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Medicaid Waivers and Assisted Living

Minnesota's Elderly Waiver pays for services inside assisted living, never room and board -- here is what that split actually means for your budget.

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Short answer

Minnesota runs one combined HCBS waiver, the Elderly Waiver, that pays for care services -- never room and board -- delivered inside a licensed assisted living facility through a customized living service plan. A near-eligible senior not yet on Medical Assistance can use Alternative Care, a state-only program with a nearly identical service list, as a bridge.

The room-and-board gap families miss

Even after Elderly Waiver approval, the resident (or their family) is still responsible for the community's room-and-board charge -- rent, meals, utilities. Only the care-services portion is covered. For very low-income residents in certain settings, Minnesota's separate state Housing Support benefit can help offset room and board, but it is not automatic and not available everywhere.

Ask this before you sign

Ask directly whether the community holds a Medicaid waiver provider agreement and how many current residents actually use it under the Elderly Waiver. A community can hold an agreement in principle and still have no waiver capacity currently available.

How families pay for care. Minnesota's Elderly Waiver and Alternative Care programs pay for care services -- never room and board -- and VA Aid and Attendance can add tax-free monthly income for eligible veterans. Read the full explanation →

Questions families ask

Who pays for a nursing home stay right after a hospitalization in Minnesota?

Medicare Part A can cover a limited number of days of medically necessary skilled nursing facility care following a qualifying inpatient hospital stay of at least three days, subject to coinsurance after day 20. After Medicare coverage ends, the resident is privately responsible unless they qualify for Medical Assistance, at which point Minnesota's long-term-care Medicaid eligibility and spend-down rules apply.

What is a MnCHOICES assessment and why does it matter for hospital discharge planning?

MnCHOICES is Minnesota's standardized long-term-care needs assessment used to determine whether someone needs a nursing-facility level of care and is functionally eligible for programs like the Elderly Waiver or Alternative Care. Starting this assessment as early as possible during a hospital stay — rather than waiting until after discharge — can shorten the gap before waiver services begin.

My parent has been diagnosed with dementia — where do I start in the Twin Cities?

Start by calling the Senior LinkAge Line (1-800-333-2433), operated by Trellis, for care navigation and options counseling. If a memory care community is eventually needed, confirm it holds MDH's 'assisted living facility with dementia care' license (Minn. Stat. 144G.10, subd. 2(b)) — verify this directly through the MDH Health Care Provider Directory rather than relying on marketing materials.

My parent keeps wandering — what safety and licensing questions should I ask a facility?

Ask directly whether the community holds the 'assisted living facility with dementia care' license, which is legally required for any secured dementia unit and mandates dementia-specific staff training under Minn. Stat. 144G.83. A base assisted living license without this designation is not licensed to operate a secured wandering-prevention unit.

I'm burning out as a caregiver for my spouse or parent — what help is available in the Twin Cities?

Trellis, the metro's Area Agency on Aging, funds and coordinates caregiver support and respite programs, and the Senior LinkAge Line (1-800-333-2433) is the free starting point to connect with them. A verified current adult day services rate for the metro was not located in this research and should be confirmed directly with a provider before budgeting.

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