Board and care homes and hospice: who pays what

What is a board and care home?

A board and care home is a small residential care home, often a house with six beds or fewer. In California most homes for older adults are licensed as a residential care facility for the elderly (RCFE) by the Department of Social Services. The home gives a room, meals, help with daily care and supervision. It is not a medical facility, and it is different from a nursing home.

You can look up any home's license, capacity and inspection history on the state's care facility search.

Can hospice come to a board and care home?

Yes, when the home holds a hospice care waiver. Under Health and Safety Code section 1569.73 and title 22, sections 87632 and 87633, an RCFE may keep or accept a resident on hospice when it has a hospice care waiver from the Department of Social Services. The home and the hospice agree on a written hospice care plan that says who does what.

We care for people wherever they call home, including nursing facilities, RCFEs and board-and-care homes, in coordination with facility staff. The waiver lets a home keep a resident on hospice. It does not require the home to. Ask the home early whether it holds the waiver and whether residents on hospice can stay through the end of life.

Who pays what when a board and care resident is on hospice?

The hospice and the home are paid separately. The hospice is paid by Medicare, Medi-Cal or a health plan. The home's monthly rate is paid by the resident or family, with help from SSI/SSP, the Assisted Living Waiver or long-term care insurance for some residents.

This table is general information, not a benefits determination. We verify your benefits and explain them to you before care starts.

How much does a board and care home cost?

Ask the home. Each home sets its own monthly rate, and rates differ by home, by room and by how much care a resident needs. Hospice does not set or pay the home's rate. Get the rate, and what it includes, in writing.

Questions worth asking: Does the rate change when a resident needs more help? How much notice do you give before a rate change? Do you accept residents who pay with SSI/SSP or through the Assisted Living Waiver?

Does Medi-Cal pay for board and care?

Not the rent. Regular Medi-Cal does not pay room and board in a board and care home. Medi-Cal does cover hospice, so a resident with Medi-Cal can have hospice in the home while the room and board is paid another way.

The main Medi-Cal exception is the Assisted Living Waiver. In a participating home, the waiver can pay for care services for a Medi-Cal member who qualifies. The resident still pays room and board. A person can be on hospice and on the waiver at the same time. Beta runs the waiver side as a separate program on alwbeta.com; see hospice and the Assisted Living Waiver.

If you have Medi-Cal with a share of cost and live in a licensed board and care home, the county can apply a board and care deduction that may lower the share of cost (DHCS letter I 26-14, April 2026). Ask your county eligibility worker.

What is the SSI/SSP board and care rate in 2026?

For 2026, the SSI/SSP payment standard for one person living in a licensed board and care home is $1,626.07 a month: $994.00 from federal SSI and $632.07 from the California state supplement (SSP). Social Security calls this category nonmedical out-of-home care. It is for people 65 or older, blind or disabled, with low income and few resources.

The resident uses this payment to pay the home and keeps a small amount each month for personal needs. Some homes accept the SSI/SSP rate as full payment and some do not. Ask the home. To apply for SSI, contact Social Security.

Other help with the monthly rate

Long-term care insurance may pay part of a board and care rate, depending on the policy. Call the insurer and ask whether the home qualifies under the policy.

Veterans and surviving spouses with limited income may be able to get a VA pension with an added amount for people who need help with daily care. See veterans and hospice and ask a county veterans service office.

Before hospice starts in a board and care home

1. Step 1

   Ask the home whether it holds a hospice care waiver

   And whether residents on hospice can stay through the end of life.

2. Step 2

   Get the home's rate in writing

   Ask what it includes and whether it changes as care needs grow. Room and board is between you and the home.

3. Step 3

   Tell the hospice about every kind of coverage

   Medicare, Medi-Cal, a health plan, SSI/SSP, the Assisted Living Waiver, long-term care insurance or a VA benefit. We check each one.

4. Step 4

   Agree who does what

   The home and the hospice write a hospice care plan. Ask to see the parts that involve the family.

Common questions

Read more

The fuller pages: hospice care in assisted living facilities, paying for care, Medi-Cal and hospice, where care happens and is it time for hospice?.