Does Medicaid Pay for Assisted Living?

Saving Money with Medicaid Waivers

The short answer is: sometimes, yes — but not in the way you might expect.

While Medicaid doesn't usually pay for room and board at assisted living communities, it helps cover care-related services through something called a HCBS waiver. For many families under financial strain, these waivers are a lifeline. Considering the potential role of Medicaid in offsetting these costs is a crucial part of the financial discussion.

Here's a 7-step guide for making the most out of Medicaid.

1. Understand Medicaid's Role in Assisted Living

2. Determine Your Medicaid Eligibility

Residency: You must be a resident of the state in which you are applying for Medicaid.

Age/Disability: Generally, you need to be age 65+ or have a disability or chronic illness.

Income Limits: Medicaid's income limits that vary by state and the specific program. For long-term care services, those limits are often lower. Some states may allow for mechanisms like Qualified Income Trusts (QITs) if your income exceeds the standard limit. In 2024, most states set the monthly income limit for a single applicant at $2,829 (300% of SSI FBR).^[2]

Asset Limits: There are also limits on your assets. While these also vary by state, many states set them at $2,000 for an individual and $3,000 for a couple. Personal assets, like your primary residence (under specific equity conditions) and one vehicle, are often exempt.^[3]

3. Research Assisted Living Programs

Contact Your State's Medicaid Agency: Reach out directly to your state's Medicaid agency to inquire about their programs that cover services in assisted living facilities. Their website or helpline will be the best starting point.

Inquire About HCBS Waivers: Specifically ask about Home and Community-Based Services (HCBS) waivers that may provide assistance for services in assisted living. These waivers often have specific names within each state.

Ask About State-Specific Programs: Your state may have additional programs or state plan options to help with assisted living costs, including potential assistance with room and board.

Understand Program Requirements: Each program will have its own specific eligibility criteria, service coverage, and application processes.

4. Contact Your Local Area Agency on Aging (AAA) or Aging and Disability Resource Center (ADRC)

Your local AAA or ADRC can provide valuable information about long-term care options in your state, including assisted living and how Medicaid might be able to help. They can also guide you through the application process and connect you with local resources.

5. Find Assisted Living Facilities that Accept Medicaid

Not all assisted living facilities accept Medicaid payments due to reimbursement rates. You will need to specifically inquire with facilities in your area whether they are "Medicaid certified" or accept relevant Medicaid waivers.

Your state's Medicaid agency or the Area Agency on Aging may have lists of facilities that accept Medicaid.

6. Apply for Medicaid in Your State

Once you know what programs are available and which facilities you're interested in, it's time to apply. This usually involves:

• Filling out an application (online, by phone, or in person)
• Providing documents like proof of income, assets, identity, and medical need

Your state Medicaid office, local senior services agency, or even the facility you're applying to can often assist with the application process.

7. Apply for Relevant HCBS Waivers in Your State

This process focuses on demonstrating your need for the specific services these waivers provide. Here's a very detailed guide for what this usually requires:

• Identify Applicable Waivers: Research the specific HCBS waivers available in your state that cover long-term care. Your state's Medicaid agency or the Area Agency on Aging will be invaluable resources for this information. Understand the target populations and the types of services each waiver covers.
• Express Interest: Once you've identified a potentially suitable waiver, you'll probably need to formally express your interest in enrolling. This might involve contacting your state's Medicaid agency, the specific waiver program administrator, or a designated intake agency.
• Do the Paperwork: There will likely be a specific application or enrollment form for the waiver program itself, separate from your initial Medicaid application. This form will gather more detailed information about your current living situation, care needs, and preferences for services.
• Complete a Functional Assessment: What level of care is needed to be covered? Waiver eligibility assessments typically evaluate your ability to perform Activities of Daily Living (ADLs) (bathing, dressing, eating, mobility) and Instrumental Activities of Daily Living (IADLs) (managing medications, preparing meals, handling finances). The results help determine if you meet the long-term care waiver criteria.
• Plan Your Care: Once eligible for the waiver, you will usually work with a case professional to develop your care plan, deciding specific services you will receive, the frequency of those services, and approved providers.
• Finalize Approval: Final enrollment in the waiver program is subject to slot availability and state approval. Many waiver programs have enrollment caps, so waiting lists are common. Your case manager or the waiver administrator should be able to update you of your status and any potential waiting periods.

Medicaid's HCBS waivers aren't a panacea, but they help a lot. And the best news is, you're not in it alone! People and organizations are ready to lend a hand at every step of this journey.

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