The Living Choices Waiver: How Medicaid Helps With Assisted Living in Arkansas

What does Living Choices actually pay for?

The waiver pays the assisted living facility for services delivered to an eligible resident: attendant care with eating, dressing, bathing, hygiene and mobility; therapeutic social and recreational activities; quarterly nursing evaluations by a registered nurse; limited nursing services; medication oversight through reminders and cues; and help arranging non-emergency transportation. Participants also get three prescriptions a month beyond the regular Medicaid pharmacy limit.

It does not pay rent or meals. The resident pays room and board from Social Security, a pension or other income, which is why families should ask each building what its room-and-board charge is for Living Choices residents.

Who qualifies?

Four tests apply. The person must be 65 or older, or 21 to 64 with a physical disability; must meet Medicaid's financial criteria; must meet nursing facility level of care; and must need at least one waiver service. For 2026, long-term care Medicaid's income cap is $2,982 a month and the resource limit is $2,000 for an individual.

Why only Level II?

Living Choices serves people who meet nursing facility level of care, and Arkansas's Level I rules bar those residents. Only Level II buildings, which must employ or contract with a registered nurse, may serve them. A parent in a Level I building who later qualifies for Medicaid will usually need to move to use the waiver.

Around Little Rock that is less of a limit than it sounds: 27 of the 31 licensed assisted living buildings in the six counties are Level II. The limit is participation. Each building decides whether to take Living Choices and how many apartments to hold for it.

How do we find a participating building?

Ask directly. Call or ask on the tour: Do you participate in Living Choices? How many Living Choices apartments do you have, and are any open? Can a private-pay resident convert to Living Choices without moving? What is your room-and-board charge for Living Choices residents?

Write the answers down; they change. A building may participate but have a waiting list, or may only accept residents who start as private pay.

How do we apply?

Apply for Medicaid through Access Arkansas online or at 1-855-372-1084, and call the Division of Aging, Adult and Behavioral Health Services at 1-866-801-3435 with questions about the waiver. A level-of-care assessment is part of the process. If income is above the cap, an elder law attorney can set up a Qualified Income Trust before the application.

Start early. Gathering five years of financial records takes time, and Medicaid reviews transfers made for less than fair value in the 60 months before the application.

What if Living Choices is not available?

The alternatives are ARChoices in Homecare or PACE for care at home, and nursing home Medicaid. Families sometimes find that a parent who could not get a Living Choices apartment does well at home with ARChoices attendant hours plus family help.

What does a Living Choices resident still pay?

The resident pays room and board, meaning rent and meals, from his or her own income, and keeps a personal needs amount. Buildings set their room-and-board charge for Living Choices residents, so it varies; ask for it in writing alongside the private-pay rate. Prescriptions, doctor visits and hospital care are covered by Medicaid and Medicare as usual, and the waiver's extended prescription benefit adds three prescriptions a month beyond the regular Medicaid limit.

Because income must cover room and board, a resident with very low income may have trouble affording even a participating building. Ask each building how it handles that situation and whether family may contribute.

How does Living Choices compare with nursing home Medicaid?

Both require nursing facility level of care and the same financial tests. Nursing home Medicaid pays nearly the whole cost of care and room and board, with the resident contributing most income and keeping a small personal needs amount. Living Choices pays only for care services, leaving rent and meals to the resident. For a parent who can still live in an apartment with help, Living Choices keeps privacy and independence; for a parent who needs 24-hour nursing, nursing home Medicaid is the only option that covers it.