Does Medicare or Medicaid pay for Assisted Living facilities? - AgingCare.com

Does Medicare or Medicaid pay for Assisted Living facilities?

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Reason being Mom (85) has very limited finances available, does not own her own home etc. etc. She was recently injured from a fall and needs assistance with the day to day things, dressing, cooking, showering pill taking etc.etc. She has been staying with us but n one is home during the daytime hours and on occasion we need to travel out of town for work and do no feel that she can be left alone for any extended periods of time. She currently has Medicare but not sure about how Medicaid works and even where to begin. Thanks for any assitance anyone can offer!!

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Dear Maine,
If she is the widow of a WWII vet, VA will help pay for it. A good ALF will help you sort out the financial aide. Look at va.gov for "surviving spouse" info.
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Think of Medicare as a recovery program. After a qualifying stay in the hospital, Medicare patients can go to a skilled facility or (Rehabilitation Center) for up to 100 days, the first 20 days paid 100% and day 21-100, required to pay a copay. This is many times covered by co-insurance, Medigap, Medicaid or by private pay. Most assisted living do not meet the level of care requirements for medicare, but as the previous answer outlines, some may be Medicaid certified or work with other waiver programs when qualified.
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Also keep in mind,the differences between Medicare & Medicaid. This site has a couple of great articles on all this. By & large, Medicaid pays for NH for those that are "at-need" both financially & medically for skilled nursing care. Most states do not have Medicaid pay for AL per se. Some states have Medicaid diversion programs which will pay for AL but the # of slots for those are limited. AL's do not have to participate in Medicaid like most NH do. For most facilities, AL is all private pay. If this is a tiered facility (goes from IL to AL to NH and with hospice) the AL is the profit center for them as it is overwhelmingly private pay. So be sure to be very clear with whatever place you all are looking at as to whether Medicaid is even an option to pay for her care
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Maine - for me the question is would now be the time for mom to go into a NH - which Medicaid will pay for IF she qualifies to be 'at-need" both financially & medically - OR it is more that case that mom can still stay in the "community" and needs community based services which can be paid for from a combination of sources.

That's really 2 very different paths. What do you think she needs in the near future - like next 3 years? And also what is her overall health like, so that would her medical file show a need for skilled nursing and her MD write the orders for skilled nursing needed?
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Medicare doesn't pay for assisted living facilities. Some states may accept Medicaid for assisted living but not many. Check and see if your state will accept Medicaid to pay for AL. If your state is one of the ones that will accept Medicaid for an assisted living facility get down to the Medicaid office and begin the application process. Go online first and see what documents you may need to take with you. It can be a lengthy process.
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