Paying for Assisted Living in California

Who pays for a residential care home

According to California Advocates for Nursing Home Reform (CANHR), a California nonprofit, most people pay privately for residential care. Public help exists, but each program covers a narrow piece. One pays for care but not rent, and only in certain counties. Others add monthly income that can go toward the bill.

This guide covers each option, who qualifies, and where to start. It doesn’t list dollar amounts. Benefit amounts and limits are updated regularly, so each section tells you where to find the current figure.

Medicare won’t pay for it

Medicare does not pay for long-term care. Medicare.gov describes long-term care, which it also calls “custodial care,” as help for people with a chronic illness or disability, and it names assisted living facilities as one of the places people receive it. That is the kind of help a residential care home (RCFE) provides. If you’re new to the term, What is an RCFE? explains it.

Medigap and most other health insurance don’t cover it either. Under Medicare, you pay all costs for services it doesn’t cover, including most long-term care.

Medicare.gov points people to Medicaid (Medi-Cal in California) or private long-term care insurance instead. But regular Medi-Cal doesn’t pay for a care home either. CANHR notes that neither Medicare nor regular Medi-Cal pays directly for residential care, because these homes aren’t medical facilities. The exception is a Medi-Cal program called the Assisted Living Waiver, covered below.

Paying privately

CANHR puts it plainly: “Most people must pay privately for care.” It adds that long-term care insurance covers only a very small percentage of people, and that public funding through SSI is very limited.

So it helps to work out early how long private money can last, and which program might cover part of the bill later. Knowing exactly what a home charges, and how its rates go up, matters as much as any program. The questions at the end of this guide help with that.

The Medi-Cal Assisted Living Waiver

The Assisted Living Waiver (ALW) is a Medi-Cal program run by the California Department of Health Care Services. It pays for care and services in a residential care home. It does not pay room and board. The resident pays the rent, and Medi-Cal pays for the care. SSI/SSP income, described in the next section, can go toward that rent.

The services include personal care and help with daily activities, meals and snacks, laundry, housekeeping, help taking medications, transportation, and intermittent skilled nursing.

To qualify, a person must be 21 or older, be eligible for full-scope Medi-Cal with no share of cost, and need a nursing facility level of care. That last point is a high bar. The waiver is for people who need the level of care a nursing home provides.

It is also limited by place. According to CANHR, the program runs in 15 counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara and Sonoma. The current waiver term runs through February 28, 2029.

And there is a wait. The program reached capacity in 2017, and the state has kept a waitlist ever since. Open slots are released to Care Coordination Agencies each month. To get on the list, contact a Care Coordination Agency in your county and fill out a one-page Waitlist Request Form. If you don’t know which agency serves your county, your local Area Agency on Aging (see the last section) is a reasonable first call.

CANHR also notes that some Medi-Cal managed care plans now offer “Community Supports,” which may help pay for assisted living for high-risk or homeless members who have Medi-Cal with no share of cost. Ask your parent’s Medi-Cal plan whether it offers this.

SSI/SSP in a licensed care home

Supplemental Security Income with the State Supplementary Payment (SSI/SSP) is a monthly income program paid for by the federal government and California. It is for people who are 65 or older, blind or disabled, and who have limited income and resources.

A person on SSI/SSP who lives in a licensed RCFE gets a higher payment, called the Non-Medical Out-of-Home Care rate. Most of that payment goes to the home. The resident keeps a smaller amount, called the Personal and Incidental Needs Allowance, for their own expenses.

There’s an important protection here. The state sets the SSI facility rate, and California regulations (Title 22, section 87464(e)) say that for an SSI/SSP recipient, a home must provide its basic services at the basic rate “at no additional charge to the resident.” Ask the home in writing which services it counts as basic and which, if any, it charges for separately.

The amounts change each January. CANHR’s fact sheet on SSI in RCFEs lists the current year’s payment, the share that goes to the home and the personal needs allowance. The California Department of Social Services publishes the official amounts.

VA Aid and Attendance

If your parent is a Veteran, or the surviving spouse of one, look at the VA pension with Aid and Attendance. It is a monthly payment added to a VA pension for qualified Veterans and survivors. One way to qualify is needing another person’s help with daily activities like bathing, feeding and dressing.

The VA does not pay a care home’s rent. Treat Aid and Attendance as extra monthly income that you can put toward the cost. In VA’s words, “You can use your Aid and Attendance payments to help pay for the services that you need.”

VA pension has an income limit and a net worth limit. The current figures, and the date they took effect, are on VA.gov’s pension rates page. You can apply online, by mail with VA Form 21-2680, or in person at a VA regional office.

Long-term care insurance

If your parent bought a long-term care policy, read it closely. In California only three categories of long-term care insurance can be sold. “Comprehensive” policies and “Nursing Facility and Residential Care Facility Only” policies cover care in a residential care home. “Home Care Only” policies do not.

Older policies may not include assisted living at all. The California Department of Insurance lists it among the benefits offered in current products, which says nothing about a policy bought years ago. Check the policy’s own wording, or ask HICAP (below) to go through it with you.

The programs side by side

Program	What it pays for	Who qualifies	Where to start
Medi-Cal Assisted Living Waiver	Care and services, not rent	Age 21+, full-scope Medi-Cal with no share of cost, nursing facility level of care, living in a participating county	A Care Coordination Agency in your county
SSI/SSP	Monthly income at a higher rate for residents of a licensed RCFE	Age 65+, blind or disabled, with limited income and resources	CANHR’s SSI fact sheet for current amounts
VA Aid and Attendance	Extra monthly income added to a VA pension	Qualified Veterans and survivors who need help with daily activities	VA.gov, by mail with VA Form 21-2680, or a VA regional office
Long-term care insurance	Depends on the policy type	People who hold a policy	The policy itself, or HICAP

Questions to ask a home about cost

Before you sign anything, ask each home the same questions and get the answers in writing.

• What does the basic monthly rate include, and what costs extra?
• Do you charge more as care needs increase? How do you decide the level of care, and how often do you reassess it?
• How often have your rates gone up, and how much notice do you give before an increase?
• What deposits or move-in fees are there, and are any refundable?
• Do you accept residents on the SSI/SSP rate? Do you take part in the Assisted Living Waiver?
• If my parent runs out of private funds, can they stay?
• If my parent later needs hospice, can they receive it here? Hospice care in an RCFE explains what that requires.

You can find licensed homes in our California directory.

Free help in California

HICAP, the Health Insurance Counseling and Advocacy Program, gives free, confidential one-on-one counseling on Medicare and long-term care insurance. Call 1-800-434-0222 or choose your county on the California Department of Aging website.

The California Department of Aging also works with 33 local Area Agencies on Aging, which coordinate services for seniors and adults with disabilities. Call 800-510-2020 to find yours.

If something in this guide looks out of date, please tell us.