Clear Money Guide
What this guide covers
A quick view of the questions and evidence developed below.
Comparison tables scroll horizontally on smaller screens.
Updated August 3, 2026. Quick answer: compare these three on total cost over the years you expect to live, not on monthly outlay, because they front-load and back-load differently. Staying home looks cheapest until care is needed. A CCRC looks most expensive until care is needed. Assisted living sits between and moves with your acuity.
The three shapes
| Up front | Monthly, while well | When care is needed | |
|---|---|---|---|
| Stay home | Nothing, or the cost of adapting the house | Existing housing costs | Rises steeply — $35 an hour for a non-medical caregiver, about $80,080 a year at 44 hours a week |
| Assisted living | Usually a community fee, not six figures | About $6,200 a month, 2025 median | Rises with acuity; a move to skilled nursing is a new contract |
| CCRC | A six-figure entrance fee | A monthly fee on top | Depends entirely on contract type — that is what you prepaid for |
The comparison people actually get wrong
Staying home is usually compared on housing cost against a community’s monthly fee, and on that basis home wins easily. But the community fee bundles food, utilities, maintenance, transport and social contact, and the home figure usually excludes all of them plus the care.
The honest version is to price the same bundle. Take your current annual housing cost including tax, insurance, utilities and maintenance, add what you would spend on food and transport, then add the care. At even 20 hours a week of paid help, home care alone approaches the median assisted-living fee before any of the rest. Adapting the house belongs in that bundle too, and the largest single item is usually the stairs: whether renting or buying a stairlift is cheaper turns on how many months you need it.
This is a six-figure decision with a long tail.
The three paths diverge most in the years you cannot forecast, which is exactly when the arithmetic stops being arithmetic. If you want a second opinion on the cash-flow side before committing an entrance fee, this is a reasonable place to get one.
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What tips each way
- Staying home wins on autonomy and on cost while you are well, and it is the only option where the asset stays yours. It fails when care needs are round-the-clock or when isolation becomes the actual health problem.
- Assisted living is the flexible middle: no large sunk cost, and you can leave. It offers no protection against the cost of the level above it.
- A CCRC is the only one that can cap your care-cost risk — and only if the contract does that. Type A does; Type C does not.
The three numbers to get before deciding
- Your real current cost of staying put, including the maintenance you have been deferring.
- Local prices, not medians. Three providers where you live. The national picture is a shape.
- What happens to the entrance fee if you leave, die, or the operator fails. That is not the simple question it looks like.
What does not change either way
Medicare does not pay for long-term care in any of the three. Neither does Medigap. That is true of the house, the apartment and the community alike — what Medicare does and does not cover. The cover that does pay for long-term care is bought separately and priced separately, and it is priced by the age at which you buy it — what a long-term-care policy costs by age.
And staying put has its own money levers worth checking first: senior property-tax relief in your state, and if you sell, how the gain is taxed.
General information drawn from IRS, Medicare, HUD and state statute and regulation, not legal, tax or financial advice. Continuing-care law is state law and differs materially between states; every figure here is year-labelled and every source named so you can check it against your own contract. Read your own signed agreement before relying on any general description, including this one.
Does Medicaid pay for assisted living, all 51 jurisdictions
Each row is that state’s own quick answer, excerpted from its own detail page. Medicaid coverage of assisted living (as opposed to home care or a nursing facility) varies by state and by which waiver or state-plan option a state runs.
| State | Does Medicaid pay for assisted living? |
|---|---|
| Alabama | Quick answer:unclear, and that itself is the finding worth knowing. Alabama’s own regulation for its Medicaid Waiver for the Elderly and Disabled (E&D Waiver) lists what the waiver pays for, and every item on that list is a service delivered in someone’s own home, not an assisted living facility. Other sources describe the waiver as covering assisted living; Alabama’s own rule text does not say so. |
| Alaska | Quick answer:yes, through Alaskans Living Independently (ALI) Waiver. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Arizona | Quick answer:yes, through Arizona Long Term Care System (ALTCS), operated by AHCCCS under a Section 1115 demonstration (no separate 1915(c) waiver name). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Arkansas | Quick answer:yes, through Living Choices Assisted Living Waiver (LCAL). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| California | Quick answer:yes, through Assisted Living Waiver (ALW). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Colorado | Quick answer:yes, through Alternative Care Facilities (ACF) benefit under the Elderly, Blind and Disabled (EBD) waiver. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Connecticut | Quick answer:yes, through Connecticut Home Care Program for Elders (CHCPE), funded by CMS 1915(c) waiver 0140.R08.00. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Delaware | Quick answer:yes, through Long Term Care Community Services (LTCCS), under the Diamond State Health Plan (DSHP) 1115 Demonstration, drawing on HCBS authorities of Sections 1915(c) and 1915(i). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| District of Columbia | Quick answer:yes, through Elderly and Persons with Physical Disabilities (EPD) Waiver: 1915(c) waiver. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Florida | Quick answer:yes, through Statewide Medicaid Managed Care Long-Term Care (SMMC LTC) Program. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Georgia | Quick answer:yes, through Elderly and Disabled Waiver Program (EDWP, formerly CCSP) and SOURCE (Service Options Using Resources in a Community Environment). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Hawaii | Quick answer:partially, through QUEST Integration (Section 1115 demonstration), HCBS benefit package: Hawaii folded its former standalone 1915(c) waivers into managed care effective February 1, 2009: coverage is real but narrower than a full assisted living placement. Medicaid does not pay the facility’s room and board either way. |
| Idaho | Quick answer:yes, through Aged and Disabled Waiver (CMS waiver ID ID.1076.R07.00). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Illinois | Quick answer:yes, through Supportive Living Program (SLP), IL Supportive Living Program Waiver (0326.R05.00). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Indiana | Quick answer:yes, through PathWays for Aging (Assisted Living Waiver, age 60+) and the Health and Wellness Waiver (under 60), governed by 455 IAC 3-1. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Iowa | Quick answer:yes, through Elderly Waiver (part of the Hope and Opportunity in Many Environments, or HOME, redesign). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Kansas | Quick answer:partially, through Frail Elderly (FE) HCBS waiver: coverage is real but narrower than a full assisted living placement. Medicaid does not pay the facility’s room and board either way. |
| Kentucky | Quick answer:no. Kentucky’s Medicaid HCB Waiver, in its own CMS-approved application, states plainly that “the settings in this waiver are non-residential”: assisted living and other residential-care facilities are excluded by design, not merely unfunded. A separate, non-Medicaid state program (State Supplementation, 921 KAR 2:015) pays toward room and board in licensed personal care homes instead. |
| Louisiana | Quick answer:no, currently. Louisiana’s active elderly/disabled waiver, Community Choices, is a stay-at-home program only. The state did build a waiver meant to cover assisted-living-type “adult residential care” settings; it was repealed January 10, 2022 because it was never approved by CMS, and Louisiana has not replaced it. |
| Maine | Quick answer:yes, through Elderly and Adults with Disabilities Waiver (MaineCare Benefits Manual Section 19), CMS control number ME.0276. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Maryland | Quick answer:yes, through Home and Community-Based Options Waiver (HCBOW), also known as the Community Options (CO) Waiver. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Massachusetts | Quick answer:unclear from what we could verify this session. Massachusetts runs a Medicaid HCBS waiver for frail elders (CMS-confirmed, 0059.R08.00), but every MassHealth-authored page that would confirm whether it (or a separate program called Group Adult Foster Care) is the one that actually pays for assisted-living-setting care returned a server block. We are not guessing between them. |
| Michigan | Quick answer:yes, through MI Choice Waiver (CMS waiver MI.0233.R06.00). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Minnesota | Quick answer:yes, through Elderly Waiver (EW). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Mississippi | Quick answer:yes, through Assisted Living Waiver (CMS waiver 0355.R05.00). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Missouri | Quick answer:no. Missouri’s Medicaid program does not currently pay for services delivered inside an assisted living / residential care setting; its HCBS waiver dollars go to other settings instead. |
| Montana | Quick answer:yes, through Big Sky Waiver (BSW). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Nebraska | Quick answer:yes, through Nebraska Medicaid Aged and Disabled (AD) Waiver, Supported Residential Living service. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Nevada | Quick answer:yes, through Home and Community Based Services (HCBS) Waiver for the Frail Elderly (FE). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| New Hampshire | Quick answer:yes, through Choices for Independence (CFI) Waiver, administered by the NH DHHS Bureau of Elderly and Adult Services. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| New Jersey | Quick answer:yes, through NJ FamilyCare Managed Long Term Services and Supports (MLTSS). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| New Mexico | Quick answer:yes, through Turquoise Care Community Benefit, Agency-Based Community Benefit (ABCB). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| New York | Quick answer:yes, through Assisted Living Program (ALP). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| North Carolina | Quick answer:yes, through State Plan Personal Care Services (PCS) Provided in Congregate Settings (Clinical Coverage Policy No. 3L-1). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| North Dakota | Quick answer:yes, through Home and Community-Based Services (HCBS) Waiver, 1915(c) [ND.0273.R06.07]: “Adult Residential Care” service. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Ohio | Quick answer:yes, through Assisted Living (HCBS) Waiver, administered by the Ohio Department of Aging under OAC Chapter 5160-33. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Oklahoma | Quick answer:yes, through ADvantage Waiver (Medicaid HCBS 1915(c)): Assisted Living service option, OAC 317:35-17-3(e)(17). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Oregon | Quick answer:yes, through Community First Choice State Plan Option (“K Plan”), 1915(k) Medicaid State Plan benefit. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Pennsylvania | Quick answer:yes, through Community HealthChoices (CHC) 1915(c) HCBS Waiver (PA.0386.R05.01). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Rhode Island | Quick answer:yes, through RI Comprehensive Section 1115 Demonstration: Office of Healthy Aging Assisted Living Program (Medicaid LTSS Assisted Living benefit). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| South Carolina | Quick answer:yes, through Community Choices (CC) Waiver, SC.0405 / Draft SC.016.05.00 renewal. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| South Dakota | Quick answer:yes, through HOPE Waiver: Home and Community Based Options and Person-Centered Excellence (SD.0189). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Tennessee | Quick answer:yes, through TennCare CHOICES in Long-Term Services and Supports: Assisted Care Living Facility (HCBS-ACLF) service, Groups 2/3. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Texas | Quick answer:yes, through STAR+PLUS Home and Community Based Services (HCBS) program: Assisted Living Services. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Utah | Quick answer:yes, through New Choices Waiver (NCW): Adult Residential Services-Assisted Living. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Vermont | Quick answer:yes, through Choices for Care (CFC): Enhanced Residential Care (ERC) option. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Virginia | Quick answer:no. Virginia’s Medicaid program does not currently pay for services delivered inside an assisted living / residential care setting; its HCBS waiver dollars go to other settings instead. |
| Washington | Quick answer:yes, through Community Options Program Entry System (COPES): 1915(c) waiver. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| West Virginia | Quick answer:no. West Virginia’s Medicaid program does not currently pay for services delivered inside an assisted living / residential care setting; its HCBS waiver dollars go to other settings instead. |
| Wisconsin | Quick answer:yes, through Family Care (Wisconsin’s managed long-term care program combining 1915(b)/(c) authority). Medicaid does not pay the facility’s room and board either way; only the care and service component. |
| Wyoming | Quick answer:yes, through Community Choices Waiver (CCW): 1915(c) waiver, Wyoming Medicaid Rules Chapter 34. Medicaid does not pay the facility’s room and board either way; only the care and service component. |
Coverage, stated honestly: 51 of 51 jurisdictions.