old who have a medical need for nursing home care, but can live in an assisted living residence with the appropriate supports. This program is unique in that it is open to both Medicaid and non-Medicaid eligible persons. The ALP can provide home health aides, personal care assistance, housekeeping services, and personal emergency response systems. While Medicaid will not pay for room and board, it is possible for SSI to supplement one’s income to cover the cost. ALP is suitable for persons in the earlier stages of dementia, but wouldn’t be suitable for persons with advanced stages of dementia, as participants must be somewhat mobile and not present a danger to other assisted living residents. More info.
Ohio Assisted Living Waiver Program

The Assisted Living Waiver Program provides supportive services in assisted living facilities for persons 21+ years of age who require a nursing home level of care. In Ohio, assisted living facilities are commonly called residential care facilities. Persons with Alzheimer’s disease and related dementias that meet the eligibility criteria can receive personal care assistance, housekeeping, non-medical transportation, health assessments and limited nursing care, and 24-hour on-site response in assisted living via this waiver. Some facilities have memory care units. More info.


MyCare Ohio
My Care Ohio, also called the Integrated Care Delivery System Medicaid Waiver, and commonly abbreviated as ICDS, has mandatory enrollment for “dual eligible” persons. (The term dual eligible refers to persons who are eligible for both Medicaid and Medicare.) My Care Ohio is a managed care program that is only available in 29 Ohio counties. Persons receiving services via Ohio’s Assisted Living Waiver (discussed above) who are dual eligible, including those with dementia, will automatically be enrolled in My Care Ohio and continue to receive the same assisted living services. More info.

Oklahoma ADvantage Waiver
The ADvantage Waiver offers a variety of home and community based services to prevent the premature institutionalization of the disabled and frail elderly. One such benefit is assisted living services, which offers personal care assistance, intermittent nursing services, medication assistance, and housekeeping in assisted living facilities. While persons with Alzheimer’s disease and related dementias are eligible to receive assisted living services, specific memory care services are not provided.
Oregon K Plan
Oregon’s K Plan, also called the Community First Choice (CFC) State Plan Option, provides home and community based services to promote independent living and prevent unnecessary nursing home admissions for persons who require a nursing home level of care. While not technically a waiver program, CFC will pay for services provided in assisted living facilities. Persons with dementia, such as Alzheimer’s disease, who meet the eligibility criteria are able to receive these benefits.
Pennsylvania Aging Waiver

Pennsylvania’s aging waiver is for residents 60 and older who need nursing home level care. The benefits include meals, transportation, physical therapy, and help with activities of daily living. Applicants who are Medicaid-eligible can receive services in their home or community, which may include memory care residences.

Rhode Island Medicaid Section 1115 Comprehensive Demonstration Waiver

RI operates its whole Medicaid program, including home and community based long-term services and supports, under the Rhode Island Medicaid Section 1115 Comprehensive Demonstration Waiver. This waiver was originally called the Global Consumer Choice Compact Waiver, or simply, the Global Waiver. Assisted living services (personal care assistance, chore and homemaker services, companionship, and medication management) is an available benefit for persons, including those with dementia, under this waiver.

South Carolina Community Choices Waiver
Via Community Choices, a variety of supportive services are provided for persons 18 and over who are not able to complete their activities of daily living without assistance, and therefore, require a level of care consistent to that which is provided in a nursing home. The impairment, resulting in the need for care, can be physical or cognitive in nature, both of which are commonly seen in persons with dementia. Program participants have the option of receiving personal care assistance and supervision in assisted living residences.
South Dakota  Home & Community-Based Options and Person Centered Excellence Waiver (HOPE)
For elderly individuals aged 65 and older and disabled adults who require the level of care provided in a nursing home, supportive services can be received in assisted living facilities. These include personal care assistance, homemaker services, 24-hour supervision and response, social and recreational activities, and medication assistance. Cognitive loss, which is common in persons with Alzheimer’s disease, is a consideration of functional need when determining eligibility for waiver services.
Tennessee CHOICES in Long-Term Services and Supports Program
CHOICES provides supportive services to help the aged and disabled to continue to live in their homes or communities rather than require placement nursing homes. While program participants must cover the cost of room and board in assisted living residences, assistance with personal care, medication administration, and homemaker tasks are available for eligible program participants. Based on the needs of a person with dementia, it is possible to meet the functional requirement for CHOICES.
Texas STAR+PLUS HCBS Medicaid Waiver
A managed care program for the elderly and disabled, service coordination and long term services and supports are provided via STAR+PLUS HCBS (home and community based services). In addition to being able to receive supportive services, such as assistance with daily living tasks at home, program participants can also receive benefits in adult foster care homes and assisted living residences. More info.
Vermont Choices for Care Program

Vermont’s Medicaid program is called Green Mountain Care and the Choices for Care Program operates under the state’s Vermont Global Commitment to Health Waiver. Via Choices for Care, elderly and disabled state residents who require a nursing home level of care can receive a variety of long-term care services and supports. This includes “enhanced residential care”, which provides services, such as personal care assistance, medication management, housekeeping, and 24-hour supervision, for program participants residing in assisted living.

Washington Community Options Program Entry System Waiver (COPES)

COPES is a Medicaid (Apple Health) Waiver for seniors 65 and over and physically disabled adults who require care consistent to that which is provided in a nursing home. Program applicants can meet the level of care need if they require supervision and assistance with at least one daily living activity due to an impairment in memory / decision making, disorientation, or wandering, which are common cognitive impairments seen in persons with dementia. In addition to a variety of supportive services that enable eligible applicants to continue to live in their own homes, eligible persons can also receive services in assisted living. More info.


Specialized Dementia Care Program

The Specialized Dementia Care Program provides services in assisted living facilities specific to persons with dementias, such as Alzheimer’s disease, Lewy Body Dementia, Creutzfeldt-Jakob disease, Pick’s disease, and vascular dementia. Assisted living staff are awake 24 / hours per day and are trained to work with persons with dementia. Nursing services are available intermittently, as well as personal care assistance, medication management, and other supportive services.

Wisconsin Family Care 
Family Care is an HCBS option under Wisconsin Medicaid which provides services and supports to disabled adults and frail elders in their homes or communities. Benefits are administered through a Managed Care Organization in one’s particular county, after a personalized care plan has been made based on unique needs. Benefits including help with activities of daily living are available in Community Based Residential Facilities, which is a legal term in Wisconsin that can include assisted living homes with dementia care.


How to Apply for an Assisted Living Waiver

The assisted living waiver application process is not the same in all states. However, the first step towards applying for assistance is to determine if you (or your loved one) is eligible for Medicaid. A non-binding Medicaid eligibility test is available here.

If determined eligible, the next step is to apply for Medicaid. Since the application process varies based on the state in which one resides, it is vital one contact the Medicaid agency in their state to enquire about the application process. To locate your state Medicaid agency, click here.

If determined ineligible, the candidate should consider contacting a Medicaid planning professional to assist them in becoming eligible.