For many seniors, seeking assisted living is a decision of both the conscience and the heart. On the one hand, seniors may choose to move into assisted living communities so they don’t have to lean on family for support with health issues or with activities of daily living, and, on the other, they see that assisted living can make it easier to maintain a healthy lifestyle, enjoy social opportunities, and engage in meaningful activities. It’s no secret that assisted living costs can stretch any family budget. However, Medicaid may help take the edge off some of the costs associated with this type of care.
Paying for assisted living often requires planning ahead of time — the median cost for assisted living in 2023 was $4,807 per month according to A Place for Mom’s 2023 Cost of Long-Term Care and Senior Living survey.
Families may find it necessary to rely on personal sources such as retirement savings or long-term care insurance. And some insurance companies will allow customers to use a life insurance policy to pay for long-term care. However, these particular assets typically disqualify an individual from Medicaid eligibility.
Enacted in 1965, Medicaid is the leading government assistance program for health care coverage. Medicaid is essentially a health insurance safety net for Americans who can’t afford the care they need on their own. A cooperative effort between the federal government and individual states, the federal government provides the majority of the program’s funding.
Also, it’s important to know that Medicaid is commonly used as a generic term to describe a number of different programs. However, industry professionals use the term to refer to a specific program that pays for medical care, similar to traditional health insurance.
In order to qualify for Medicaid, a person must meet several requirements:
Each state has its own application 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 eligibility for benefits and the Medicaid application process.
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 waiver programs cover some costs of assisted living in most states. It’s important to note that Medicaid generally does not cover room and board but may include various care services:
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If you’re looking for Medicaid-certified assisted living communities, first review information online about Medicaid waiver programs available in your state. Waivers enable states to work around certain rules in federal Medicaid laws. The use of waivers gives individual states flexibility toward specific objectives that they’re 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 specific options for Medicaid beneficiaries. Each state can create individual HCBS waivers to support the needs of specific groups, allowing qualified individuals to receive care services in their home or community as opposed to an institutional setting.
You can also contact your local Medicaid office, Department of Aging, Department of Elder Affairs, or social service agency for assistance with understanding your care options. 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:
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The specific amount that Medicaid will pay for assisted living varies for each person. Certain states may impose copayments, coinsurance, deductibles, and other similar charges for non-emergency services based on an individual’s income.
Medicaid waivers can help contribute to the cost of care in an assisted living facility. For eligibility, individuals must demonstrate that care is needed, in addition to proving that either their income falls below a certain level or that the cost of care they require exceeds their income. This may allow them to qualify for limited Medicaid benefits through a medically needy or income spend-down program, in 36 states and the District of Columbia.
And, while Medicaid offers numerous options to help cover assisted living costs, many families still find themselves having to seek additional resources.
Read more:Medicare, Medicaid, and Long-Term Care
Unlike Medicaid, Medicare will not cover services provided in an assisted living facility. However, Medicare, which provides federal health insurance coverage to most people 65+ can be helpful for covering medical costs, regardless of where a senior lives.
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.
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 helpful options. Your state ultimately determines the type of services that are covered by Medicaid, but some alternatives to assisted living may be available to you:
If you or your loved one are currently in a skilled nursing facility under Medicaid, one payment assistance option 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 other living arrangements in their community.
The Program of All-Inclusive Care for the Elderly (PACE) is another community-based Medicaid offering that provides both medical and social services to eligible seniors. PACE is designed to deliver coordinated care through an interdisciplinary team of health professionals who are assigned to PACE participants. The program provides an alternative to nursing homes and allows many seniors to receive care in their own homes.
While the costs of assisted living continue to increase, there are a number of resources to help low-income seniors 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.
Centers for Medicaid & Medicare Services. Eligibility.
Centers for Medicare & Medicaid Services. Home and community based services.
Centers for Medicare & Medicaid Services. Cost sharing out of pocket costs.
Centers for Medicare & Medicaid Services. Money follows the person.
Centers for Medicare & Medicaid Services. Program of all-inclusive care for the elderly.
The information contained on this page is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.
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