Medicaid and Assisted Living: What’s Covered and How to Qualify

Are daily tasks around the house becoming more challenging? Or perhaps you’re worried about living alone because there won’t be anyone around to help if something happens to you.

If that’s the case, you may be considering moving into an assisted living community. 

But how will you pay for that extra help? Does Medicaid cover assisted living?

The answer to that question isn’t necessarily straightforward and depends on several factors, including where you live.

But don’t worry. You have options, and we’ll break them down for you here.

Read on to learn:

• If and how much Medicaid will pay for assisted living
• Additional ways to pay for the extra help you need
• Why Senior Services of America is the ideal resource to help you find an assisted living facility that meets your specific needs

Does Medicaid Cover Assisted Living Costs?

Can Medicaid pay for assisted living?

The short answer is … maybe.

Medicaid is a state and federal program designed to assist with the coverage of health care costs for individuals who have both limited income and resources. Medicaid benefits vary by state because the Medicaid program is partly funded by the federal government and partly by each state. 

47 states and Washington, D.C., currently provide some level of assistance for qualifying seniors residing in assisted living facilities. 

So, if you’re considering moving into assisted living, it’s important to learn about eligibility requirements that are specific to where you live. 

How Much Will Medicaid Pay for Assisted Living?

Because Medicaid benefits are defined on a state-by-state basis, it’s difficult to say exactly how much Medicaid will pay for assisted living. The coverage amount will vary based on the:

• State where a senior resides
• Program a senior is enrolled in
• Level of care a senior needs

Still, the majority of state Medicaid programs cover some assisted living costs for residents who meet the eligibility requirements.

What Does Medicaid Pay for in Assisted Living?

Most qualifying seniors will have access to the following Medicaid-sponsored assisted living services:

• Nursing care
• Case management
• Medication management
• Medical assessments and exams

It’s important to note that state Medicaid programs cannot directly pay for assisted living room and board. However, several states have optional supplements and assistance programs to help seniors with that expense. These programs are often administered by either the Department of Health and Human Services (HHS) or the Social Security Administration (SSA).

Nursing Care

While the cost of assisted living usually includes assistance with ADLs (activities of daily living), medication management, and coordination with health care providers, more in-depth medical care like skilled nursing is not typically included. Funding for additional nursing care is often covered by Medicaid for eligible seniors.

Case Management

Assisted living facilities typically communicate frequently with a resident’s health care providers. 

However, some seniors might need more targeted case management. In this case, some (but not all) states provide financial assistance for a Medicaid recipient to utilize a case manager.

Medication Management

At most assisted living facilities, medication management is typically included in the monthly fee. But, if that isn’t the case at the licensed assisted living facility you’ve selected, you may be able to get those fees taken care of with Medicaid resources.

Medical Assessments and Exams

Medical assessments and exams are generally outside the scope of what an assisted living facility provides through its monthly care fee. 

This is where Medicaid may step in. In many cases, it covers:

• Preventative check-ups 
• Medical assessments
• Diagnostic exams

How Do You Determine if You’re Eligible for Medicaid–Covered Assisted Living?

Medicaid won’t just pay for in-home senior care or assisted living care once you’ve reached a certain age. Seniors must qualify for assisted living resources covered by Medicaid.

First, a senior must be a resident of the state in which they are applying for Medicaid. Additionally, the assisted living facility where they want to reside must be licensed by the state and accept Medicaid.

Services, benefits, and eligibility requirements vary from state to state, but typically, you must demonstrate both functional and financial need to be eligible for Medicaid-covered assisted living.

Functional Needs

Seniors who want Medicaid to cover their assisted living costs must meet specific medical requirements.

Some states demand that anyone seeking financial assistance for senior care benefits must show medical need, such as needing assistance with at least two ADLs. Depending on the benefit or specific program a senior is applying for, there may also be additional medical assessments or requirements to qualify.

Financial Needs

To receive Medicaid benefits, you must meet specific financial requirements. This is typically a combination of income and assets.

In many states, the income limit for a single senior is $2,901 per month, and the asset limit is $2000.

Details can be subject to change and vary from benefit to benefit or between states. 

3 Additional Resources That Could Help Pay for Assisted Living

According to the 2024 Genworth Cost of Care Survey, assisted living in the U.S. costs an average of $5,900 per month. The average length of stay in an assisted living community is close to two years.

So, let’s say you spend two years at an assisted living community where you pay $6,000 per month — just over the national average. That means you can expect to have to come up with $144,000 for your care. That’s a big number to wrap your head around.

If Medicaid isn’t an option in your state, or if you need to supplement Medicaid to pay for your assisted living care, you may consider a combination of these financial resources:

• Veterans’ benefits
• Long-term care insurance
• Private funds

#1: Veterans Benefits

For qualified veterans and surviving spouses, the U.S. Department of Veterans Affairs offers an Aid & Attendance benefit to help with the cost of assisted living. 

This benefit can be used for care in any state-licensed care setting and can provide up to $2,727 a month to a veteran and their spouse or up to $2,300 a month for a veteran without a dependent.

• Medical Eligibility: The individual must need assistance with at least two Activities of Daily Living (ADLs) within VA guidelines. Details on these needs can be best explained by an expert at your local VA office or by contacting a Veterans Benefits Advisor.
• Financial Eligibility: Many assets, including some annuities and pre-paid funeral expenses, may be exempt from consideration in the financial qualification guidelines. For more information regarding financial qualifications, seek the professional advice of a VA-accredited attorney.

Less than 5% of eligible veterans are currently taking advantage of this benefit.

For more information about the Veteran’s Pension Benefit with Aid & Attendance program, visit your local or regional VA center or VA website.

#2: Long-Term Care Insurance

At least 70% of people over the age of 65 will need some type of long-term care, such as assisted living. This makes long-term care insurance a good investment.

A long-term care insurance policy removes the burden of having to pay for 100% of care from personal funds by helping to supplement monthly payments to an assisted living provider.

Long-term care insurance can cover:

• Home care
• Assisted living
• Adult daycare
• Nursing home care
• Memory care
• Respite care
• Hospice care

Many experts suggest investing in this type of coverage before the age of 55 as part of an overall retirement plan. It’s important to note that premiums paid on long-term care insurance policies may be eligible for an income tax deduction.

#2: Private Funds

Many families or individuals pay for assisted living with private funds. This is typically a combination of:

• Savings
• Social Security benefits
• Pension payments
• Stocks
• Retirement accounts
  • 401(k)
  • IRA

Senior Services of America: Find an Assisted Living Facility That Accepts Your Benefits and Enhances Your Quality of Life

If you’re seriously considering an assisted living or other senior living community as your next home, it’s important to choose the right one for you. It’s also vital to find a facility that accepts your financial benefits.

Some facilities accept Medicaid payments but only offer a certain percentage of their rooms to Medicaid recipients. And there are others who do not accept it at all. 

That’s where Senior Service of America comes in.

We specialize in the management and operation of senior housing communities, including:

• Independent living
• Assisted living
• Memory care

Our communities are centered around our residents, designed with life-enriching programming in mind, and meant to keep you healthy, happy, and fulfilled during your senior years.

Does this sound like what you’re looking for?

If you need a little extra help to make day-to-day life easier and more comfortable, or it’s important for you to have a support network nearby, we’re here to help. If you’re worried about the cost of assisted living, our professionals are ready to discuss your options.

Contact an advisor at a Senior Services of America community today. We’ll evaluate and work with your specific benefits, including Medicaid, to help you find the best living situation for your golden years.