My mother is on Medi-Cal. What do we do first?
Start at the county, not at a community. Confirm she has full scope Medi-Cal, ask whether a share of cost applies and what it would mean for the waiver, and ask whoever answers what date their figures are current as of. Nothing else starts until that coverage exists.
Then find out whether she clears the gate, because this is where families get turned back. The waiver is generally written for people who would otherwise need the level of care a nursing facility provides, and a nurse assessment decides that, not the family's sense of how much help she needs. A parent who is frail but managing is often too well for it. Ask a Care Coordination Agency to check her against the criteria as they stand now.
That agency also takes the intake call and puts her on the waiting list, so get on it early. Qualifying and being housed are two different things, because only a subset of Los Angeles homes take part. The program itself is on our Assisted Living Waiver page.
Why is a nursing home funded when assisted living is not?
Nobody decided assisted living was less deserving. Nursing facility care is generally something a state Medicaid program has to cover. Care in a residential home reaches people through optional waiver programs instead, and optional is why there are capped slots and a line. Medicaid also does not pay anyone's housing, so the rent stays with the resident even where a waiver covers the care.
The arithmetic is worse for everybody. The setting with public money behind it is the expensive one, and Californians who cannot fund assisted living end up in nursing homes nobody thought they needed.
| Setting | What Medi-Cal generally covers | Who pays for the room | Typical Los Angeles cost |
|---|---|---|---|
| Assisted living or board and care, private pay | Nothing toward rent or care | The family, from income and savings | $4,500 to $8,000 a month, $3,500 to $6,000 in a small home |
| Assisted living under the Assisted Living Waiver | Care services, for eligible enrollees in participating facilities | The resident, from SSI or other income | Capped at a state rate, not the market |
| Skilled nursing, long term stay | Long term care for those who qualify | Covered as part of the stay | $10,500 to $15,000 a month privately |
These are typical Los Angeles market ranges rather than prices we set or quote, and they move with care level, room type, and neighborhood. Confirm coverage with the Department of Health Care Services.
Is any of this Medicare?
No, and it is the mix up that costs families most: Medicare pays for nobody's assisted living, nobody's custodial care and nobody's long term residence anywhere, and the narrow skilled nursing stay it does cover is worked through on our Medicare page.
What if we are not in California?
Then the specifics above are not yours, and you should be told that rather than left to assume it. Room and board still falls to the resident nearly everywhere, and assisted living care is covered only where a state has built a waiver that reaches it. Ask your state Medicaid agency about home and community based waivers, then call your Area Agency on Aging, free in every state, for an honest read on the wait.
What can you check for yourself today?
Two things, both free. Care homes here are licensed as Residential Care Facilities for the Elderly and the record is public, so look up any home you are shown in the CCLD Care Facility Search. If what you find worries you, CDSS resources for residents and families is where a family takes it next. Nursing facilities sit under a different department, in Cal Health Find. That search has had outages, so try again before deciding a home is missing.
On the money the authority is the Department of Health Care Services rather than either of those. Read its own Assisted Living Waiver material rather than anyone's summary, ours included.
- CCLD Care Facility Search, California Department of Social Services, Community Care Licensing Division
- CDSS resources for residents and families, California Department of Social Services
- Cal Health Find, California Department of Public Health, Center for Health Care Quality
How is Senior Placement Agency LA paid?
Communities and licensed homes pay us a referral fee when a family we introduced moves in. Families pay nothing.
That model has a hole here. Waiver placements and homes taking residents at the SSI rate generally pay a referral agency nothing, so a Medi-Cal family is the one free help thins out around. Ask any agency, ours included, how it handles a Medi-Cal case.
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Talk it through with someone who has made these calls
If your mother is on Medi-Cal, or about to be, say so in the first minute and we will tell you what is realistic and how long it takes. Free to families, no obligation.
Questions families ask us
- Does Medicaid pay for assisted living?
- Generally not the room and board, which in most states stays with the resident. What a state may cover, through an optional waiver with capped enrollment and a waiting list, is the care delivered inside a participating facility. Nursing facility care is the part Medicaid funds most reliably.
- Is Medi-Cal the same as Medicaid?
- Yes. Medi-Cal is California's Medicaid program, run by the Department of Health Care Services. What a waiver covers, and who can get it, is still decided state by state.
- Who qualifies for California's Assisted Living Waiver?
- Broadly, someone on full scope Medi-Cal, in a participating county such as Los Angeles, assessed by a nurse as needing the level of care a nursing facility provides, who can be placed in a participating facility with an open slot. The criteria change, so confirm them with a Care Coordination Agency.
- If the waiver pays for the care, who pays the rent?
- The resident, out of monthly income, which for many enrollees means SSI. What a participating facility may charge for room and board is capped and tied to a state rate that moves. Ask a Care Coordination Agency for the current figure and get it in writing before anyone moves in.
- What are the Medi-Cal income and asset limits for assisted living?
- Nobody should quote you one from memory, ours included. California's rules have moved, and a figure one revision out of date can send a family down a path that was never open to them. Call your county Medi-Cal office and ask about share of cost.