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My mom will be entering assisted living and spending down her assets. Once she is on Medicaid (in Massachusetts, I've learned that her monthly allowance will be $75), will she be responsible for co-pays on doctor visits? Also - can I ask her new facility for any kind of guarantee that she will continue to have her same apartment there, after she is on subsidies?

There are several Medicaid programs in Massachusetts that can help cover the costs of assisted living. The business offices at the facilities you are considering can tell you which programs they can access. There are other sources of information to help decide which program is the best fit.

Group Adult Foster Care (GAFC) pays for services for elders in subsidized senior housing and in assisted living centers. GAFC pays for services such as daily personal care, homemaking, meals, and transportation.

The assisted living center may combine the GAFC services with the room and board which is paid by the resident, and another program called SSI-G. But you do not have to be eligible to receive SSI-G in order to qualify for GAFC.

To qualify for GAFC, the person must have low monthly income, or obtain the MassHealth Home and Community Based Services waiver.

Senior Care Options (SCO) combines Medicare and Medicaid benefits. There are several SCOs serving people age 65+ in Massachusetts.

Ask to see the apartments that are allotted to these programs in the facilities you are considering. It's likely the subsidized units are shared with a roommate.

Program of All-Inclusive Care for the Elderly (PACE) is for patients (including residents of some assisted living facilities) who are eligible for Medicare and Medicaid. The purpose of the program is to help prevent nursing home admissions, and keep the member safely at home or in assisted living for as long as possible. If a nursing home admission becomes necessary, the PACE plan pays for the long-term care in the facility. Services provided by the PACE Interdisciplinary Team are coordinated with assisted living facilities that participate in PACE.

When a patient becomes eligible for Medicaid, MassHealth covers the co-pays that Medicare would otherwise leave to the patient. But the Patient Paid Amount assessed by Medicaid is based on monthly income and leaves only the Personal Needs Allowance that you mentioned ($72.80 / month).
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Reply to John L. Roberts
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In NJ, you have to have private paid for at least 2 years before Medicaid will take over. There is no guarantees that an AL can even keep Mom in the facility. ALs are private owned. There is a percentage of residents they will allow to have Medicaid. Some ALs don't except Medicaid. When it comes to a room, if they had a suite at 10K a month, they may have to go down to a 5k studio. Medicaid only pays a portion of the room, nothing near what the AL gets in private pay.

So no, don't think you can get guarantees.

If she does get Medicaid for her care, Medicare will be her primary and Medicaid secondary. If she is now paying for a suppliment, it can be dropped. Medicaid will pay the copays and 20% Medicare doesn't cover. Her $75 can only be used on her personnally. That can be candy she likes, clothing, shoes, socks, books, cigarettes, use of vending machines, etc. Can't be used for gifts to others etc.
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Reply to JoAnn29
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