top of page

Medicare, MediCal, Assisted Living 

​

​

Key Points:

  • Medicare: Medicare generally does not cover long-term custodial care. Medicare mainly focuses on medical expenses and does not cover the cost of room and board or custodial care (assistance with daily living tasks like bathing, dressing, and eating) in assisted living or RCFEs.

  • Assisted Living Waiver Program: California has the Assisted Living Waiver (ALW) program through Medi-Cal, which may help eligible low-income individuals in some counties receive assisted living services in an RCFE. However, this program does not cover room and board costs.

  • Medi-Cal's Role: Medi-Cal (California Medicaid) is a crucial funding source for long-term care, particularly in nursing homes. While it may cover nursing home care and various home and community-based services (HCBS) in certain situations, it generally doesn't cover room and board in RCFEs.

  • Cal Health Find: The California Health Facilities Information Database (Cal Health Find) allows you to search for licensed healthcare facilities, including RCFEs, and can provide information about whether a facility accepts Medicare and/or Medi-Cal.

  • Nursing Home Compare: The federal government's Nursing Home Compare website lists Medicare- and Medicaid-certified nursing homes and allows for comparison of quality of care and staffing. 

​

​

To find RCFEs in California that may work with Medi-Cal, you can:

  1. Use the Cal Health Find database: Search for RCFEs in your desired location and look for information regarding their certification status (acceptance of Medicare and/or Medi-Cal).

  2. Contact the facilities directly: Inquire about their specific payment policies and whether they accept Medicare for any services or participate in programs like the Assisted Living Waiver.

  3. Explore the Assisted Living Waiver Program: Check if the ALW program is available in your county and determine if the individual meets the eligibility criteria.

  4. Consider other resources: Utilize resources like the California Department of Aging (CDA), Local Area Agencies on Aging (AAA), and California Advocates for Nursing Home Reform (CANHR) for information on assisted living and funding options. 

​

Remember to thoroughly research any facility you consider, verify their licensing status, and carefully review their payment policies to understand what services are covered and how costs are billed

bottom of page