Many states offer a certain level of assistance for people in assisted living but exactly how much does Medicaid pay for assisted living?
Now, Medicaid assistance for seniors in assisted living varies by state which means the rules are quite sophisticated. Similarly, the dollars payable under Medicaid assisted living oscillate from state to state.
So, How Much Does Medicaid Pay For Assisted Living?
The amounts differ. Some states cover only the personal care services given in Medicaid assisted living facilities while others add nursing services. Likewise, coverage for medication, home health services, and recreational activities vary by state.
The federal government doesn’t allow any state to cover room and boarding costs in any arrangement.
States, however, understand that assisted living can be costly to families and have devised ways of reducing these costs, for example, by limiting the amounts the facilities can charge.
Some states offer eligible seniors supplementary social security assistance while others help you pay for meal preparation plus serving but are careful to exclude actual food costs.
What is Medicaid?
Medicaid is the main government funded healthcare assistance program and helps millions of Americans including senior citizens to pay for medical expenses. It’s run cooperatively by the states and the federal government.
The main source of its funding is the federal government but each state has some financial obligation as per the set rules and requirements.
Medicaid can help seniors and the disabled pay for quality healthcare despite having limited incomes.
Does Medicaid Pay For Assisted Living?
Does Medicaid cover assisted living? As I had indicated, yes!
But, as earlier mentioned, states have the leeway to decide whether to cater for the costs incurred in assisted living.
You can contact your Medicaid’s office locally to confirm the extent of coverage and your responsibilities (if any).
Can I Rely on Medicaid For Assisted Living Funding?
While Medicaid is a very good healthcare funding program and one of the best administrated globally, it would be unwise to rely on it to fund your (or a loved one’s) assisted living bills.
First, because the reimbursement rates aren’t that high and secondly because not all assisted living communities accept it as a payment option.
And those are not the only issues:
Officially, Medicaid provides assistance only for a limited number of services in assisted living centers so you may have to chip in here and there.
There are also enrollment caps and sometimes, lengthy waiting lists for the Medicaid waivers.
Eligibility For Medicaid
Medicaid was expanded in 2010 to cover practically all low-income Americans below 65.
Individuals must also satisfy certain non-financial eligibility conditions:
For instance, to be a beneficiary, you must be a resident of the state you’ll be receiving Medicaid from.
You must also be an American citizen or a lawful permanent resident. Additionally, some groups are locked out due to age, pregnancy or their parenting status.
Seniors aged 65 years and over are also eligible on the basis of their age. The same special treatment is accorded the disabled including the blind.
What Does Medicare Cover For Assisted Living?
While Medicaid is limited in terms of the coverage offered, Medicare could even be worse as far as meeting the assisted living costs is concerned.
Medicare will not, in any event, cover any costs incurred in assisted living communities or any long-term care centers.
It’s restricted to covering only healthcare-related costs administered by a licensed medic while you live at an authorized facility or permitted home health care bills.
Its takes exceptional circumstances and authorization to have Medicare cover any other cost item.
Medicaid Assisted Living Waiver
Many states allow their citizens to use medicaid assisted living waiver to pay for their assisted living services if such services can be accessed at a reduced cost.
The greatest strength of Waivers is that they permit participants to have elevated income eligibility limits compared to regular Medicaid.
To illustrate, currently, most waivers have monthly income limits capped at $2,250 while regular Medicaid Plans have a limit of $750 per month.
But there are no guarantees considering that each state has its separate regulations and eligibility requirements.
To qualify, applicants will most likely have to prove that they need care equivalent to what’s offered to nursing home residents.
Again, in some states, the waiver programs cover only selected regions.
Understanding How Assisted Living Works
Assisted living accommodation aims at helping elders remain independent as much as possible while providing assistance whenever necessary.
It’s a combination of conducive housing, healthy eating, personal care, lifestyle support, social activities, medical administration, (for some homes), and round the clock monitoring for seniors.
Your loved one will be assisted in getting dressed, to bath, laundry, run personal errands, and sometimes to exercise.
He/she will feel cared for and is much better than dropping them at a nursing home (which could even be costlier).
Assisted living communities are an amazing choice for seniors who are unable to live alone, but do not, as of yet, need nursing care.
What Assisted Living Facilities Accept Medicaid?
But for a couple of states, you will find a healthy distribution of assisted living facilities accepting Medicaid across the many states.
The question is how to locate them:
Option 1: Use Relevant Websites
Well, a number of websites can help:
- Visit gov and search for assisted living facilities accepting Medicaid.
- Visit the massive Medicaid services website hhs.gov and run a similar search.
In both cases, pick the informative links highlighted under references/resources for guidance and tips.
Option 2: Contact your State’s Medicaid Agency
The medicaid.gov website also has all the various State’s Medicaid Agency’s contact. Search for the applicable agency’s contact and get in touch.
Option 3: Call Medicaid
You may also want to call Medicaid on 877-267-2323 and ask about homes that offer the services (under Medicaid).
What to Know:
Some states have been providing partial coverage for long-term care expenditure at eligible assisted living facilities for years and may have more communities registered for the Medicaid program.
Others have only begun offering Medicaid help (assisted living care) recently and may only have scattered choices.
New York and Ohio are some of the pioneers in extending coverage. Mississippi, Nebraska, and a number of states followed soon thereafter.
Yet other states like Alabama are still dragging their feet and will not help much with Medicaid coverage with regard to assisted living.
How Can I Find The Best Medicaid Assisted Living Near Me?
Over forty states have assisted living centers which accept Medicaid. The task lies in finding that community which is near you.
Well, here you have several options:
Option 1: Search Online
You can log in to your computer or phone and go to Google. The type “Medicaid assisted living near me”
In most cases, the search will yield facilities close to your residence, their contacts, and directions from Google Maps.
To simplify your task, Google ranks them from the nearest to the farthest. Lastly, to narrow down your search, remember to read the reviews published on the websites by past clients.
Option 2: Contact the Aging Department in Your State
You can also call or visit your state’s aging department office or any other office departmental office dealing with Medicaid issues and long-term care.
Once there, ask for the telephone numbers of locally licensed assisted living facilities accepting Medicaid.
Some officials may also know the precise directions so you can get location assistance.
Option 3: Ask For Referrals
You can also ask around from friends or relatives who have at one point stayed in assistance living residences (or have been in contact).
This is one of the best ways as your friend/relative is more likely to give an honest recommendation.
Your loved one may also be familiar with someone who has been to such facilities and could help you with their contacts as you dig more information.
Things to do:
Even before going too far, find out from your local Medicaid office if your state’s plan extends to assisted living facilities.
And if it does, what costs do residents meet? Also, seek information about how to maneuver the Medicaid process.
When comparing assisted living homes, ask all the nagging questions. What services should I expect? What’s your staff/patient ratio? How are the meals? Is healthcare included?
If your state won’t offer Medicaid coverage for your assisted living needs or offers very minimal coverage, look for payment alternatives such as private medical insurance.
Final Thoughts
As you have seen, the answer to the question of how much does Medicaid pay for assisted living has several angles to it because of the way the Medicaid program is set.
But generally, it’s good to know that Medicaid alone may not be enough to meet all the expenses associated with the services given in an assisted living residence.
But will Medicaid pay for assisted living? Of course, yes! However, coverage is only partial. Thankfully, some states have support programs besides regular Medicaid such as higher waiver programs and offer reasonable help.
Ultimately, the best way to know the level of assistance you can expect is to research the structure of Medicaid in your state!