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Will Medicaid Help Pay for Assisted Living? – Ask After55.com

The quick answer: Medicaid may pay for some of your expenses in assisted living. Meanwhile, Medicaid will pay for nursing homes in nearly all cases. Read on for details.

The options for suitable long-term care and senior housing are not necessarily limited because you or a loved one is on a fixed income or disabled. With the help of government programs such as Medicaid, seniors can live in various types of care facilities without worrying who is going to foot the bill. However, it’s important to look into your state’s Medicaid program and eligibility requirements before deciding on a long-term care plan.

medicaid written on umbrella over a house

What Is Medicaid?

Medicaid is a federal and state health insurance program designed for certain low-income individuals and families. It is jointly funded and covers children and senior citizens, as well as those who are blind, disabled, and others who are eligible for federal assistance. It also offers benefits not typically covered by Medicare such as nursing home and personal care services.

State-specific programs called Medicaid Waivers provide support and care to seniors not living in nursing homes. Instead, they typically live at home or in assisted living facilities. Medicaid Waivers are not entitlements like nursing home care, but instead are programs that have enrollment caps and waiting lists.

Long-Term Care Eligibility

The federal requirements for Medicaid are broad, and each state has authority to design its own programs. This includes establishing eligibility standards, determining services and benefits coverage, and setting a payment rate. To be eligible for Medicaid long-term care, you must qualify financially and medically. The requirements are specific to the state in which you live, your age group, and the Medicaid waiver or program. Here are some general rules that apply:

Financial Qualifications: Your income and assets are major factors, and although they may exceed federal or state limits, you can still qualify for Medicaid. This cap may be set at a hard income limit (three times your SSI payment) or income that is relative to the cost of your care.

Medical Requirements: While medical qualifications may differ from state to state, Medicaid long-term care covers you if you need skilled nursing care, are afflicted with Alzheimer’s disease or other dementia, or if you cannot care for yourself at home. If skilled nursing is not needed, then Medicaid will tie its medical eligibility to the required amount of Activities of Daily Living (ADL) needed such as assistance with bathing, cooking, etc.

Other Qualifications: Medicaid long-term care services are available to all seniors 65 years and older. If you are younger than 65 and considered disabled, you may still be eligible. Your marital status does not necessarily impact your eligibility unless it changes your income and asset limits. Veteran status also does not impact your eligibility.

dollars and a stethoscope, to illustrate medicaid costs

Medicaid Services and Benefits

If you are eligible for Medicaid long-term care services, you may qualify for some or all the following programs depending on where you live:

Nursing Homes/Skilled Nursing: Medicaid pays for all nursing home care no matter where you live as long as it is a Medicaid-certified facility.

Assisted Living Communities: The number of assisted living communities covered by Medicaid is increasing. In most states, it will pay for some assisted living costs mainly with Medicaid Waivers. It will not pay for room and board or rent, but it will help with some medical assistance. Get more information about your state’s assisted living policy and learn more about other programs available to Medicaid beneficiaries.

Adult Day Care/Adult Day Health Care: These two types of care are covered by Medicaid and Medicaid Waivers in all 50 states for some beneficiaries. Some states will only cover one and not the other. Learn more about your state’s specific policies.

Home Health Care/Non-Medical Home Care: Through Medicaid’s personal care assistance programs and Medicaid Waivers, you can receive coverage of your home health care. These waivers also support non-medical home care, as well as other domestic services in and around your home. Get more information about coverage in your state.

Your turn: What is your experience with using Medicaid for long-term care such as assisted living or nursing home care? What do you recommend? Share your thoughts in the comments below.

Related: Will Medicare Help Pay for Senior Housing?

What Are Your Senior Housing Questions?

Ask After55 is a monthly feature of After55.com by correspondent Mary Beth Adomaitis. Submit your questions for consideration in one of two ways:

– Comment below on this article. (Your question will be displayed publicly, so we suggest that you don’t include personally identifying information.)

Fill out this form. (Your question will be sent to us privately. Note, however, that we aren’t able to answer all questions, especially on individual situations.)

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  • Mary Beth Adomaitis

    About Mary Beth Adomaitis:

    Mary Beth Adomaitis a freelance writer living in Southern California. She has written about senior topics for several senior living websites. She also has a blog, Unwrinkled Hearts, which was started after her mother-in-law passed away in 2015. It focuses on elderly living in the 21st century. Mary Beth has been a writer/journalist for more than 25 years, lending her talents to companies such as The Los Angeles Times, where she also served as a copy editor and graphic designer.

    Comments

    1. Joseph Herrera says:

      Hello

      My mother is 92 years old and she has dementia… My brother is staying with her temporally. She is able to dress herself and take care of her hygiene needs. She is receiving medicaid. Her husband – my father past away for few months. She gets about 1300-1400 a month for SS in NY. She should be in a facility due to not being able to cook for herself so is not getting her nutrition needs meet. She has some money in the bank but that is to be use if she passes away.. Not sure what to do? I live in Colorado and I may be able to bring her out here with me but I still have the same problem needing someone to stay with her while at work and how to pay for it.

    2. Hello my name is Randy I have Idiopathic Pulmonary Fibrosis , and receive 750.00 in ssi and ssdi and have Medicaid and Medicare I’ve became home less I’m on Oxygen and don’t know what too do ,07/03/17

    3. Thomas N Haynie says:

      SSI is 1200 monthly with Medicaid paying medication premium. Are there senior housing facilities availiible to me near Montgomery, Al.?

    4. Brenda Flores says:

      I live in Michigan. I cannot take care of my home ,it is difficult for me.Iwill be 65 in 4 months. I would like to move to an independent living apartment.

    5. Sandra George says:

      I am a 60 year old woman with no family left. All 3 of my childdren have been killed and I need a place to live around Dallas Tx. I am on a fixed income of 754.00 a month, have medicare and medicade. I really need some help please. Can you help me?

    6. Dale plante says:

      I now live in ga. Amd getting home health through Medicaid. Thinking about moving to mn was wondering if mn offered that same yype of program

    7. Corina Orozco says:

      My mom is 76 years old and is currently living with family. She does not want to live with family anymore and really wants to live independently. I need to find a place for her near me in Doral Florida where I can keep a close eye on her due to her early dementia. Can you recommend rentals hear by…zip code 33178? She is on a fixed income and has medicare/medicade. Is there a social worker that can help me in the area?

    8. Mary Mask says:

      I would like to know if help is also available through VA benefits for me as a results of my deceased husbands service(Korean War) I am nearly 85! I also live in Mississippi!

    9. Shirley Gayles says:

      I’m 65 years old and on Medicare I want to know if medicare help pay for dentures though my Aetna ppo essential plan or can you tell me how I could get help because I don’t have any teeth and it is hard for me to chew my food and it takes days for my food to digest

    10. Alex H Evans says:

      What are the requirements in Arizona for two to have assisted living?

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