Does Medicaid Pay For Assisted Living?
June 01, 2023 / Assisted Living
A time comes for many seniors when daily tasks around the home become more challenging and they begin to need additional support for health issues. Many seniors make the decision to search for options as to how they can get the support they need without putting additional stress on their families. Assisted living facilities are often one of the first choices for seniors needing support with the activities of daily living. They can receive support from the facility while still having independence, enjoying social opportunities, and building a community. Assisted living facilities can be very expensive, with a median cost of $4,500 per month, but there are services out there that can help seniors reduce these costs. Medicaid is one such option for qualifying seniors seeking assisted living facilities.
What Is Medicaid?
Medicaid is the leading government assistance program for health care coverage, which is essentially a health care payment option for individuals who can’t afford the care they need. The majority of Medicaid’s funding is provided by the federal government, although some amount comes from the states due to the cooperative effort between state and federal governments. Medicaid covers seniors who meet certain qualifications, including individuals whose income falls below their state’s Medicaid income limit, individuals with assets that meet the acceptable range for their state requirements, and individuals who have requisite medical needs.
How to Apply for Medicaid
A senior who wishes to apply for Medicaid must meet strict financial and medical requirements in order to be approved. The income and asset limits will vary from state to state and will also depend on the kind of care required, their medical diagnosis, and their marital status. Individuals who wish to apply for Medicaid to cover the costs of their assisted living must have a doctor certify that assisted living is medically necessary for them. The application varies from state to state and can be complex. To begin the application, contact your state’s medical assistance office for details. It is also helpful to work with an elder care specialist to determine what requirements must be met and how you can work with your family and your doctors to meet those requirements.
What Assisted Living Costs Does Medicaid Cover?
Once approved, Medicaid serves as health insurance to cover most costs of healthcare services, including some long-term care options. Medicaid will generally not cover room and board in assisted living facilities, and what is covered may vary from state to state, but in most states, Medicaid will cover the long-term care costs associated with an assisted living facility. It also covers prescription drugs, physical therapy, speech therapy, eyeglasses, hearing aids, and personal care services. Medicaid will often copay for hospitalization and skilled nursing care that is not covered by the program.
What Assisted Living Facilities Accept Medicaid?
Just under half of all assisted living facilities accept Medicaid, and some that do may have limited beds available for Medicaid patients, so it can be difficult to find an assisted living facility that will accept it. Working with the Senior Care AZ team can make this process easier. We offer senior placement services in Arizona and can provide detailed information about assisted living facilities that accept Medicaid and advocate on your behalf when it comes to finding space in a limited-bed facility.
How Much Will Medicaid Pay For Assisted Living?
The exact amount that Medicaid will pay for assisted living varies from state to state. Certain states may impose copayments, deductibles, or other similar charges that will require the senior to pay more depending on their income level. Medicaid waivers can help contribute to the cost of care in an assisted living facility if an individual qualifies for them. They must prove that their income falls below a certain level and that they require the care they are asking Medicaid to pay for. They can also prove that the required cost of care is above their level of income. This waiver may allow an individual to qualify for limited Medicaid benefits through a medically needy or income-based program.
Other Ways to Pay For Assisted Living
While Medicaid may pay for a small or large portion of the costs associated with assisted living, many seniors and their families still must seek alternative options to cover the costs of these facilities and other forms of elder care. Some such options include digging into retirement savings or long-term savings. Some insurance companies may use a life insurance policy to pay for long-term care costs. For support with tasks such as shopping, transportation, budgeting, and legal assistance, many communities have programs where volunteers can help serve seniors for free. Meal programs and companionship programs can be there to help seniors in need when Medicaid cannot.
Medicare provides health insurance coverage to most people over the age of 65, and while this will not cover the costs of assisted living, Medicare can be helpful in covering some of the medical costs associated with aging, regardless of their residence.
Assisted Living Alternatives That May Be Covered by Medicaid
Determining the best care plan for a loved one that is within your means but still provides the level of care they need can be a complicated process. There are alternatives to assisted living that will provide a similar level of care to seniors while being more affordable and more likely to be covered by Medicaid. Adult day services, in-home nursing and therapy, care coordination and case management, and in-home care are all other options you can consider, depending on the level of assistance needed.
Determining Eligibility for Medicaid Covered Assisted Living
To determine your eligibility for Medicaid covered assisted living, you must first take a look at your functional and financial needs. For functional needs, there are certain medical requirements that must be met to qualify an individual for Medicaid covered assisted living. Demonstrating this medical need will generally include proving that a senior needs assistance with at least two activities of daily living. Demonstrating financial need includes proving that an individual’s income and assets are lower than the state limits for Medicaid eligibility. In most states, the income limit for a single senior is $2,382/month and the asset limit is $2000. If you meet the financial and functional requirements, you may qualify for Medicaid covered assisted living.