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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

Does an assisted living facility in Minnesota need a separate food service license?

No. Under Minn. Stat. 144G.10, subd. 3, facilities licensed as assisted living under Chapter 144G are not separately required to hold a boarding-establishment, food-and-beverage, hotel/motel, or restaurant license under Minnesota's general lodging and food code, Chapter 157. MDH's assisted living survey process covers that ground instead.

Who regulates home care agencies that send caregivers into a senior's home in the Twin Cities?

Home care providers in Minnesota are licensed and regulated by MDH, and complaints against a licensed home care agency go to the same Office of Health Facility Complaints line as facility complaints: 651-201-4200 (metro) or 1-800-369-7994 (greater Minnesota). No separate, dedicated home-care-only complaint hotline exists.

What is the Elderly Waiver and what does it cover?

The Elderly Waiver (EW) is Minnesota's Medicaid home- and community-based services waiver for seniors 65+ who are Medical Assistance eligible and assessed via MnCHOICES as needing a nursing-facility level of care. It covers personal care assistance, homemaker services, home health aide, case management, adult day services, respite care, home-delivered meals, and — inside licensed assisted living — 'customized living' or '24-hour customized living' service packages, but it never pays room and board.

What is Alternative Care and how is it different from the Elderly Waiver?

Alternative Care (AC) is a Minnesota state-funded program — no federal Medicaid match — for seniors who need Elderly-Waiver-equivalent services but aren't yet financially eligible for Medical Assistance. It uses largely the same service array and cost cap as EW and is designed to delay or prevent a Medicaid spend-down or nursing home placement, while EW itself requires the person to already be MA-eligible.

How do I apply for Medical Assistance long-term care or a waiver in the Twin Cities?

Start by contacting your county human services agency (Hennepin, Ramsey, Dakota, Anoka, or Washington County) or calling the Senior LinkAge Line at 1-800-333-2433 to request a MnCHOICES long-term-care needs assessment, which determines functional eligibility, alongside a separate financial application for Medical Assistance.

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