Medicaid bed in AL: Does Medicaid pay for LOC too?

Thank you all,

Sister’s AL will transition to Medicaid. It’s more expensive than other places we looked at, but we chose it for this reason. It will be no problem to provide the personal care items for her, at least I don’t think it will be. I will ask the AL facility when I go next week, but I am planning questions for my next lawyer visit and want to make sure I have a little knowledge about the process before I go!

This facility offers care through the skilled nursing level, so I hope they will be able to care for her through end of life. I will discuss this all with them.

States do vary in the personal needs allowance for Medicaid recipients. In my state (Maine), the allowance is $70/month for assisted living and $40/month for nursing home residents. Unlike some states, Maine Medicaid (called MaineCare) does cover assisted living, but as in nursing homes, Medicaid beds are in short supply. Not all AL facilities in the state accept Medicaid, and ALs are governed by a very different set of state regulations than nursing homes (different kinds of licenses).

It works pretty much like LTC. The recipients SS and any pension goes to the AL to offset the cost of her care and Medicaid pays their share. If her care increases, the AL just gets what Medicaid pays which is a flat rate. A small amount of the SS will go into a Personal Needs account for anything the recipient needs. In my state its only $50. The difference between an AL and LTC is family will be responsible for clothing, Depends and toiletries. That $50 will not go far. LTC has to provide toiletries and depends. Clothing not so much. And them needing clothing that have no family, there are donations aides get clothes from.

Medicaid rules differ by state. Most states' Medicaid pays for LTC only, so the resident needs to qualify for that level of care. A Medicaid bed almost always means a shared room.

As ALFs are individually owned and run, and has not the limitations and restrictions and laws governing licensed nursing homes, they tend to be more individual. Ask the adminstration at your own ALF. And good luck.