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Does Medicaid Cover Assisted Living Costs?

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Your Guide to Medicaid Coverage and Assisted Living Costs

Are daily tasks around the house becoming more challenging? 

If that’s the case, you may be considering moving into an assisted living community. There you’ll be provided a little extra help with activities of daily living (ADL’s) like dressing, bathing, or taking medication.

But how will you pay for that extra help?

Does Medicaid pay for 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’ve got options. And you’ve come to the right place.

Read on to learn:

  • If and how much Medicaid will pay for assisted living

  • Additional ways to pay for the extra help you need; and 

  • Why Senior Services of America is the ideal resource to help you find an assisted living facility that meets your specific needs.

Table of Contents

Will Medicaid Pay for Assisted Living?

Does Medicaid cover 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. 

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

Qualifying seniors. Those are keywords to keep in mind.

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

It’s also important to note that Medicaid and Medicare are different programs.

Keep reading to learn more about how to determine whether you are eligible for Medicaid-covered assisted living.

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

  • The program a senior is enrolled in

  • The level of care a senior needs

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

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

  • Nursing care

  • Management of medications

  • Medical exams and medical assessments

  • Case Management

But, you might be wondering “does Medicaid pay for room and board in assisted living?

The answer to this question can be tricky as well. 

Not exactly.

That’s because 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 supplements and programs are often administered by either the Department of Human Services (DHS) or the Social Security Administration (SSA).

Does Medicaid Cover Additional Costs Associated With Living in an Assisted Living Facility? 

By nature, assisted living facilities are “all-inclusive.” This typically means one monthly senior living fee for your:

  • Accommodations 

  • Utilities 

  • Meals 

  • Transportation

  • Activities 

  • And more 

However, you may find some “extras” come at an additional cost, especially for those who need additional or specialized medical care. 

Thankfully, that’s where Medicaid assistance comes into play.

In many states, Medicaid provides financial assistance with:

  • Nursing care

  • Case management

  • Medication management

  • Medical assessments and exams

Nursing Care

While the cost of assisted living usually includes assistance with … 

  • ADL’s 

  • 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 that situation, 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. 

However, 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. 

Medicaid, in many cases, does cover:

  • Preventative check-ups 

  • Medical assessments; and 

  • Diagnostic exams

How Do I Determine if I am 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 off, a senior must be a resident of the state in which they are applying for Medicaid. Additionally, the assisted living facility 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.

Caregiver assisting senior woman putting on shoes

Functional Needs

Certain medical requirements have to be met to qualify for Medicaid benefits. 

Some states require that anyone seeking financial assistance for senior care benefits be able to 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 be additional medical assessments or requirements to qualify.

Financial Needs 

To receive Medicaid benefits, it is typically necessary to meet financial requirements. For these purposes, this is typically a combination of income and assets.

In many states, for a single senior the income limit is $2,382/month and the asset limit is $2000.

Again, details can be subject to change and vary from benefit to benefit. 

To find the most dependable and current numbers and information, your best option is to contact an advisor at a Senior Services of America community to go over the financial assistance options available to you.

3 Additional Resources and Ways to Pay for Assisted Living

If you’re reading this article, you’ve likely considered how much assisted living will cost

According to the 2020 Genworth Cost of Care Survey, assisted living in the U.S. costs an average of $4,300 a month. It’s important to note, though, that these rates do vary widely. Memory care costs (on average) an additional $800-$1,200 per month.

AARP reports the average length of stay in an assisted living community is 2.5-3 years

So let’s say you spend 2.5 years at an assisted living community where you pay the national average of $4,300 a month. You’re looking at a whopping $129,000. 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:

  1. Veterans benefits

  2. Long-term care insurance

  3. 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 $2,200 a month to a veteran and their spouse or up to $1,900 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 visit the 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.

#3: 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

    • 401k

    • IRA

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

If you’re seriously considering an assisted living facility as your next home, it’s important to find the right facility for you. Not only that, you need to find a facility that accepts your financial benefits.

That's because some facilities accept Medicaid but can only offer so many rooms to Medicaid recipients, while others do not accept it at all. 

That’s where Senior Service of America comes in.

Senior Services of America specializes in the management and operation of senior housing communities, including:

  • Independent living

  • Assisted living; and

  • Memory care

Our communities are:

  • Centered around our residents

  • Designed with life-enriching programming in mind; and

  • Meant to keep residents healthy, happy, and fulfilled during their senior years

Does this sound like what you’re looking for?

If you’re looking for that little extra help to make day-to-day life easier and more comfortable, we’re here to help. If you’re worried about the cost of assisted living, our professionals are ready to talk it through with you.

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.

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Senior Services of America

800-689-0493

1201 Pacific Avenue Suite 450 Tacoma, WA 98402 US