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In-Home Waiver Help: Elderly Waiver and Alternative Care

Minnesota does not run a separate in-home-only waiver -- the Elderly Waiver covers in-home services too, with Alternative Care as a pre-Medicaid bridge program.

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Short answer

Minnesota does not split "assisted living" and "in-home" into separate waiver programs the way some states do. The same Elderly Waiver (EW) that pays for services inside assisted living also covers in-home personal care, homemaker services, home health aide visits, and related supports for Medical-Assistance-eligible seniors assessed as needing a nursing-facility level of care.

Alternative Care: the pre-Medicaid bridge

For seniors who need EW-equivalent help but are not yet Medical-Assistance-eligible, Minnesota funds a second, state-only program: Alternative Care (AC). It offers a nearly identical service array and cost cap to EW, specifically designed to delay or prevent a Medicaid spend-down or a premature nursing home placement.

Who administers it

Both programs are set at the state level by DHS and administered locally through county and Tribal human services agencies, coordinated regionally through Trellis, the Twin Cities' Area Agency on Aging, and the Senior LinkAge Line (1-800-333-2433).

Free help in your area. Trellis, the Twin Cities Area Agency on Aging, and the Senior LinkAge Line (1-800-333-2433) cover the entire metro at no cost. Read the full explanation →

Questions families ask

What's the difference between assisted living and memory care in Minnesota?

Assisted living (Minn. Stat. 144G.10, subd. 2(a)) provides housing plus health-related and supportive services for residents who need help with daily activities but not specialized dementia care. Memory care requires the separate 'assisted living facility with dementia care' license (subd. 2(b)), mandatory dementia-specific staff training (Minn. Stat. 144G.83), and a secured unit with a required written pre-admission disclosure (Minn. Stat. 325F.72).

What's the difference between the Elderly Waiver and Alternative Care in Minnesota?

The Elderly Waiver (EW) is a federal-state Medicaid HCBS waiver requiring the applicant to already be Medical Assistance eligible, while Alternative Care (AC) is a state-only-funded program (no federal match) for seniors who need EW-equivalent services but aren't yet financially MA-eligible. Both use a similar service array and cost cap and never pay room and board.

How does a nursing home differ from assisted living in Minnesota?

Nursing homes provide 24-hour skilled nursing care for residents with significant medical needs and are licensed and regulated separately from assisted living, with their own Nursing Home Report Card. Assisted living, licensed under Chapter 144G, serves residents who need help with daily activities and some health-related services but not continuous skilled nursing oversight, and is generally less expensive.

Independent living vs. assisted living vs. memory care — how do I know which one my parent needs?

Independent living is unlicensed housing with no care services; assisted living is a licensed setting (Chapter 144G) providing help with daily activities and some health services; memory care is the separately licensed 'assisted living facility with dementia care' category for residents needing secured, dementia-specific care. The right fit depends on a functional assessment of daily living needs, cognitive status, and safety risk, not just preference.

Assisted living vs. in-home care — which is better for a parent who wants to stay independent?

In-home care lets a parent remain in their own home with support delivered through the Elderly Waiver (personal care, homemaker, home health aide) or private-pay caregivers, while assisted living moves a parent into a licensed community with built-in staffing, meals, and social programming. The better fit depends on the level and predictability of care needed, home safety, and cost once care hours increase significantly.

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