Last Updated on November 18, 2022 by Anne-Sophie Reinhardt
Medicaid will pay for assisted living costs, including memory care because this program is an extended care program that includes personal care and specialised home care services. Medicaid can also cover skilled nursing and emergency response costs.
However, they don’t cover accommodation and board. Medicaid is a state program; therefore, the program’s benefits and qualifications can vary from one state to the next. This is because the federal government allows each state flexibility in running their Medicaid programs.
Each state has its own Medicaid program with different eligibility requirements; that’s why it’s not easy to determine if Medicaid will cover assisted living. It is essential that you know that there are two types of Medicaid programs in most states: the normal state Medicaid program and HCBS (Home and Community Based Services).
Every state must provide personal care assistance through Medicaid. Some states offer it through regular state programs, while others provide it through HCBS waivers. Many states offer it through both Medicaid and HCBS waivers. Medicaid is available in all 50 states. However, assisted living facilities are not available in all states.
What Is Regular State Medicaid?
Regular state Medicaid is an entitlement program that provides many of the Federal Government’s health care benefits.
All states, for instance, are required to pay the cost of home-nursing for all residents who are eligible. Optional benefits are also included by the federal government, but they can be implemented at the state’s discretion. Assistive personal care is one such benefit.
What Are HCBS Medicaid Waivers?
Many states offer 1915(c) waivers, also known as HCBS Medicaid Waivers. These waivers allow residents to live at home or in the community without assisted living facilities placement.
This is done by waivers, which provide care and other benefits to enable independent living.
How Can You Qualify Assisted Living Coverage Under Medicaid?
State Medicaid programs limit recipients’ earnings to either the following:
- 100% FPL (Federal Poverty Level) = $1073/monthly
- 100% FBR (Federal Benefit Rat) = $794/monthly
The FBR must be below 300% to qualify for the HCBS waiver. Regular state Medicaid waivers and HCBS waivers usually limit assets to $2000.
The recipient must be able to receive nursing care or hospitalization. Each state has its own requirements which means, some states may require beneficiaries to receive assistance with two aspects of daily living, such as:
- Chop up their food and eat.
- Dressing up and down.
- Cleaning up and after going to the bathroom.
- You can move from a bed into a couch.
Some programs require that recipients have a doctor statement. A confirmation of Alzheimer’s disease is not an indication that you are eligible for assisted living benefits.
Which Assisted Living Service Does Medicaid Cover?
Medicaid’s assisted living benefits will differ depending on where the recipient lives and what Medicaid program they enrolled in. are the following list outlines the most common assisted living services that are available under Medicaid:
- Personal care (dressing, cleaning, eating, and toileting)
- Home care (food preparation, grocery shopping, housecleaning, and laundry)
- Management of cases.
- Emergency response personnel
Medicaid does not cover the cost of accommodation or board for assisted living. Many states offer an OSS (Optional States Supplement), a cash aid program that helps cover the cost for housing and board.
This benefit, also known as SSB (State Supplementary benefits), is added to federal SSI earnings.
Although the agency issuing these federal payments varies between states, it is usually either the SSA (Social Security Administration), or DHS (Department of Human Services). Visit the Medicaid portal contains a list of all DHS outlets in each area.
What Is the Extent of Coverage for Assisted Living Under Medicaid?
It will all depend on:
- The state in which the recipient resides.
- The state Medicaid program (Regular Medicaid, HCBS Medicaid).
- How much care the recipient needs.
To determine how many hours Medicaid will pay, a needs assessment will occur. For example, beneficiaries who are dependent on assisted living will receive more caregiver hours per month.
Which Assisted Living Centers Accept Medicaid?
Some assisted living facilities are not willing to accept Medicaid coverage as payment. Therefore, you have to make sure you check if the residence is Medicaid-approved before making your decision. Even though the care centre does not accept Medicaid, it may allow third-party caregivers to enter and provide assistance.
Medicaid will pay the third-party caregiver if they aren’t working for an assisted living facility. This alternative is worth considering. Make sure you inquire at the care center whether they accept third party caregivers.
Unfortunately, there is not a national database of assisted living facilities that take Medicaid, therefore, for assistance in finding these homes, contact your local AAA (Area Agency on Aging).
AAA offices have a list of assisted living facilities that accept Medicaid. They will provide a link to a searchable database that includes a list of centres in the state if they do not have one.
Notice that assisted living facilities that accept Medicaid have a limit on the number of available beds for Medicaid-sponsored residents. This also means that there are fewer beds for Medicaid recipients.
It is best to create a list of local care centers and then call most of them. Ask them about the third-party caregivers if they do not allow Medicaid-sponsored residents.
Some states provide assistance through Medicaid, others through their HSBS waivers and others through state plans and releases.
Discuss the possibility of Medicaid being used to pay for assisted living with a Medicaid planning specialist. Different people may need assisted living services, while others might face challenges. Moreover, if you are not eligible for Medicaid, there are alternatives that you can consider.