Assisted Living Waiver
Does Medi-Cal pay for custodial care?
Custodial care is help with bathing, dressing, meals and medications. Medicare does not pay for it. Medi-Cal does: nursing facility, the ALW, or at home.
Yes, in the right setting. Custodial care is help with the tasks of daily life: bathing, dressing, meals, using the toilet, moving about and taking medications on time. Medicare does not pay for it. Medi-Cal pays for custodial care in a nursing facility, in an assisted-living or board-and-care home through the Assisted Living Waiver (ALW) in fifteen counties, and in your own home through In-Home Supportive Services (IHSS).
Custodial care and skilled care
| Custodial care | Skilled care | |
|---|---|---|
| What it is | Help with daily life: bathing, dressing, meals, toileting, moving about, reminders and medication help | Nursing or therapy that needs a licensed professional: wound care, intravenous medicines, rehabilitation after a hospital stay |
| Who gives it | Caregivers and aides, in a home or a facility | Nurses and therapists |
| Who pays | Medi-Cal in a nursing facility, through the ALW, or through IHSS; long-term-care insurance; private pay | Medicare for up to 100 days in a skilled nursing facility after a qualifying hospital stay, then Medi-Cal for people who qualify |
Why Medicare does not pay
Medicare.gov says it plainly. Long-term care, "also called custodial care", "includes medical and non-medical care for people who have a chronic illness or disability", and "Medicare doesn't pay for long-term care". Medicare Part A covers a short stay in a skilled nursing facility after a qualifying hospital stay, up to 100 days. Once the need is daily help rather than skilled treatment, Medicare stops, and Medicare.gov points to Medicaid, which in California is Medi-Cal. Medicare and the waiver, compared.
Where Medi-Cal pays for custodial care
- In a nursing facility. Medi-Cal pays the facility for people who need that level of care and qualify, with or without a monthly share of cost. What Medi-Cal covers for long-term care.
- In an assisted-living or board-and-care home, through the ALW. Medi-Cal pays the home a daily rate for care; the resident pays room and board from income. The waiver runs in fifteen counties and needs full-scope Medi-Cal with no monthly share of cost. Does Medi-Cal pay for assisted living?
- At home, through IHSS. The county pays for hours of help in the person's own home, including help from a family member who is hired as the provider. IHSS ends when the person moves into a licensed home. how IHSS and the waiver compare.
How people pay for custodial care
Medi-Cal, in one of the three settings above, is the public route. Long-term-care insurance pays when the policy's conditions are met. Everyone else pays privately. How to pay for assisted living in California lists every route with its dollar lines, and running out of money in assisted living says what to do before it happens.
Custodial care in a board-and-care home
A board-and-care home is a small licensed home, usually six beds, where custodial care is the whole day's work: meals, medication help, bathing, dressing and supervision. Medi-Cal pays for that care only through the ALW. Board-and-care homes and Medi-Cal. Sub-acute units and long-term acute care hospitals are skilled settings, not custodial ones; they are not part of this page.
Questions people ask
Is custodial care covered by Medi-Cal?
Yes, in a nursing facility, through the Assisted Living Waiver in an assisted-living or board-and-care home, or at home through IHSS. Each has its own eligibility rules and, for the waiver, a waitlist.
Does Medicare cover custodial care at home?
No. Medicare home health covers skilled nursing and therapy visits ordered by a doctor, not daily help with bathing, dressing or meals. Medicare.gov lists long-term care as not covered.
What is the difference between custodial care and skilled nursing?
Custodial care is help with daily life and can be given by a caregiver or aide. Skilled nursing is treatment that needs a licensed nurse or therapist. Medicare pays for skilled care for a limited time; it does not pay for custodial care.
Does the ALW pay for custodial care?
Yes. The waiver pays a participating home a daily rate for the waiver's care services, set by the person's care needs. The resident pays room and board from income.
If the person needs daily help and has or may qualify for Medi-Cal, the fit check shows whether the waiver is worth looking at.
About this informationReviewed October 20, 2026. Program details may change. View official sources and page limitations.
Written by Beta's ALW team and reviewed by Sergio B., Program Coordinator, against the official sources this page lists; facts checked through October 20, 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.