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Does Medicaid Pay for Assisted Living?

By Kevin RyanFebruary 1, 2022
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For many seniors, seeking assisted living is a conscientious decision. Many individuals are choosing to move into assisted living communities so they can easily maintain a healthy lifestyle, enjoy social opportunities, engage in meaningful activities, and not have to rely on family for support with health issues or with activities of daily living.

But it’s no secret that assisted living costs can stretch any family budget. The median cost for assisted living in 2020 was $4,300 per month, according to Genworth’s Cost of Care Survey. However, Medicaid may help take the edge off some costs associated with this type of care.

Medicaid: government health care assistance for low-income seniors

Originally signed into law in 1965, Medicaid is the leading government assistance program for long-term care coverage. Medicaid is essentially a safety net for Americans who can’t afford the care they need without some extra help. Provided as a cooperative effort between the federal government and individual states, the majority of Medicaid funding comes from the U.S. government.

In order to qualify for Medicaid, a person must meet the following requirements:

  1. Their income must fall below a state’s Medicaid income and countable asset limits, or their medical-related care expenses must exceed their income.
  2. They must reside in the state where they wish to receive benefits.
  3. They must be a permanent resident of the United States or have U.S. citizenship.

Medicaid eligibility varies by state, but federal law requires each state to cover certain populations. For example, while the eligibility process differs, low-income families and individuals with disabilities are mandated to be eligible for Medicaid in every state.

Seniors looking to finance long-term care may qualify for Medicaid but with a few caveats. Unlike low-income families, whose eligibility is dictated by their Modified Adjusted Gross Income (MAGI), eligibility for individuals over 65 is determined by Supplemental Security Income (SSI), with guidelines administered by the Social Security Administration. Individuals over 65 who don’t have a disability may need to show both that care is needed and the cost of care exceeds their income. In this case, individuals may be eligible for a “medically needy” or “spend-down program,” offered in 36 states and the District of Columbia, which allows them to qualify for limited Medicaid benefits.

Each state has its own guidelines, so it’s important to contact your state’s medical assistance office for more details. Or, you can contact an elder law attorney who can walk you through the nuances of a Medicaid application.

Does Medicaid cover assisted living?

Medicaid acts as health insurance that covers nearly every type of health care cost, including some long-term care costs. While each state has its own rules and regulations, Medicaid covers some costs of assisted living in most states. This Medicaid coverage may include the following:

  • Long-term care provided by assisted living communities, residential care homes, and nursing homes
  • Inpatient and outpatient hospital services not covered by Medicare
  • Home health services
  • Prescription drugs
  • Physical, occupational, or speech therapy
  • Eyeglasses and hearing aids
  • Personal care services
  • Hospice
  • Co-pays for hospitalization and skilled nursing care not covered by Medicare

Finding assisted living that accepts Medicaid

If you’re looking for Medicaid-approved assisted living communities, first review information online about Medicaid waiver programs available in your state. Waivers enable the federal government to work around certain rules in the Medicaid laws. The purpose of waivers is to give individual states flexibility around specific objectives that states are aiming to achieve, like improving or expanding care for certain groups of people and reducing costs.

Home and Community-Based Services (HCBS) is an example of a waiver program that provides options for Medicaid beneficiaries to receive services at home or in their community as opposed to an institutional setting. Each state can create individual HCBS waivers to support the needs of individual groups who prefer to receive care services in their own home or community.

You can also contact your local Medicaid office, Department of Aging, Department of Elder Affairs, or social service agency. Be sure to request a list of all Medicaid programs in your state that you or your loved one may be eligible for.

Here are some other questions to keep in mind when speaking with an agent:

  • What is the process for applying for Medicaid?
  • Are there social workers or case workers available to assist with the application process?
  • Is there a waiting list? If so, how long is it? Are they currently adding individuals to the list?
  • What are the income and asset qualifications for Medicaid waiver programs?
  • Are there any programs that provide services in the home?
  • Are there any programs that provide services in assisted living communities?

Other ways to supplement assisted living costs

While Medicaid offers numerous options to help pay for assisted living costs, many families find themselves having to seek additional resources. Medicare may fill some of the gaps, but most families find it necessary to rely on personal sources such as retirement savings or long-term care insurance. Some insurance companies will also allow customers to use a life insurance policy to pay for long-term care.

For support with tasks like shopping, transportation, budgeting, or legal issues, there may be organizations or volunteer groups in your community that offer help for a small fee or perhaps even free of charge. Meal programs, companionship programs, and senior centers may also be available to provide additional support when Medicaid does not.

Talk with a Senior Living Advisor

Our advisors help 300,000 families each year find the right senior care for their loved ones.

Alternatives to assisted living that may be covered by Medicaid

Finding the best care arrangement for a loved one can be a stressful process. While an assisted living community can offer care services and peace of mind, there may also be other options. Your state ultimately determines the type of services that are covered by Medicaid, but some of the following alternatives to assisted living may be available to you:

  • Adult day services
  • In-home nursing and therapy
  • Care coordination and case management
  • In-home care, which may include help with cooking, cleaning, or other daily activities

If you or your loved one is currently in a skilled nursing facility under Medicaid, another option for funding assistance is the Medicaid program called Money Follows the Person. It provides states with federal funding to help seniors move out of facilities like nursing homes and back into their own homes or community.

While the costs of assisted living have continued to increase, there are a number of resources to help pay for care. For those who have additional questions or need guidance searching for assisted living options, a Senior Living Advisor at A Place For Mom can provide information to help you find the communities that best fit your family’s financial and care needs.

Sources:

Centers for Medicare & Medicaid Services. “Your Guide to Choosing a Nursing Home or Other Long‑Term Services & Supports.”

Centers for Medicaid & Medicare Services. “Eligibility.”

Centers for Medicare & Medicaid Services. “Home & Community Based Services.”

Centers for Medicare & Medicaid Services. “Long Term Services & Supports.”

Author
Kevin Ryan

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