Yes, many assisted living waivers have waitlists, and tight state budgets are keeping slots limited. Assisted living waivers are Medicaid home- and community-based services waivers that pay for care and supervision in assisted living instead of a nursing home. According to KFF's 23rd survey of Medicaid home-care programs, 41 states had waiver waiting lists in 2025, with more than 600,000 people waiting nationwide KFF waiting-list analysis. KFF analysis summarized by RevCare links pressure to the July 4, 2025 reconciliation law, with about $911 billion in Medicaid cuts over 10 years RevCare summary of KFF analysis.
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Table of Contents
- Why do budget cuts hit these waivers first?
- How long are the lines in California and Kentucky?
- What is Indiana trying with cost caps?
- What can you do if you face a waitlist?
Why do budget cuts hit these waivers first?
KFF reporting describes these home-care waivers as optional, which states may trim by capping slots when money tightens. A slot cap freezes enrollment even when need grows.
For dementia families, that means help with bathing, meals, medication prompts, and overnight supervision can stall at the application stage. When provider rates also fall, fewer assisted living sites accept waiver clients.
How long are the lines in California and Kentucky?
California DHCS data reported through a state tracker counted about 14,847 people enrolled and 18,365 on the waitlist in Dec. 2025. The same tracker notes the program is capped near 18,000 participants and runs in only 15 counties California ALW county tracker.
Kentucky officials told lawmakers nearly 19,000 people were on Medicaid waiver waitlists as of July 13, 2026. Only about 1,000 spots were available, and a 4% provider rate cut took effect Aug. 1, 2026, according to Kentucky Lantern reporting Kentucky Lantern report on waiver waitlists. For dementia, these numbers mean a diagnosis does not move you forward; your place depends on slots, county, and provider capacity.
What is Indiana trying with cost caps?
Indiana FSSA's official waitlist page states 55,969 federally approved slots covered the PathWays and Health and Wellness waivers for July 2025-June 2026. The same page lists 12,680 people waiting as of October 2026. Indiana HEA 1277 was signed March 12, 2026.
It directs FSSA to seek federal approval for an individual PathWays cost cap not exceeding nursing-facility cost, according to Indiana Capital Chronicle reporting. The goal is to save hundreds of millions annually and open waitlist slots. A per-person cap could stretch slots to more people but may limit high-need dementia care that costs close to nursing-home care.
What can you do if you face a waitlist?
KFF cautions that waitlists are an incomplete, non-comparable measure of need because states screen eligibility and manage lists differently. Do not read list size alone as proof of cuts in your county. Ask these questions when you call the waiver agency: Bring a medication list, fall history, wandering episodes, and nighttime needs to every screening, and keep a dated copy of each form you submit.
- Am I screened and on the actual waitlist, and what tier am I in?
- Does this waiver serve my county and dementia supervision needs today?
- What care can fill gaps while waiting, such as family help, adult day, or home aides?
- What change should I report right away, and how do I report it?
