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Minnesota's Elderly Waiver, Explained

The Elderly Waiver pays for services -- never room and board -- inside a licensed Minnesota assisted living facility. Here is how it actually works.

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Short answer

The Elderly Waiver (EW) is the Minnesota HCBS Medicaid waiver that can pay for care services, through "customized living" or "24-hour customized living" service packages, delivered inside a licensed assisted living facility, for seniors who are already Medical-Assistance-eligible and assessed as needing a nursing-facility level of care.

What it covers, and what it does not

EW pays for the care-services portion of assisted living -- personal care, medication management, health monitoring, and similar services billed under a customized living service plan. It does not pay for room and board. A resident using EW still owes the community's room-and-board charge out of pocket, from income, a family contribution, or (for very low-income residents in certain settings) Minnesota's separate state Housing Support benefit.

Administration and how to apply

The Minnesota Department of Human Services (DHS) sets policy for EW, but applications and assessments are handled locally through county or Tribal human services agencies, using the state's MnCHOICES assessment tool to determine nursing-facility-level-of-care eligibility. Start with your county's human services agency or call the Senior LinkAge Line at 1-800-333-2433 for a warm handoff.

Current waitlist and capacity status for EW was not confirmed during this site's research and should be verified directly with DHS or your county before advising a specific family.

Where to get free help in the Twin Cities

The entire seven-county Twin Cities metro -- Anoka, Carver, Dakota, Hennepin, Ramsey, Scott, and Washington counties -- is served by a single Area Agency on Aging: Trellis (formerly the Metropolitan Area Agency on Aging). Because one agency covers the whole metro, families anywhere in the region use the same contact points rather than being split across regional agencies.

  • Senior LinkAge Line -- 1-800-333-2433 -- Minnesota's free, statewide information and assistance helpline for older adults and caregivers, operated by Trellis under contract with the Minnesota Board on Aging. Handles Medicare counseling, long-term-care options counseling, and waiver/assessment referrals. trellisconnects.org
  • Trellis (Area Agency on Aging) -- funds and coordinates caregiver support and respite, nutrition programs, and community-based aging services across the metro. trellisconnects.org
  • Disability Hub MN -- 1-866-333-2466 -- a companion statewide resource line for people with disabilities of any age. disabilityhubmn.org

Questions families ask

Who pays for a nursing home stay right after a hospitalization in Minnesota?

Medicare Part A can cover a limited number of days of medically necessary skilled nursing facility care following a qualifying inpatient hospital stay of at least three days, subject to coinsurance after day 20. After Medicare coverage ends, the resident is privately responsible unless they qualify for Medical Assistance, at which point Minnesota's long-term-care Medicaid eligibility and spend-down rules apply.

What is a MnCHOICES assessment and why does it matter for hospital discharge planning?

MnCHOICES is Minnesota's standardized long-term-care needs assessment used to determine whether someone needs a nursing-facility level of care and is functionally eligible for programs like the Elderly Waiver or Alternative Care. Starting this assessment as early as possible during a hospital stay — rather than waiting until after discharge — can shorten the gap before waiver services begin.

My parent has been diagnosed with dementia — where do I start in the Twin Cities?

Start by calling the Senior LinkAge Line (1-800-333-2433), operated by Trellis, for care navigation and options counseling. If a memory care community is eventually needed, confirm it holds MDH's 'assisted living facility with dementia care' license (Minn. Stat. 144G.10, subd. 2(b)) — verify this directly through the MDH Health Care Provider Directory rather than relying on marketing materials.

My parent keeps wandering — what safety and licensing questions should I ask a facility?

Ask directly whether the community holds the 'assisted living facility with dementia care' license, which is legally required for any secured dementia unit and mandates dementia-specific staff training under Minn. Stat. 144G.83. A base assisted living license without this designation is not licensed to operate a secured wandering-prevention unit.

I'm burning out as a caregiver for my spouse or parent — what help is available in the Twin Cities?

Trellis, the metro's Area Agency on Aging, funds and coordinates caregiver support and respite programs, and the Senior LinkAge Line (1-800-333-2433) is the free starting point to connect with them. A verified current adult day services rate for the metro was not located in this research and should be confirmed directly with a provider before budgeting.

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