How to pay for long-term care in Minnesota
Medicare pays for no long-term custodial care. It covers up to 100 days of skilled nursing after a qualifying hospital stay, at $217 a day for days 21 through 100 in 2026, per CMS. Everything beyond that is private funds, Medical Assistance, the Elderly Waiver, insurance or VA benefits.
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Who actually pays for long-term care in Minnesota?
Seven payers turn up in nearly every Minnesota conversation about long-term care, and families usually discover their rules one painful phone call at a time. Here they are side by side. Read down the "room and board" column first — it is the column that breaks budgets.
| Payer | Assisted living services | Room and board | Nursing home | Home care | Hospice |
|---|---|---|---|---|---|
| Medicare | No | No | Partial — up to 100 days of skilled care after a qualifying hospital stay, not long-term custodial care | Partial — short-term skilled care only, not ongoing personal care | Yes — through the Medicare hospice benefit |
| Medical Assistance (Minnesota's Medicaid) | Partial — not directly; it pays through the Elderly Waiver as customized living | No | Yes — for people who qualify financially and are assessed as needing that level of care | Yes — at published DHS rates, such as $105.07 per skilled nurse visit | Yes — the MA state plan hospice benefit follows the Medicare hospice rules |
| Elderly Waiver | Yes — capped monthly by case mix, from $3,081 to $7,164 | No — DHS states you pay room and board yourself | No — the waiver is the alternative to a nursing facility, not a way to pay for one | Yes — waiver services can be delivered in your own home | Separate — hospice is billed to Medicare or MA, not the waiver; ask your case manager |
| Alternative Care | Within a monthly budget limit of $4,621 to $10,744 by case mix | No | No | Within the same monthly budget limit | Separate — ask your county or tribal agency |
| Private pay | Yes | Yes | Yes | Yes | Yes |
| Long-term care insurance | Depends entirely on the policy | Depends entirely on the policy | Depends entirely on the policy | Depends entirely on the policy | Depends entirely on the policy |
| VA Aid and Attendance | Cash to the veteran, not the provider — usable for any of these | Cash to the veteran — usable for room and board | Cash to the veteran | Cash to the veteran | Cash to the veteran |
Waiver and Medical Assistance figures are DHS service rate limits effective April 1, 2026 (DHS-3945-ENG). Medicare figures are the CY2026 CMS amounts. Long-term care insurance is a contract, not a programme, so no general answer is possible. Alternative Care budget limits are published by DHS; its eligibility rules could not be traced to a primary DHS source and are described honestly below.
Two sources carry most of the weight in that table. The Minnesota figures come from DHS's service rate limits effective 1 April 2026 (Minnesota DHS, Long-Term Services and Supports Service Rate Limits effective April 1, 2026 (DHS-3945-ENG)) and DHS's own consumer publication on Elderly Waiver services in assisted living (Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024)). The Medicare figures are the CY2026 Part A amounts (CMS CY2026 Medicare Part A deductible and coinsurance amounts (reported November 2025)).
What does Medicare actually cover?
This is where most families start and where most of them lose a month. Medicare is health insurance. Long-term care — help with bathing, dressing, eating, moving, remembering — is custodial care, and Medicare does not cover it, no matter how long it is needed or how obviously it is needed.
What Medicare does cover is a short, conditional skilled benefit. After a qualifying inpatient hospital stay, it will pay toward a skilled nursing facility stay for up to 100 days in a benefit period. That benefit is designed for recovery, not for residence, and it ends.
| Item | 2026 amount | What it means for a family |
|---|---|---|
| Inpatient hospital deductible | $1,736 | Paid per benefit period before Part A hospital coverage starts. Up $60 from 2025. |
| Hospital coinsurance, days 61–90 | $434 per day | Applies to a long inpatient stay, before any long-term care question arises. |
| Lifetime reserve day coinsurance | $868 per day | Only 60 reserve days exist in a lifetime. |
| Skilled nursing facility coinsurance, days 21–100 | $217 per day | Roughly $6,510 for a full 30 days at that stage. In 2025 it was $209.50. |
| After day 100 | Medicare pays nothing | This is the cliff. From day 101 the cost is private funds or Medical Assistance. |
CMS CY2026 Part A deductible and coinsurance amounts, effective January 1, 2026. CMS publishes a coinsurance amount only for skilled nursing days 21 through 100 — confirm the terms for days 1 through 20, and your own eligibility, with Medicare directly.
The 100-day figure is also a maximum, not an entitlement. Coverage continues only while a person still needs and benefits from daily skilled care, so a stay can end well before day 100 when therapy goals are met. Families routinely plan around "we have 100 days" and then get a notice at day 34.
If a hospital discharge is what brought you here, read the skilled nursing benefit terms at Medicare.gov — Skilled nursing facility care and ask the facility's social worker for the expected coverage end date in writing on day one, not day twenty.
Medical Assistance is Minnesota's Medicaid — and the name matters
Minnesota calls its Medicaid programme Medical Assistance, usually shortened to MA. Every national article about "Medicaid and nursing homes" is describing the same programme under a different name, which is why searching for Minnesota answers using national vocabulary returns so little that fits.
For long-term care, MA does two distinct jobs, and confusing them is the single most common mistake in this whole subject.
Job one: paying for nursing facility care directly
MA pays nursing facilities directly for residents who qualify financially and are assessed as needing that level of care. This is not a fringe route — just under 54% of all nursing facility days in Minnesota were paid by MA in the 2024 reporting period, and the monthly average was 11,284 MA recipients in nursing facilities in fiscal year 2025. To qualify for MA payment, a person must be screened by a long-term care consultation team and determined to need nursing-facility-level care. Source: MN House Research, "Nursing Facility Reimbursement and Regulation" (April 2026).
Job two: paying for services in the community, through a waiver
MA does not pay an assisted living facility directly for a resident's care. It funds those services through a waiver — for people 65 and older, that is the Elderly Waiver, and the service package is called customized living. The building is licensed assisted living; the funding is customized living. Two names, one apartment.
There is one more Minnesota-specific rule worth knowing before you compare a nursing facility bill to anything else. Minnesota law bars a nursing facility from charging private-pay residents more than the state-approved MA rate for similar services, with damages of three times the excess payments if it does. Source: Minn. Stat. § 256R.06 subd. 2. Minnesota is unusual in this, and it means a private-pay nursing home quote is not a freely-set market price.
The Elderly Waiver: services yes, room and board never
The Elderly Waiver is for people age 65 or older who need the level of care provided in a nursing home but choose to live in the community. The asset limit is $3,000 for most people. DHS states the boundary of the benefit in one sentence: "the Elderly Waiver only pays for your services", and "you are responsible for paying the costs of room and board." Source: Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024).
What the waiver will pay for services is capped by case mix — the classification assigned through assessment. These are the ceilings, not the amounts anyone automatically receives, and they exclude rent entirely.
| Measure | Lowest (case mix A) | Highest (case mix K) |
|---|---|---|
| Customized living services | $3,081 | $7,164 |
| 24-hour customized living services | $5,483 | $13,450 |
| Total Elderly Waiver monthly budget | $6,162 | $14,326 |
| Alternative Care monthly budget, for comparison | $4,621 | $10,744 |
Minnesota DHS, Long-Term Services and Supports Service Rate Limits effective April 1, 2026 (DHS-3945-ENG). Case mixes A through K are the common range; the same document also lists case mix L and a case mix V. None of these figures include room and board.
Two practical constraints get discovered late. First, DHS says plainly that "not all assisted living facilities accept residents receiving Elderly Waiver services; some limit the number of residents in facilities who are receiving Elderly Waiver services." Second, "your assisted living provider must be enrolled with the Department of Human Services in order for the Elderly Waiver to be able to pay them." Source: Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024). Qualifying for the waiver and finding a building that will take it are two separate problems.
The full mechanics — the asset limit, the community spouse allowance, the five-year transfer lookback, estate recovery, and the application timeline — are in the Elderly Waiver guide. What the service package actually contains, priced component by component, is in what customized living means in Minnesota.
So who pays the rent?
If the waiver pays the care half of an assisted living bill, something has to pay the housing half. In practice there are three answers, and most Minnesota families end up using more than one.
- Your own income. Social Security, a pension, an annuity, rental income. For most waiver recipients this is the primary source for room and board.
- Housing Support. DHS says some people may be eligible for the Housing Support programme, which pays for room and board — but also that not everyone who qualifies for the Elderly Waiver will qualify for Housing Support. Ask your county or tribal financial worker whether you qualify and what the current room-and-board rate is; the rate is set separately and changes.
- Family contribution. Common, rarely planned for, and worth writing down as an agreement rather than an assumption.
We have deliberately not published a Housing Support room-and-board dollar figure here. The number circulating in trade publications could not be confirmed against DHS or the statute, and on a bill this consequential a plausible-looking figure is worse than no figure. Ask for the current amount directly. The DHS statements about Housing Support eligibility above are from Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024).
Alternative Care and Essential Community Supports
Two smaller Minnesota programmes come up often enough to be worth naming, with an honest statement of what we can and cannot verify about each.
Alternative Care (AC) has its own monthly budget limits, published in the same DHS rate document as the Elderly Waiver's: $4,621 at case mix A rising to $10,744 at case mix K, effective 1 April 2026. Those limits are verified. What we could not trace to a primary DHS source is the eligibility rule that separates AC from the Elderly Waiver — descriptions online are consistent with each other but not sourced, so we are not repeating them. Ask your county or tribal agency which programme you are being assessed for and why. Rate source: Minnesota DHS, Long-Term Services and Supports Service Rate Limits effective April 1, 2026 (DHS-3945-ENG).
Essential Community Supports (ECS) carries a monthly limit of $634.00, applied 1 January 2026, with an annual service coordination limit of $600.00. Again, the limits are verified from the DHS rate document; the programme description is not, so we describe only the money. Source: Minnesota DHS, Long-Term Services and Supports Service Rate Limits effective April 1, 2026 (DHS-3945-ENG).
This is not hedging for its own sake. Programme eligibility rules are exactly the sort of detail that a confident-sounding paragraph gets wrong, and a family acting on the wrong rule loses months. The free state helpline below exists to answer precisely these questions and does not sell anything.
Long-term care insurance, and the Partnership question
If a policy exists, it is a contract and the contract governs. There is no general answer to "does long-term care insurance pay for assisted living" — there is only what the schedule of benefits says. Before you rely on a policy, pull it out and answer these six questions from the document itself.
Read your own policy for these six things
- The daily or monthly benefit amount, and whether it is indexed to inflation.
- The elimination period — how many days of care you pay for yourself before benefits begin.
- The benefit trigger: how many activities of daily living must you need help with, and who certifies it.
- Whether assisted living, adult foster care, and home care are covered settings, or only nursing facilities.
- The lifetime maximum, in dollars or in days.
- Whether the insurer pays the provider directly or reimburses you after you have paid.
Minnesota is often described as having a Long-Term Care Partnership programme, under which buying a qualifying policy lets you protect additional assets if you later need Medical Assistance. We could not confirm the mechanism against a primary Minnesota source, so we are not describing how it works. Two questions get you the real answer: ask your insurer, in writing, whether your specific policy is a Minnesota Partnership policy, and ask your county or tribal financial worker what that status would mean for an MA application.
VA Aid and Attendance: a maximum, not a payment
Aid and Attendance increases the pension of a qualifying wartime veteran or surviving spouse who needs help with daily activities. It is paid as cash to the beneficiary, which makes it unusually flexible — it can go toward assisted living, home care, adult foster care, or rent.
| Claimant | Maximum annual rate | Roughly per month |
|---|---|---|
| Veteran with no dependents | $29,093 | $2,424 |
| Veteran with one dependent | $34,488 | $2,874 |
| Surviving spouse with no dependent children | $18,697 | $1,558 |
U.S. Department of Veterans Affairs, effective December 1, 2025 following a 2.8% cost-of-living adjustment. The surviving spouse net worth limit for the same period is $163,699. Rates change each December — re-check before relying on them.
Rates and the definitions of countable income and net worth are published by the VA itself: U.S. Department of Veterans Affairs — Veterans Pension rates, effective December 1, 2025 and U.S. Department of Veterans Affairs — Survivors Pension rates, effective December 1, 2025. Accredited help with a claim is free through a Veterans Service Officer; charging a fee to prepare an initial claim is not permitted.
Which payer fits which situation
Most Minnesota families are in one of five situations. This is the shortest honest route through each.
| Your situation | Where the money most likely comes from | First call |
|---|---|---|
| Leaving hospital, needs rehab | Medicare skilled nursing benefit, then private funds or MA from day 101 | The hospital discharge planner — ask for the expected coverage end date in writing |
| Needs daily help, has savings and income | Private pay, with a plan for what happens when funds run down | Communities directly; ask for rent and care as separate numbers |
| Needs daily help, limited assets, age 65+ | Medical Assistance plus the Elderly Waiver for services; income or Housing Support for room and board | County or tribal agency to request a free needs assessment |
| Needs nursing-facility-level care and cannot pay | Medical Assistance paying the facility directly, after a long-term care consultation screening | County or tribal agency |
| Wartime veteran or surviving spouse needing daily help | VA Aid and Attendance cash on top of whichever route above applies | An accredited Veterans Service Officer — free |
Nothing here is advice about your circumstances. Eligibility is decided by your county or tribal agency, not by a website.
Gather these before your first financial appointment
- Proof of income for both spouses: Social Security award letters, pension statements, annuity statements.
- Twelve months of statements for every account, including any account closed in the last five years.
- Deeds, vehicle titles, life insurance policies with cash value, and any burial fund or prepaid funeral contract.
- Any transfer or gift over the last five years, with dates and amounts — the lookback is five years and unreported gifts cause the worst delays.
- Long-term care insurance policy documents, in full, not the summary page.
- Military discharge paperwork if a VA claim is possible.
Assemble that folder before the assessment rather than after it. The financial application is the slow half of the process — DHS says it may take up to 45 days or longer — and almost every avoidable delay traces back to a missing statement.
Where to look next
Once you know who is paying, the question becomes what you are buying and what it costs. Start with what assisted living actually costs in Minnesota, then compare settings in assisted living versus a nursing home, and check any provider you are considering using the licence and inspection guide.
To see who actually accepts what near you, browse assisted living, nursing homes, home care and adult foster care across Minnesota, or narrow to a city such as Minneapolis or Saint Paul. Every listing shows the licence number we hold on file.
For free, unbiased help from someone who does not sell care: Minnesota Aging Pathways, formerly the Senior LinkAge Line, on 1-800-333-2433, and Disability Hub MN on 1-866-333-2466 for people under 65.
Questions people ask
Does Medicare pay for assisted living or a nursing home in Minnesota?
Medicare does not pay for long-term custodial care in either setting. It covers up to 100 days of skilled nursing care in a benefit period after a qualifying inpatient hospital stay, and in 2026 the resident pays $217 a day for days 21 through 100. After day 100 Medicare pays nothing toward that stay, and the cost falls to private funds or Medical Assistance.
What is Medical Assistance in Minnesota?
Medical Assistance, usually shortened to MA, is Minnesota's name for Medicaid. It pays nursing facilities directly for residents who qualify financially and are assessed as needing that level of care — just under 54% of all Minnesota nursing facility days were paid by MA in the 2024 reporting period. For care in assisted living, it pays through a waiver instead.
Source: MN House Research, "Nursing Facility Reimbursement and Regulation" (April 2026)
Does Medical Assistance pay for assisted living in Minnesota?
Not directly. Medical Assistance funds the care services inside a licensed assisted living facility through the Elderly Waiver, where the service package is called customized living. Room and board is never covered by the waiver: DHS states that it "only pays for your services" and that "you are responsible for paying the costs of room and board."
Source: Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024)
How much will the Elderly Waiver pay toward assisted living?
It is capped by case mix, the classification assigned through assessment. Effective April 1, 2026, monthly customized living limits run from $3,081 at case mix A to $7,164 at case mix K, and 24-hour customized living limits from $5,483 to $13,450. These are ceilings on the service payment only and exclude room and board entirely.
How much does VA Aid and Attendance pay in Minnesota?
Effective December 1, 2025 the maximum annual pension rate with Aid and Attendance is $29,093 for a veteran with no dependents, $34,488 for a veteran with one dependent, and $18,697 for a surviving spouse with no dependent children. These are maximums reduced by countable income, not amounts you are guaranteed to receive, and they change each December.
Source: U.S. Department of Veterans Affairs — Veterans Pension rates, effective December 1, 2025
Who pays for room and board if a waiver pays for the care?
You do, from your own income, unless you also qualify for Minnesota's Housing Support programme. DHS is explicit that not everyone who qualifies for the Elderly Waiver will qualify for Housing Support. Ask your county or tribal financial worker whether you qualify and what the current room-and-board rate is before you sign anything.
Source: Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024)
How long does it take to get approved for Medical Assistance long-term care in Minnesota?
DHS says the needs assessment should occur within 20 calendar days of your request, and that the financial application process may take up to 45 days or longer in some situations. If the assessment is done first, coverage may retroactively begin back to the date of that initial needs assessment — but the assessment must be updated if it is more than 60 days old when the application is finalised.
Source: Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024)
Sources
- CMS CY2026 Medicare Part A deductible and coinsurance amounts (reported November 2025)
- Medicare.gov — Skilled nursing facility care
- Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024)
- Minnesota DHS, Long-Term Services and Supports Service Rate Limits effective April 1, 2026 (DHS-3945-ENG)
- MN House Research, "Nursing Facility Reimbursement and Regulation" (April 2026)
- Minn. Stat. § 256R.06 subd. 2
- U.S. Department of Veterans Affairs — Veterans Pension rates, effective December 1, 2025
- U.S. Department of Veterans Affairs — Survivors Pension rates, effective December 1, 2025
- Medicare.gov — Hospice care
- Minnesota Aging Pathways (formerly the Senior LinkAge Line), 1-800-333-2433 — Minnesota Board on Aging
This guide was last checked against these sources on August 14, 2026. RightCare MN is a Minnesota care directory, not a clinical, legal, or financial adviser — this is general information, not advice about your situation. Programs, rates, and rules change; confirm anything you are relying on with the agency directly before you act on it.