Medicaid Assisted Living Waivers | Helping Persons with Dementia Afford Residential Memory Care
What is an Assisted Living Waiver?
Medicaid is a state-run health insurance program for financially needy individuals. They cover children, families, pregnant women, disabled persons, and seniors. For this article, we will focus on patients with Alzheimer’s disease and related dementias, such as Parkinson’s disease dementia, frontotemporal dementia, and Lewy body dementia. Medicaid programs help pay for aspects of assisted living. The terms “Memory Care”, “Special Care Unit”, and “Alzheimer’s Care” all refer to assisted living facilities for people with dementia. In these communities, the staff is specially trained and there are extra design elements and security measures to make the residences safer and dementia friendly.
While some of the 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 referred to as 1915(c) Medicaid waivers, these waiver programs are intended to prevent (or at the very least delay) the move into a nursing home.
With the benefit of these waivers, long-term care is provided for the disabled and elderly, and often people with dementia. This can take place in a variety of settings, including:
– One’s own home
– The home of a relative
– An adult foster care home
– An adult day care center
– A group residential living facility
– An assisted living or memory care community
This article will focus on the last of those, assisted living and assisted living with memory care. From the assisted living waivers, a variety of benefits are provided in assisted living and memory care. They allow patients who otherwise would not be able to live independently to remain in the community.
Assisted living waivers DO NOT cover the cost of room and board. Instead, they cover the cost of caring for your loved one. This can include assistance with activities of daily living (ADLs). Some examples might be:
– Bathing
– Dressing
– Grooming
– Mobility (getting from room to room)
– Going to the bathroom
– Eating
Personal care assistance, attendant care, and custodial care are all standard terms used for this type of care. Homemaker services, medication management, transportation, and activities (social, recreational, and educational) are also frequently provided. Benefits change state by state because they are based on the specific state’s assisted living waiver.
The HCBS waivers providing care assistance in assisted living residences may be commonly referred to as 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, they may not be able to receive benefits immediately through the program. This is because these waivers have caps on enrollment, which means that there is only a limited number of participants who can be accepted to a program. Once those slots are filled, a waitlist is created.
Relevance for Persons with Alzheimer’s / Dementia
To be eligible for an assisted living waiver, certain requirements must be met. There are both functional and financial requirements regardless if one has Alzheimer’s disease or another form of dementia. This means a diagnosis of Alzheimer’s disease does not make one automatically eligible. When people with dementia do meet the criteria, a Medicaid waiver can be the difference between moving to a nursing home facility and continuing to live in the community with more independence.
Change can be particularly difficult for people with dementia. The ability to live in a home-like setting or assisted living can be beneficial. In these settings, patients receive supervision and care rather than having to move to an institution. Residing in an assisted living residence also allows patients to maintain a greater degree of independence which leads to a higher quality of life.
Some assisted living waivers offer dementia care, also called “memory care”. These are facilities where staff is specifically trained and equipped to handle the needs of people with dementia. Specific activities, such as music and art, may be organized to stimulate memory and cognitive functioning.
Eligibility Requirements
Financial Criteria
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 for the majority of the states and waivers:
– In 2023, a single applicant must not have income greater than 300% of the Federal Benefit Rate, which is $2,742 per month.
– The asset limit is $2,000 for an individual. Some assets are exempt, which means they do not count toward the limit. In most cases, primary homes are exempt. See state specific eligibility requirements here.
For married couples where only one spouse is applying for the assisted living waiver, there are spousal impoverishment rules in place to prevent the non-applicant 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 ensure non-applicant spouses are financially stable but also help to lower the countable income and assets of applicant spouses. As of 2023, in most states, up to $3,715.50 per month in income can be transferred from the applicant to the non-applicant spouse. Additionally, the non-applicant spouse can retain up to $148,600 of the couple’s joint assets.
Level of Care Requirements
In addition to meeting the financial requirements, applicants of Assisted Living Waivers must demonstrate a functional need for the assistance provided in these programs. In most cases, an applicant must show a level of care consistent with that which is provided in a nursing home residence. Often, an assessment is made by a healthcare professional working for Medicaid, who visits the applicant and uses a state-specific checklist to determine care needs.
It is not easy to define what nursing facility level of care (NFLOC) means. This is because each state, and even various programs within a state, define this designation differently. For instance, nursing facility level of care 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, nursing facility level of care 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
Patients with dementia who have income or assets over the Medicaid eligibility limit(s) are not automatically disqualified from Medicaid or an assisted living waiver. Instead, several planning techniques can be implemented to meet the financial eligibility requirements.
Excess Income
The two main ways an applicant with income above the Medicaid limit can still be approved for Medicaid are via the Qualified Income Trusts and the Medically Needy Pathway.
– Qualified Income Trusts allow people to deposit their “excess” income (the income over Medicaid’s income limit) into an irrevocable trust. This is managed by someone other than the Medicaid applicant, normally 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 qualified income trusts, 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. In other words, the Medically Needy Pathway 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 can range from 1 month to 6 months. Once the Medicaid applicant has spent their income down to the medically needy income limit for the spend down period, they are 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 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 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 but only 30 months in California and New York. This is where 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 the market value during the “look-back” period, the applicant will be punished with a period of Medicaid ineligibility. This rule is in place to prevent people from giving away their “excess” assets to meet the asset limit.
Other ways to get one’s assets below the limits are Irrevocable Funeral Trusts (prepaying for funeral and burial costs for the applicant or a family member) and Medicaid-exempt Annuities (where a lump sum of cash is converted into a regular income stream).
How Medicaid Planning Can Help
Medicaid planners are instrumental to the Medicaid application process by:
– 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 or asset limit. Remember that allowable planning strategies vary by state, and not all states allow qualifying income trusts or permit a medically needy pathway.
If one is over the financial eligibility limit, it is suggested one seek the counsel of an experienced Medicaid planner. In addition to helping Medicaid applicants meet the income and asset limits, professional planners also assist families in saving financial resources from Medicaid’s estate recovery program and preserving them as an inheritance.
Some of these techniques are complicated and time-consuming. Incorrectly implementing a planning strategy to meet Medicaid’s income or asset limits 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 people with Alzheimer’s disease and related dementias. There are links with 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.
Room and board ARE NOT covered by benefits from assisted living waivers. However, a variety of supportive benefits may be provided. This includes 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 dementia care support for patients with Alzheimer’s or dementia. Remember, not all assisted living waivers are called “assisted living waivers”.
| Medicaid Assisted Living Waivers for Alzheimer’s / Dementia (Updated Jan. 2023) | |
| 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. |
| Alabama | Alabama’s Elderly and Disabled Waiver (E&D Waiver) Through this Home and Community-Based Services program, people can stay in their homes instead of moving into a nursing home. The definition of home can include the individual’s residence or adult foster care. The covered benefits are support services and vary depending on one’s needs. They can range from respite care to in-home care. |
| Arizona | Arizona Long Term Care System (ALTCS) Through ALTCS, seniors and disabled individuals who require a nursing home level of care can 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 because people who are not eligible for Medicaid may also be program participants (though some financial limits still apply). For persons with Alzheimer’s disease or 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. Program participants can reside and receive care assistance in assisted living communities. |
| 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 people 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 people 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 a 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 the 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 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 support 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 intending to prevent and delay 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. People with dementia are eligible to receive benefits, which include attendant care, homemaker and chore services, recreational activities, and onsite staff 24 hours per 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 several benefits allow program participants to live independently in their homes, assisted living services are 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 help nursing home-eligible people to remain living in their homes. 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 called 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 patients with dementia can be a possibility if there is a facility that is on the approved provider list and provides this type of care. Applicants may be placed on a waitlist. |
| Maine | Maine Medicaid Home and Community Benefits Waiver for the Elderly and Adults with Disabilities (MaineCare) This program is intended to help people avoid nursing homes by staying in their homes as long as possible. That is done via long-term care and support. This can include in-home care, meals delivered to one’s home, and medical equipment. Participants must live in their own homes or that of a loved one. That means to be eligible for this waiver, one can not reside in an assisted living community. Meeting the waiver’s requirements does not mean your loved one will receive benefits. There can be a waitlist list for MaineCare because there is limited space in this program. |
| Massachusetts | MassHealth Personal Care Attendant Program (PCA) This program gives recipients benefits with help with activities of daily living (ADL). That means there can be extra help with everyday living like going to the bathroom, getting dressed, meal prep, and light housework. Through extra support and in-home care, patients can stay in their homes longer and avoid an early move into a nursing home.Frail Elder Waiver (FEW) This waiver is part of Home and Community-Based Services and provides extra care and support services so participants stay in their own homes as long as possible and avoid a costly move into a nursing home. Individualized care plans are created offering each patient a unique long-term care plan. Support benefits can range from in-home care to medical devices and respite care. Enrollees must live in their own home, that of a loved one, adult foster care, or some other home-like setting. Meeting the program’s qualifications does not guarantee coverage. This waiver has a cap on how many participants it can enroll, so there might be 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 individuals 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 |
| 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 those 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 needed 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. The safety of dementia patients is taken into account when creating one’s care plan. |
| Missouri | Missouri Medicaid Aged and Disabled Waiver (ADW) The ADW is meant to offer long-term support services to enrollees enabling patients to stay in their homes. The thought is that with additional support services, your loved one will not need to move into a nursing home. Participants must live in their own homes or that of a loved one. Through this program, there can be benefits in the form of adult day care, meal delivery, respite care, and help with household chores. There is an enrollment cap with this waiver, so there could be a waitlist. More info.MO HealthNet Structured Family Caregiving Waiver (SFCW) The SFCW offers extra assistance with activities of daily living (ADL) to patients with Alzheimer’s and dementia. With extra support services, participants can stay in their homes as long as possible and avoid moving into a nursing home prematurely. The benefits offer in-home long-term care options. There can help with bathing, eating, meal prep, and light household chores. There is limited space in this program, so there can be a potential waitlist. More info. |
| 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 the 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 needed (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 eligible waiver recipients can 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 people of all ages who meet the eligibility criteria. When determining functional needs, 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. Because dementia is a covered condition, determining the need for nursing facility level of care can include patients with 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 support. This program is unique in that it is open to both Medicaid and non-Medicaid-eligible recipients. 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, SSI can supplement one’s income to cover the cost. ALP is suitable for people 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. |
| North Carolina | North Carolina Medicaid Community Alternatives Program for Disabled Adults (CAP/DA) This waiver is designed to offer long-term care to program enrollees. That means that individualized care plans are created depending upon the amount of care someone already has combined with what they need. This Home and Community-Based service offers your loved one the opportunity to stay in their homes for as long as possible and not move into a nursing home until necessary. Benefits can range from help with activities of daily living (ADL) to respite care and adult day care. There is limited availability with this waiver, so once the program is full a waitlist starts. More info. |
| North Dakota | North Dakota Home and Community-Based Services Medicaid Waiver (HCBS) The HCBS waiver is meant to offer qualified applicants long-term care. This program is designed to prevent moving into a nursing home early by providing extra support. This aids the elderly and disabled in living independently as long as possible. Benefits are tailored to each patient’s individual needs and range from support services like in-home and respite care to medical equipment and meal delivery. There is an enrollment cap in this program, so even if you meet the functional and financial criteria, there can be a waitlist. More info. |
| Ohio | Assisted Living Waiver Program
The Assisted Living Waiver Program provides supportive services in assisted living facilities for people who are older than 21 and require a nursing home level of care. In Ohio, assisted living facilities are commonly called residential care facilities. People 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 |
| 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 offer 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 is also called the Community First Choice (CFC) State Plan Option. This program 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. People with dementia, such as Alzheimer’s disease, who meet the eligibility criteria are able to receive these benefits. |
| Pennsylvania | Pennsylvania’s Community HealthChoices Program (CHC) Pennsylvania’s Medicaid waiver is for residents who need long-term care and meet the financial and medical requirements. This program is for those who need nursing home level care. The benefits include meals, transportation, physical therapy, and help with activities of daily living. Applicants can receive services in their home or community, which may include memory care residences. There is limited space in this waiver, so there can be a waitlist to receive benefits. 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 | Rhode Island Medicaid Long-Term Services and Supports (Medicaid LTSS) RI operates its Medicaid program which includes this Home and Community-Based waiver. This program’s goal is to keep elderly and disabled residents in their homes and living as independently as possible. By focusing on supporting long-term care, patients can prevent going into nursing homes early. Assisted living services (personal care assistance, chore and homemaker services, companionship, and medication management) are an available benefit for qualified applicants of this waiver. Additionally, there can be coverage afforded to medical equipment, adult day care, and more depending on an individual’s need. There is limited space in this waiver, so after meeting the eligibility requirements, there can be a wishlist. |
| 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 with 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 needs 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 continue to live in their homes or communities rather than require placement in 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. |
| Utah | Utah’s Aging Waiver This waiver provides long-term care and support to qualified Medicaid individuals. This program is meant to help residents who are over 65 stay living independently as long as possible and not have to move into a nursing home. Through this Home and Community-Based Services program, benefits are offered to match the needs of your loved one. Support in the form of help with activities of daily living, light housework, and meal prep is available. There can also be coverage for medical equipment and safety home upgrades. Additionally, there can be adult daycare options and respite care. A requirement of the program is that individuals must live on their own or with a loved one. They can not live in adult foster care or an assisted living community. There are caps on how many people can be admitted to this program, so it is possible after being accepted there is a waitlist. |
| 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. |
| Virginia | Virginia Medicaid’s Commonwealth Coordinated Care Plus Waiver Program (CCC Plus) This Medicaid waiver helps patients who qualify through their finances and medical needs with long-term care services. By offering in-home support, individuals can stay independent for as long as possible before moving into a nursing home. Support services are tailored for each recipient and are based on what they currently have and need to live safely. Benefits can be given in the form of respite care, adult day care, medical equipment, and help to transition from a nursing home into a residential community. This is a program that is limited by space, so after qualifying, there can be a waitlist. |
| 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 with that which is provided in a nursing home. Program applicants can meet the level of care needed if they require supervision and assistance with at least one daily living activity due to an impairment in memory or 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 dementia, 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. |
| West Virginia | West Virginia Medicaid Aged and Disabled Waiver (ADW) The ADW is a long-term care support service provided by the Home and Community-Based Service. They aim to prevent people from moving into nursing homes early by offering benefits that support them living individually in their own homes. The help can range from helping with activities of daily living, light housework, and chores, to transportation and nursing services. There is limited availability for this waiver, so you can find a waitlist after qualifying. |
| 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. |
| Wyoming | Wyoming Community Choices Waiver (CCW) The Wyoming Community Choices Waiver offers long-term care through the Home and Community-Based Services program. Built to keep people from having to make a costly move into a nursing home, extra support is offered. There can be benefits in the form of respite care, adult day care, nursing services and help with activities of daily living. Applicants can live in their own homes, in an assisted living community, or adult foster care. After meeting the requirements through finances and medical needs, there is no guarantee of benefits. There is an enrollment cap for this waiver, participants are put on a waitlist. More info. |
How to Apply for an Assisted Living Waiver
The assisted living waiver application process is not the same in all states. The first step towards applying for assistance is to determine if you (or your loved one) are 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 to contact the local Medicaid agency and enquire about the application process. To locate your state Medicaid agency, click here.
If determined ineligible, consider contacting a Medicaid planning professional to seek help becoming eligible.