Medicaid and Assisted Living: What’s Covered and What’s Not

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In virtually every state it is possible to have Medicaid pay for certain services when an individual is living in an assisted living facility. However, it is important to note that that the assisted living facility's cost of basic room and board will not be paid for by Medicaid, as it would be if the family member resided in a nursing home. Only residents of nursing homes will have their room and board paid for by Medicaid, if they qualify for Medicaid coverage.

To have Medicaid cover some assisted living services (not including room and board) the facility must be "Medicaid certified," so you will want to make sure about that when searching for a facility to move your family member into. The best way to find out is to call and ask your state Department of Human Services for a list. If you are interested in a particular facility, just call the facility's financial office and ask.

What Medicaid Does Cover in Assisted Living

The 2010 federal Affordable Care Act includes a number of provisions that expand the reach of community-based care such as HCBS by providing funding for additional optional state HCBS-type programs. For example, the Community First Choice rule is a new state option under Medicaid that provides states choosing to participate in this option an increase in federal Medicaid matching funds for providing community-based attendant services and supports to people who would otherwise be confined to a nursing home.

Programs that cover the cost of certain services at assisted living are known as Home and Community Based Services (HCBS). The individual must need the same level of care as that provided in a nursing home and satisfy the same asset and income requirements needed to apply for nursing home Medicaid coverage.

In general, HCBS will pay for the following assisted living services:

  • Nursing care
  • Case management
  • Medication management
  • Assessments
  • Medical exams

For an assisted living resident with no other options available to pay for room and board, it may be possible to obtain assistance through state-funded welfare programs or programs run by religious organizations. If the resident is a veteran or surviving spouse of a veteran, they may qualify for a VA pension to pay for long-term care. If there is a demonstrated medical need, such programs will generally pay the full cost of the assisted living facility, including room and board. Check with your state's Area Agency on Aging, or speak with the executive director at your loved one's assisted living facility about programs and options that can help.

K. Gabriel Heiser is an attorney with over 25 years of experience in elder law and estate planning. He is the author of "How to Protect Your Family's Assets from Devastating Nursing Home Costs: Medicaid Secrets," an annually updated practical guide for the layperson.

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8 Comments

I have a friend in Asst. Living in Newport, WA. and every so often she visits her
grown children. The administrator told her she must move out because Medicaid
only allowed 20 days a year to be absent from the facility. Is this true?
I'm confused by this article. I've been advised to rely on Medicaid to pay for ALF care (including room and board) after my folks' LTC benefits run dry. I believe the way it works in my state is that the people receiving care get a small allowance from out of their social security, the rest goes to the ALF, and the ALF gets a certain rate of reimbursement from the state via Medicaid funds. We live in Washington. Maybe it's different in every state but for sure if they were to give up nearly every cent of their SS they wouldn't have enough left to pay for room & board which is over $3500 a month at most ALFs in this state.
The article is informative however it doesn't say any thing about: if the parent is living at home with the husband taking care as the caregiver .Is there any information about help for the caregiver or suggestions regarding this .