Does Medi-Cal Pay for Assisted Living? Sacramento Has the Waiver, Placer Doesn't

Quick answer: Standard Medi-Cal does not pay for assisted living. California’s Assisted Living Waiver (ALW) can pay for care services in participating homes, but only in 15 counties. Sacramento County is one. Placer County is not. Your parent still pays room and board, and there is a waitlist, so plan for a wait.

If money is tight, this is often the first question families ask: “Will Medi-Cal pay for Mom’s care home?” The honest answer is “sometimes, partly, and usually not quickly.” This guide explains the program in plain English so you can plan without false hope.

The short version

• Medicare does not pay for assisted living. Standard Medi-Cal does not either.
• The Medi-Cal Assisted Living Waiver can help pay for care in some homes, in some counties.
• Sacramento County has it. Placer County does not.
• Your parent pays room and board out of their own income.
• There is a waitlist. Don’t count on it for an urgent move.

What is the Assisted Living Waiver?

The Assisted Living Waiver is a Medi-Cal program run by the California Department of Health Care Services (DHCS). It helps people who need a high level of daily care get that care in an assisted living setting instead of a nursing home (DHCS).

Here is how the money works:

• Care services (help with bathing, dressing, medications, etc.). Who pays under the ALW: The waiver pays the home for these.
• Room and board (the room and meals). Who pays under the ALW: Your parent pays the home directly, from their own income.
• Personal spending money. Who pays under the ALW: Your parent keeps some funds for personal needs.

The current waiver runs from March 1, 2024, through February 28, 2029, according to DHCS.

Is it available in Sacramento and Placer?

The waiver only operates in 15 California 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 (DHCS).

• Sacramento County (Sacramento, Citrus Heights, Elk Grove, Fair Oaks, Folsom, Orangevale). ALW available? Yes. What it means: A lower-income senior may have a Medi-Cal path into a participating home, after the waitlist.
• Placer County (Roseville, Rocklin, Granite Bay, Lincoln, Auburn). ALW available? No. What it means: Most families pay privately; the ALW is not an option for a home in Placer.

DHCS says the participant must be willing to live in an assisted living setting in one of the 15 counties. So a Placer family can sometimes look at a participating home in Sacramento County, if that works for the family.

Who qualifies?

DHCS lists these main requirements (DHCS):

• Age 21 or older
• Full-scope Medi-Cal with no share of cost
• Care needs at the same level as people on Medi-Cal living in a nursing home
• Able to live safely in an assisted living home or subsidized housing
• Willing to live in one of the 15 ALW counties

That third point surprises people. The waiver is for people who need a lot of help, not for someone who is mostly independent.

What is the Medi-Cal asset limit in 2026?

Medi-Cal started counting assets again on January 1, 2026, for people who are 65 or older, have a disability, or live in a nursing home. According to DHCS (Asset Limit FAQ):

• Through June 30, 2027. Asset limit: $130,000 for one person, plus $65,000 for each additional household member (up to 10)
• Starting July 1, 2027. Asset limit: $21,000 for one person, $31,000 for two, plus $1,550 for each additional member.

Some things don’t count, like your parent’s main home and main car. Some married couples can qualify for higher limits under “spousal impoverishment” rules. DHCS also notes that giving away assets on or after January 1, 2026, can delay long-term care coverage. These rules are detailed, so ask your county Medi-Cal office or a qualified advisor before moving money.

How long is the waitlist?

Here’s the honest part. DHCS says the number of waiver slots is limited and there is currently a waitlist. New slots are released to Care Coordination Agencies over time, and DHCS posts enrollment and waitlist numbers on a dashboard updated monthly (DHCS).

What this means for your family:

• The waiver is rarely a fast answer, especially after a hospital stay.
• You may need a plan to pay privately while you wait.
• Apply early if your parent may qualify. Getting on the list sooner is better than later.

DHCS directs applicants to contact a Care Coordination Agency for ALW enrollment. The DHCS ALW page lists these agencies.

The surprise most families hit: Medicare does not pay for assisted living at all. It covers hospital care, short-term rehab and hospice (Medicare.gov).

If the waiver isn’t an option, how do families pay?

Licensed care homes in the Sacramento area typically cost $4,000 to $15,000 a month. Families often combine:

• Social Security, pensions and savings
• Long-term care insurance, if your parent has a policy
• VA Aid & Attendance, for some wartime veterans and surviving spouses (VA.gov)
• Choosing a shared room or a small board and care home with an all-in rate

A simple decision list:

• If your parent lives in Sacramento County, has very limited savings and needs a lot of care, then ask about the ALW now, and plan for the wait.
• If your parent lives in Placer County, then plan to pay privately, or ask whether a participating home in Sacramento County could work.
• If your parent is a wartime veteran or surviving spouse, then ask an accredited VA representative about Aid & Attendance.
• If the hospital is discharging soon, then focus on a safe place now; the waiver is a longer-term path.

How Nonna Placements works: Nonna Placements is free to families. Licensed homes pay us a placement fee when someone moves in. You can choose any home. This article is general information, not medical, legal, or financial advice.

Talk it through with us

Money questions feel heavy, especially in a crisis. If you want to talk through options in Sacramento or Placer County, call us. We’ll explain what’s realistic, help you find licensed homes that fit your parent’s needs and budget, and set up tours. It’s free to your family.

Call or text (916) 261-2644 or email roberto@nonnaplacements.com. If a hospital discharge is coming up fast, tell us right away.

Related reading: How Much Does Assisted Living Cost in Sacramento in 2026? · Board and Care or Assisted Living: Which Fits Your Parent? · The Hospital Says Mom Can’t Go Home. Now What?

Sources

• California DHCS, Assisted Living Waiver: https://www.dhcs.ca.gov/services/long-term-care-alternatives-home-and-community-based-service-options/assisted-living-waiver/
• California DHCS, Asset Limit Frequently Asked Questions: https://www.dhcs.ca.gov/medi-cal/help/asset-limit-frequently-asked-questions/
• Medicare.gov, Long-term care: https://www.medicare.gov/coverage/long-term-care
• U.S. Department of Veterans Affairs, Aid and Attendance and Housebound benefits: https://www.va.gov/pension/aid-attendance-housebound/

About the author

Roberto Hategan is the CEO & Founder of Nonna Placements, a senior placement service in Granite Bay serving families across California, with a focus on Placer and Sacramento counties. Contact: roberto@nonnaplacements.com

Photo credits: T Leish, SHVETS production, and Andrea Piacquadio, via Pexels, Pexels License.