What is "customized living" in Minnesota?

The one-paragraph answer

If you have been handed a document that says "customized living" and you cannot find that phrase on any brochure, you have not misread anything. Customized living is a payment category, not a place. It is the bundle of care services that a Minnesota Medicaid waiver pays for when someone lives in a licensed assisted living facility rather than a nursing home. The apartment, the meals plan and the front door are assisted living. The help getting dressed, the medication setup, the aide who checks in at night — when a waiver is paying for them, that is customized living.

The distinction matters because the two halves are governed by different agencies, cost different amounts, and are approved on different timelines. Mixing them up is why families believe they have been approved for housing when they have been approved for services, and why a monthly quote and a waiver limit so rarely line up.

The licence and the funding are two different things

Minnesota has licensed assisted living facilities through the Department of Health since 1 August 2021, under Minnesota Statutes chapter 144G. There are two licence types — assisted living facility, and assisted living facility with dementia care — plus provisional licences. Source: Minnesota Department of Health — Assisted Living Licensure. None of that has anything to do with who pays.

Read across the bottom two rows. A community can hold a perfectly good MDH licence and still be unable to bill your waiver, because DHS enrollment is a separate thing it has to have done. And a community can be enrolled and still decline waiver-funded residents this month because it caps how many it takes. Licence, enrollment, and willingness are three questions, not one.

Customized living versus 24-hour customized living

Two tiers exist, and the difference is staffing intensity rather than a different menu of services. Twenty-four-hour customized living covers a round-the-clock staffing arrangement, and its rate limits are roughly 1.8 to 1.9 times the standard limits at every case mix.

Case mix is assigned through assessment. It is not chosen, negotiated, or set by the facility, and it can change when needs change. A family cannot ask for case mix K any more than it can ask for a different blood pressure reading — but it can, and should, make sure the assessor sees the full picture including the bad nights, not just the good morning on which the assessment happened to be scheduled.

What each component of the package is worth

This is the table almost nobody outside a billing office has seen. DHS publishes a price for each individual service inside the customized living package, with separate columns for waivers. The first column is what DHS's rate document labels CADI/BI; the second is the Elderly Waiver. Source: Minnesota DHS, Long-Term Services and Supports Service Rate Limits effective April 1, 2026 (DHS-3945-ENG).

Three things become obvious once you can see the components.

• The package is assembled, not averaged. A service plan is built from these units, which is why two residents in identical apartments can be funded at very different levels.
• The unit rates differ by waiver. The same home care aide hour is priced at $23.72 under CADI/BI and $33.42 under the Elderly Waiver, so the waiver someone is on changes what a given package costs the state.
• Group socialization is priced at a fraction of one-to-one time — $3.71 an hour against $33.41 under the Elderly Waiver. That is a legitimate cost difference, and it is also worth understanding when a community describes its activities programme as personalised attention.

The DHS rate document labels the first column CADI/BI. These are separate Minnesota disability waivers with their own eligibility rules, which we have not summarised here because we could not verify those rules against a primary source. If someone is being assessed under one of them rather than the Elderly Waiver, ask the assessor to explain which programme and why. What is verified is the money, shown above, from Minnesota DHS, Long-Term Services and Supports Service Rate Limits effective April 1, 2026 (DHS-3945-ENG).

Which waiver pays, and what it still will not cover

For people 65 and older, the route into customized living is the Elderly Waiver. DHS states the eligibility test as being age 65 or older, needing "the level of care provided in a nursing home but choose to live in the community", and meeting Medical Assistance rules — the asset limit being "$3,000 for most people". Source: Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024).

And whichever waiver pays, one thing never changes: "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). Customized living is care funding. It has nothing to say about rent.

The full mechanics of qualifying — the asset limit, the community spouse allowance, the five-year transfer lookback, estate recovery, and the application timeline — are set out in the Minnesota Elderly Waiver guide. If you are still working out who pays for what across Medicare, Medical Assistance and private funds, start with how to pay for long-term care in Minnesota.

Why Minnesota funds care this way

The logic behind customized living becomes clear once you see what the alternative costs. To have Medical Assistance pay for a nursing facility, a person must be screened by a long-term care consultation team and determined to need nursing-facility-level care — and just under 54% of all Minnesota nursing facility days were paid by Medical Assistance in the 2024 reporting period. Source: MN House Research, "Nursing Facility Reimbursement and Regulation" (April 2026).

The Elderly Waiver applies the same level-of-care test and then funds services somewhere else. Its name says so: a waiver of the rule that this level of care has to be delivered in an institution. Someone who qualifies could be paid for in a nursing facility; customized living is what the state pays instead when they choose to stay in the community. Source: Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024).

The money involved is not small. Genworth's 2024 Cost of Care Survey put the Minnesota median at $146,000 a year for a semi-private nursing home room and $168,813 for a private room — roughly $12,167 and $14,068 a month. Against that, the highest 24-hour customized living limit at case mix K is $13,450 a month, and the standard customized living limit at the same case mix is $7,164.

The honest comparison is service ceiling against service charge, and rent against rent. Statewide, the 2024 Minnesota median for assisted living was $69,900 a year, about $5,825 a month, and that figure blends both halves together. Source: Genworth, 2024 Cost of Care Survey — Minnesota. Which is exactly why the two-numbers-in-writing rule matters so much: until a community splits its quote, you cannot tell whether a waiver would cover a little of it or most of it. We work through the published estimates and why they disagree in what assisted living actually costs in Minnesota.

What this means when you are touring

Customized living stops being an abstraction the moment you sit in a community's office. These are the questions that turn it into numbers you can act on.

The waiver-specific questions come close to verbatim from DHS's own recommended list, which is published in Minnesota DHS, "Elderly Waiver services in assisted living" (DHS-7935-ENG, 7-2024). Asking them early costs you nothing; asking them in month thirteen can cost a move.

One more practical note. Because the funding and the licence are separate systems, a good answer on funding tells you nothing about care quality. Check the MDH licence and the inspection record separately, on every building you are seriously considering.

Where to look next

Verify any provider before you commit: how to check a Minnesota care provider's licence, inspections and ratings. To see how customized living compares with the alternative that Medical Assistance funds directly, read assisted living versus a nursing home in Minnesota, and for the smaller, home-based setting that many waivers also fund, adult foster care in Minnesota.

To see who is actually available near you, browse assisted living across Minnesota or adult foster care, or start from a city: Minneapolis, Saint Paul, Rochester.

Free help understanding an assessment or a service plan: Minnesota Aging Pathways, formerly the Senior LinkAge Line, on 1-800-333-2433. For advocacy about a service package or a facility decision, the Office of Ombudsman for Long-Term Care on 1-800-657-3591. Both are free and sell nothing.