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Medicare and the Assisted Living Waiver: who pays for what
Medicare does not pay for assisted living, custodial care or room and board. It pays for medical care. ALW is a Medi-Cal program, and people with both Medicare and Medi-Cal keep both. Who pays what.
Medicare does not pay for assisted living, for custodial care (help with bathing, dressing, meals and medications) or for room and board. It pays for medical care: doctor visits, hospital stays and short skilled nursing facility stays after a qualifying hospital stay. The Assisted Living Waiver (ALW) is a Medi-Cal program. People who have both Medicare and Medi-Cal keep both.
Important: ALW pays a participating home for care and pays for care coordination. It never pays room and board (the room and meals). The California Department of Health Care Services (DHCS) decides who is eligible and releases waitlist openings (the state calls them slots) in priority order. Beta's ALW team is a Care Coordination Agency (CCA), the state-listed organization that does the ALW paperwork with you. Beta can't promise eligibility, an opening, a date or a room.
Who pays what
The Medicare column comes from Medicare's own pages, linked below. The ALW column comes from DHCS's ALW pages.
| Cost | Medicare | Medi-Cal and ALW |
|---|---|---|
| Medical care: doctor visits, hospital stays, tests | Medicare pays first. | Medi-Cal may help with what Medicare leaves, such as premiums and copays. |
| Prescription drugs | Medicare drug coverage (Part D). People with both programs are enrolled in a Medicare drug plan and get Extra Help with costs. | Medi-Cal may cover a few drugs Part D does not. |
| Short rehab in a skilled nursing facility after a hospital stay | Up to 100 days in each benefit period, after an inpatient hospital stay of at least 3 days. In 2026 you pay $217 a day for days 21 to 100. | Medi-Cal may help with that daily amount. A long nursing-home stay is a Medi-Cal matter. |
| Care in an assisted-living home | No. | Through ALW, Medi-Cal pays the home for care, at a daily rate DHCS sets by care tier. |
| Room and board | No. | No. You pay it from income, such as SSI/SSP. |
| Care coordination | No. | Through ALW, at no charge to you. |
SSI/SSP is Supplemental Security Income plus the State Supplementary Payment. What ALW pays for and what you pay has the 2026 figures.
What Medicare pays
Medicare's long-term care page says Medicare and most health insurance do not pay for long-term care, which it also calls custodial care, in a nursing home or in the community. If your family member needs help with daily tasks and nothing more, Medicare does not pay for it, in any setting.
Medicare does pay for a short skilled stay. After a qualifying hospital stay, Part A covers up to 100 days of skilled nursing facility care in each benefit period, when the person needs daily skilled care. Medicare's skilled nursing facility page has the rules.
What ALW pays
Through ALW, Medi-Cal pays a participating assisted-living home for care, in fifteen California counties, for people DHCS finds eligible when their turn comes. The state licenses these homes as a Residential Care Facility for the Elderly (RCFE) or an Adult Residential Facility (ARF). ALW does not pay the room and meals. Does Medi-Cal pay for assisted living? has the full answer.
What people ask
Does Medicare Advantage pay for assisted living?
No. A Medicare Advantage plan has to cover at least what Original Medicare covers, and Original Medicare does not cover assisted living or custodial care. Some plans add extra benefits. Ask the plan, in writing, what it covers.
I only have Medicare. Can I get ALW?
Not with Medicare alone. ALW needs full-scope Medi-Cal with no monthly share of cost. The county Medi-Cal office decides whether you can have that. How to check the kind of Medi-Cal ALW needs.
Will I lose Medicare if I enroll in ALW?
No. You keep both. Medicare pays first for the medical care it covers, and Medi-Cal pays after it. ALW adds to your Medicare and does not change your doctors or your drug plan.
Before anyone moves
Keep the person safely where they are until three things are in writing: DHCS has found them eligible, your agency has the enrollment date, and the home has agreed to admit them under ALW. A Medicare rehab stay that is ending is not one of those three. Not sure which program pays for what in your case? Request a callback.
About this informationReviewed October 12, 2026. Program details may change. View official sources and page limitations.
Written by Beta's ALW team and checked against the official sources this page lists; facts checked through October 12, 2026. Where this page and an official source differ, the source controls.
This page gives general California ALW information. DHCS decides eligibility after the nurse assessment and releases openings. Each home decides its own admissions. Nothing here is an eligibility decision or a promise of enrollment, and it does not guarantee a place in a home. You may choose any Care Coordination Agency listed by DHCS and any participating home.
Something out of date? Tell Beta's ALW team.