Three different levels of care
Staying at home with support:the individual lives in their own home and receives services there — personal care aides, home health, adult day programs. This is what Medicaid home-and-community-based-services (HCBS) waivers, like Virginia's CCC+, are built to fund, specifically so someone can avoid a facility.
Assisted living:a residential facility for people who need help with daily activities (bathing, dressing, medications, meals) but don't need 24-hour skilled nursing care. Residents typically have their own room or apartment with communal support staff on-site.
Nursing home (skilled nursing facility): the highest level of residential care, for people with significant medical needs requiring 24-hour licensed nursing supervision — not just help with daily activities, but ongoing clinical care.
The Medicaid gap that surprises families most
Medicaid generally does notcover the room-and-board cost of assisted living — which is the largest part of what assisted living actually costs. This is true nationally, not just in Virginia. Medicaid can sometimes cover certain support services delivered within an assisted living facility, but not the facility's basic housing/board cost itself.
Nursing home care is the opposite: Medicaid does cover it in full for those who qualify — room and board included — once someone meets both the financial and functional (nursing-facility level of care) requirements.
Why this changes the practical choice
This is exactly why HCBS waivers with a consumer-directed or agency-directed option matter so much — for someone who qualifies for nursing-facility level care but wants to stay home instead, the waiver is often the more fully-covered path. Assisted living, by contrast, usually means paying privately for room and board regardless of Medicaid eligibility.
Exact program names and whether any state-specific supplement exists for assisted living room-and-board costs vary by state.
Virginia specifics
Auxiliary Grantsare Virginia's state supplement specifically meant to help close the assisted-living room-and-board gap described above, for low-income adults living in an assisted living facility. This doesn't exist in every state — it's a Virginia-specific program, not a Medicaid benefit itself.
CCC+ Waiver services (personal care, respite, and similar) are generally built around staying in a private home, not paying for assisted living room and board.
For a program that combines Medicare and Medicaid into one for people who need nursing home level care but want to live in the community, look into PACE (Program of All-Inclusive Care for the Elderly) — eligibility requires being 55 or older, living in the PACE service area, and needing nursing-home level of care. In Northern Virginia, PACE is operated by Insight PACE at 703-539-9000.