Minnesota Customized Living Services: What the Elderly Waiver Covers in Assisted Living

What Customized Living Means in Minnesota

Customized living is the service model Minnesota uses to deliver Elderly Waiver (EW) benefits inside a licensed assisted living facility. Instead of paying the facility directly for a standard service package, the state builds a personalized budget based on the resident's assessed needs, and the facility delivers services against that budget.

The term shows up constantly in Medicaid paperwork and facility contracts, but most families never get a clear explanation of what it actually means for their parent's care and finances.

How a Customized Living Plan Gets Built

The process starts with the MnCHOICES assessment. A county or tribal lead agency assessor evaluates your parent's functional needs — which activities of daily living they need help with, their cognitive status, medical conditions, and safety risks. If your parent meets the Nursing Facility Level of Care (NF LOC) standard and qualifies financially for Medical Assistance, they're approved for the Elderly Waiver.

The county case manager then works with the assisted living facility's clinical staff to build a customized living service plan. This plan specifies exactly which services the Elderly Waiver will fund:

• Personal care assistance (bathing, dressing, grooming, toileting, transfers)
• Medication setup and administration
• Health-related tasks delegated by a registered nurse
• Homemaker services within the unit
• Meal preparation assistance
• 24-hour emergency response monitoring
• Overnight protective supervision (when clinically documented as necessary)

The key constraint: the Elderly Waiver covers services, not housing. Room and board — rent, meals, utilities — must be paid privately by the resident or their family. The facility bills the Elderly Waiver for the care services and bills the resident separately for room and board.

The Budget Cap

Each resident's customized living budget is calculated based on their assessed level of need, not the facility's standard pricing. The budget reflects what it would cost to provide equivalent care in a nursing facility, with adjustments for the community setting.

Facilities can provide services up to the budget cap but cannot bill the Elderly Waiver above it. If your parent's needs exceed the authorized budget, ask the county case manager for a reassessment and confirm what services and charges are authorized. Do not assume that additional care charges are covered by the waiver.

Under the Alternative Care (AC) program, a similar customized living service is available but capped at 75% of the comparable Elderly Waiver budget. AC serves people who meet the clinical threshold but have assets above the Medical Assistance limit.

What Customized Living Doesn't Cover

Beyond the room and board exclusion, there are services that fall outside the customized living framework:

• Skilled nursing care — if your parent needs continuous clinical monitoring, they may need to transition to a skilled nursing facility
• Therapies — physical, occupational, and speech therapy are covered under Medicare or Medical Assistance as separate benefits, not through the customized living plan
• Transportation to medical appointments — some supplemental waiver services cover this, but it's not part of the standard customized living plan
• Personal items — clothing, toiletries, phone, and entertainment

How the Room and Board Split Works in Practice

This is the part that trips families up. Your parent is living in the assisted living facility and receiving a single bill, but the payment comes from two sources: the Elderly Waiver pays for care services, and the resident pays for room and board.

For an Elderly Waiver recipient, the Special Income Standard allows the individual to retain $1,353 per month (2026 figure) from their income to cover room and board and personal expenses. Income above that amount goes toward the cost of care, reducing what the Elderly Waiver pays.

If your parent's income alone doesn't cover the facility's room and board charges, the family is responsible for the gap. This is one reason families need to compare facilities on room and board costs specifically — the Elderly Waiver equalizes the care side, but room and board varies widely between facilities.

Requesting a Reassessment

If your parent's condition changes — a fall, cognitive decline, new medical diagnosis — their customized living budget may no longer cover the services they need. Ask the county case manager for a reassessment.

After reassessment, if the new clinical profile supports a higher level of care, the budget adjusts accordingly. If the assessor determines your parent's needs have exceeded what can be safely delivered in an assisted living setting, the case manager will work with you on transition planning to a skilled nursing facility.

Pulling It Together

Customized living is the financial mechanism that makes assisted living affordable for Medicaid-eligible Minnesotans. Understanding how the budget works, what it covers, and where the gaps are gives you leverage when negotiating with facilities and planning your parent's finances.

The Choosing Care in Minnesota guide walks through the full Elderly Waiver application process, room and board budgeting, and customized living plan negotiation in detail.

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