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.
“ Medicaid supports assisted living costs through Home and Community-Based Services (HCBS) waivers, allowing states to offer services in community settings.
Usual Coverage: Medicaid can often help pay for long-term services and supports within assisted living. This frequently includes assistance with ADLs (activities of daily living), homemaker services, medication management, case management, and sometimes transportation.
Usual Exclusions: Medicaid doesn't cover the cost of room and board in assisted living, as this is usually considered a living expense (akin to rent).
Home and Community-Based Services (HCBS) Waivers: Medicaid supports assisted living costs through Home and Community-Based Services (HCBS) waivers. These waivers allow states to offer services in community settings like assisted living, rather than solely in nursing homes.[1]
State-Specific Programs: Many states have additional programs or state plan options that can further assist with assisted living costs.
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]
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.
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.
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.
Once you know what programs are available and which facilities you're interested in, it's time to apply. This usually involves:
Your state Medicaid office, local senior services agency, or even the facility you're applying to can often assist with the application process.
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:
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.
Navigating Medicaid eligibility and assisted living options can be complex. Our experienced senior care advisors can help you understand your options and find the right care solution for your loved one.
Our experienced agents will provide a free consultation to help you understand your options.