Paying for Assisted Living in California

Private pay, long-term care insurance, the Medi-Cal Assisted Living Waiver, SSI/SSP, and VA benefits, plus what Medicare won't cover.

Assisted living in California is paid for mostly by residents and families, but several public and private sources can help. This guide explains the main options, what each one covers, and where the common misunderstandings are. Costs vary widely by region, facility size, and care level, so always get a written rate sheet from each facility you consider.

What Medicare does and does not cover

The most common surprise is that Medicare does not pay for assisted living. The official Medicare.gov long-term care page states plainly that Medicare doesn't pay for long-term care, and that Medicare and most health insurance, including Medicare Supplement (Medigap) policies, don't pay for long-term care services. Room, board, and personal care in a Residential Care Facility for the Elderly (RCFE) are not Medicare benefits.

Medicare still covers eligible medical services for a person living in assisted living, such as doctor visits, hospital care, and prescriptions under the relevant parts of Medicare. Medicare hospice coverage can be provided where you live, including an assisted living facility, but Medicare does not cover room and board while you receive hospice care there.

Private pay

Most residents pay privately from income, savings, home sale proceeds, or family contributions. California law gives private-pay residents several protections:

• The admission agreement must describe what is included in the basic monthly fee and list the fees for any services not included, and residents must get a monthly statement itemizing separate charges (Health and Safety Code section 1569.884).
• Facilities must give at least 90 days' written notice of rate increases, with the reasons, except for increases tied to a change in the resident's level of care, and may not charge nonrecurring lump-sum assessments (section 1569.655).
• After a resident dies, no fees accrue once personal property is removed, and prepaid fees for the time after that must be refunded within 15 days (section 1569.652).

Ask each facility how "levels of care" or "points" are assessed, how often they are reassessed, and what triggers a price change.

Long-term care insurance

If the resident has a long-term care insurance policy, read it carefully before choosing a facility. Policies differ in whether they cover assisted living (not only nursing homes), how they define an eligible facility, what triggers benefits (often needing help with a certain number of activities of daily living or having a cognitive impairment), how long the elimination or waiting period is, and the daily or monthly maximum. Ask the insurer for the claim forms early; they often require documents from the facility and a physician.

California's Health Insurance Counseling and Advocacy Program (HICAP), offered through the Department of Aging, provides free, confidential counseling on Medicare and long-term care insurance. You can reach it at 1-800-434-0222.

Medi-Cal Assisted Living Waiver (ALW)

Medi-Cal generally does not pay for assisted living directly, but the Assisted Living Waiver run by the Department of Health Care Services (DHCS) can pay for care services in participating RCFEs. Key points from DHCS:

• Eligibility: Medi-Cal eligibility without a share of cost, age 21 or older, and a need for a nursing facility level of care.
• Location: the waiver operates only in certain counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma.
• Room and board is not covered. Participants must have enough income to pay the facility's room and board, with some left for personal needs.
• Limited slots and a waitlist. DHCS says enrollment is capped and there is a waitlist; current numbers are posted on its enrollment dashboard.
• Participating facilities only. The facility must be enrolled as an ALW provider. A Care Coordination Agency develops the participant's service plan and helps with placement.

DHCS has announced that it has ended planning to move the ALW into Medi-Cal managed care and that the waiver will continue to operate under its existing federal approval. Check the DHCS page for current details before applying.

SSI/SSP for board and care

People with limited income and resources who receive Supplemental Security Income with California's State Supplementary Payment (SSI/SSP) may qualify for a higher payment standard for non-medical out-of-home care when they live in a licensed facility and receive care and supervision. Federal program instructions from the Social Security Administration indicate this rate applies to residents of licensed community care facilities whose license status is licensed, provisional, or probationary, and not while a license is still pending.

Title 22 requires that when a resident is an SSI/SSP recipient, the facility provide its basic services at the basic rate with no additional charge. Not every facility accepts the SSI/SSP rate, and those that do are often smaller board-and-care homes, so ask directly. The payment amounts change periodically; check with the Social Security Administration or CDSS for the current figure.

VA Aid and Attendance

Veterans and surviving spouses who receive a VA pension may be eligible for Aid and Attendance, a monthly amount added to the pension. According to the VA, eligibility can be based on needing another person's help with daily activities such as bathing, feeding, and dressing, among other criteria. You must be eligible for the pension to receive Aid and Attendance. Applications can be filed online, by mail using VA Form 21-2680, or at a VA regional office.

Putting it together

1. Get written rates, including level-of-care fees and any one-time fees, from every facility.
2. Confirm whether each facility accepts the ALW, SSI/SSP, or long-term care insurance.
3. Check whether the resident may qualify for VA benefits.
4. Plan for how costs will be covered if care needs increase.

This guide is general information, not legal, tax, or financial advice. Program rules and payment amounts change; confirm with the agency before relying on them.

Updated 2026-09-30.