Let's say an AL has 40 rooms. Out of those 40 only 15 can be designated for Medicaid. If the AL already has 15 people on Medicaid then you have to wait until they pass or go on to a NH. It also works if all 40 rooms are private pay. Until someone passes or goes to a NH a Medicaid room is not available. Then you have a list.
It’s going to be dependent on if your state does this and then just how many AL choose to participate in the Medicaid AL waiver program.
It seems to be an average it’s 2 years of private pay till a Medicaid bed is available in states that do Medicaid AL waivers.
States are not required to spend Medicaid $ for AL (unlike NH which has dedicated required funding). Most states Medicaid do not cover AL. If yours does, that fortunate. Then it’s up to AL to determine if they even want to participate in AL Medicaid and if so how many beds to have. If an AL can easily have 100% occupancy from private pay, then no need to do Medicaid. Plus waiver programs can change requirements and payment structure every so often, so it’s harder to plan with waiver $ so that’s a disincentive to participate as well. For those AL that choose to participate maybe 20% of beds will be Medicaid and almost always filled from a waiting list of private pay current residents.
Also the trend is for Medicaid waivers to go to community based programs, like PACE, rather than a 1-on-1 payment for AL.
If it’s at all possible for your mom to show to be “at need” medically for skilled nursing aka a NH, you might want to try to get her into a NH instead. Most NH in the US participate in Medicaid & Medicare, so between the 2 all costs covered.
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It seems to be an average it’s 2 years of private pay till a Medicaid bed is available in states that do Medicaid AL waivers.
States are not required to spend Medicaid $ for AL (unlike NH which has dedicated required funding). Most states Medicaid do not cover AL. If yours does, that fortunate. Then it’s up to AL to determine if they even want to participate in AL Medicaid and if so how many beds to have. If an AL can easily have 100% occupancy from private pay, then no need to do Medicaid. Plus waiver programs can change requirements and payment structure every so often, so it’s harder to plan with waiver $ so that’s a disincentive to participate as well. For those AL that choose to participate maybe 20% of beds will be Medicaid and almost always filled from a waiting list of private pay current residents.
Also the trend is for Medicaid waivers to go to community based programs, like PACE, rather than a 1-on-1 payment for AL.
If it’s at all possible for your mom to show to be “at need” medically for skilled nursing aka a NH, you might want to try to get her into a NH instead. Most NH in the US participate in Medicaid & Medicare, so between the 2 all costs covered.
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