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I am not in this situation but I think others might be or will soon.


It is my understanding that independent and assisted living are private pay, only. I am not sure LTC policies pay for either.


there are buy in CCRC where a significant buy in is required as well as a monthly nut. Private pay also.


I see some discussions about AL memory care. Some parts of the country have those, some don't.


Where I am confused is when Medicaid comes in. It was my understanding that Medicaid only pays for NH or MC, or home based services , but not AL, because Medicaid doesn't pay for room and board unless there is a medical need like memory care or nursing home care?


Is this different by state?


I hope my question is clear.

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Also to qualify for medicaid, as the name implies, there has to be a medical need. Even being bedridden is not necessarily a medical need. Just being old is not.
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Segoline Feb 17, 2019
I wonder how the income caps and fine print vary by state as to whether Medicaid pays for AL. Maybe it comes down to the options by state.
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The CCRC where I live works this way. You pay like 200k to have the ability to go from independent living (cottage or Apartment) to AL and if needed LTC all in the same complex. If IL or AL this is private pay in addition to the 200k you put out. If you need LTC, a portion of that 200k goes to your care in the LTC and when that runs out, u go on Medicaid.

ILs are private pay. In NJ ALs are private pay. But if you have paid at least two years and money runs out you may get Medicaid to pay only if the AL hasn't already used the % of medicaid rooms they allow for other residents.

LTC Medicaid will pay for if person meets criteria which means they have no money and what income they have doesn't go over the cap they allow.
Each state is different when it comes to the cap.
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Segoline Feb 17, 2019
Thats exactly how I thought it worked. Some of these buy in fees are unreal and escalating.

And in addition to that escalation, the monthly increases!

If their income goes over the cap then that is just an increased SOC through a Miller or Qualified Income Trust. Or that is my understanding.
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It depends on the state. Some state Medicaid programs will cover room & board in an AL and some will not.
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Segoline Feb 17, 2019
Ok, I wondered about that. I could not figure out how some people were in AL and getting Medicaid to pay for it.
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I know nursing homes may have that requirement, but not with AL.
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I think some states require AL's to reserve a small percentage of space for Medicaid residents. My aunt lives in another state from me, she moved into a ten-room facility as a Medicaid resident. The facility had to keep one room for Medicaid, so my aunt was on a waiting list for a while for the room. My dad lives in a memory care facility here in my state. It recently sold to a non-profit and I received a form letter that I could fill out if my dad is or becomes unable to pay for the room. They recently told me if his money runs out they will not evict him but keep him indefinitely. I assume that means some sort of govt. funding.
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