Medi-Cal Long-Term Care: Nursing Home, ALW or Home (2026)

Medi-Cal pays for long-term care in three settings: a nursing facility, an assisted-living or board-and-care home through the Assisted Living Waiver (ALW) in fifteen counties, and your own home through In-Home Supportive Services (IHSS) and the Home and Community-Based Alternatives (HCBA) waiver. Medicare does not pay for long-term care; it covers up to 100 days of skilled nursing after a hospital stay. Which setting applies depends on the level of care the person needs, the county, and the waitlists.

Which program fits?

Where Medi-Cal pays for long-term care

Setting	Program	What Medi-Cal pays	What you pay	Where to start
A nursing facility	Medi-Cal long-term care (aid codes 13, 23 and 63)	The facility's bill for care, room and board	Your monthly income above a personal needs allowance of at least $35, as your share of cost	The county Medi-Cal office, usually with the facility's help
An assisted-living or board-and-care home	The Assisted Living Waiver, in fifteen counties	A daily rate for the waiver's care services, $95.69 to $270.80 a day in 2026 by tier	Paid to the home from income: $706.07 room and board plus up to $738.00 care and supervision, $1,444.07 in all; the resident keeps at least $182.00	A Care Coordination Agency, which sends the waitlist request
Your own home	IHSS; the HCBA waiver for higher needs	Hours of help in the person's own home from a provider the person chooses; the waiver adds nursing and case management	Nothing for the hours; your own housing and living costs	The county IHSS office; an HCBA waiver agency

Does Medicare pay for long-term care?

No. Medicare.gov calls long-term care "custodial care" and says plainly that "Medicare doesn't pay for long-term care". What Medicare Part A does cover is a short stay in a skilled nursing facility after a qualifying hospital stay, up to 100 days. For the daily help most people need for months or years, Medicare.gov points to Medicaid, which in California is Medi-Cal. Medicare and the waiver, compared.

Medi-Cal in a nursing facility

A person who needs nursing-facility care can get Medi-Cal with or without a monthly share of cost. The resident keeps a personal needs allowance of at least $35 a month, set by Welfare and Institutions Code section 14005.12, and the rest of the month's income goes to the facility as the share of cost; Medi-Cal pays the difference. The county may send form MC 604, "Additional Income and Property Information Needed for Medi-Cal", when it needs long-term-care income or property details; answer it by the date on the letter. In 2026 the countable asset limit is $130,000 for one person through June 30, 2027, the limit for the Medi-Cal the waiver requires; the figures and what counts are on income and asset limits. This page does not cover the rules for a spouse who stays at home or what happens to a home after death; ask the county eligibility worker and get the answer in writing. Moving from a nursing facility to the waiver.

Medi-Cal in an assisted-living home: the ALW

Medi-Cal does not pay for assisted living on its own. Through the Assisted Living Waiver, Medi-Cal pays a participating home for a person's care, in fifteen California counties, and the resident pays room and board from income. The waiver needs full-scope Medi-Cal with no monthly share of cost, a nurse assessment at the nursing-facility level of care, and a place on the state's waitlist. Does Medi-Cal pay for assisted living?

Medi-Cal at home: IHSS and the HCBA waiver

In-Home Supportive Services pays for help in the person's own home, for hours of care from a provider the person chooses. IHSS ends when the person moves into a licensed home. The Home and Community-Based Alternatives waiver adds nursing care and case management at home for people with higher needs, and it has a waitlist of its own. how IHSS and the waiver compare and the HCBA waiver explain both.

Which Medi-Cal do you need?

Nursing-facility Medi-Cal accepts a monthly share of cost; the Assisted Living Waiver needs none. Ask the county IHSS office how a share of cost affects IHSS. Full scope with no share of cost is possible for a person 65 or older, blind or disabled whose income is within the 2026 figure for the Aged, Blind and Disabled program, $1,836 a month for one person and $2,490 for two from April 1, 2026, and whose countable assets are within $130,000; the county decides. How a senior gets full-scope Medi-Cal before the ALW walks through the application.

Questions people ask

Does Medi-Cal pay for nursing homes?

Yes, for people who need that level of care and qualify, with or without a share of cost. The resident keeps at least $35 a month for personal needs; the rest of the income goes to the facility.

Does Medi-Cal pay for assisted living?

Only through the Assisted Living Waiver, in fifteen counties, and only for the care. The resident pays room and board from income.

What is the Medi-Cal long-term-care income limit?

Nursing-facility Medi-Cal has no fixed income cap: income above the $35 allowance goes to the facility as share of cost. The waiver needs full-scope Medi-Cal with no share of cost, which in 2026 means income within $1,836 a month for one person under the Aged, Blind and Disabled program; the county decides.

Can I keep my house?

The county decides how a home is treated, for the applicant and for a spouse who stays in it, under Medi-Cal's property rules. Ask the county eligibility worker and get the answer in writing; this page does not state those rules.

How do I apply?

For nursing-facility Medi-Cal, through the county, usually with the facility's help. For the waiver, through a Care Coordination Agency after Medi-Cal is in place. For IHSS, through the county IHSS office.

Six questions show which program to look at first.