Does Medicaid Cover Assisted Living[Get The Facts]

Finding all of the relevant Medicaid information might be challenging at times. This is because each state has the authority to govern the rules differently, and individuals are frequently confused about what Medicaid covers and how to utilize it.

This is one of the reasons we’re going to learn more about Medicaid and Assisted Living, as well as what you may expect for your loved ones.

So, without further ado, let’s get straight into the subject and find out everything we can.

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What is Assisted Living?

Before we can determine whether or not your Medicaid will fund Assisted Living, we may need to describe it further. This sort of aged care is for those who can live independently but require assistance with some daily duties.

This involves bathing, moving around, eating, clothing, and a variety of other activities.

Assisted Living is a form of accommodation for the elderly and disabled who require additional care but are mostly self-sufficient. Individual rooms, flats, or even shared rooms can be used to organize the living areas. The goal is to make the patient feel at ease and to encourage their independence.

Does Medicaid Cover Assisted Living?

The short answer is yes because Assisted Living is covered to some extent by Medicaid in the majority of states. But, in actuality, this is a difficult issue to answer.

Because Medicaid is supported in part by the states and the federal government, each country has the authority to implement the rules and regulations as they deem proper. As a result, depending on the state in which you live, the laws are different for everyone.

There are certain common criteria that we will explain to help you comprehend the entire notion. So, keep reading for more information.

Which services will Medicaid cover?

The restrictions will differ depending on the state you live in, which is why it is critical to check with your local Medicaid reps to ensure what is covered.

Medicaid will, in general, cover:

  • Personal Care Assistance – Entails a variety of personal tasks such as dressing, eating, and bathing. However, it also includes a variety of other tasks.
  • Homemaker services – Entail tasks around the house that the elderly may find difficult to complete, such as shopping, washing, food preparation, and so on.
  • Management of Cases
  • Transportation
  • Personal Emergency Response Systems (PERS)

Remember that Medicaid will NOT pay the room and board portion of the charges. However, there are various methods to compensate for this, lowering the overall cost.

Given that the average monthly cost of Assisted Living is $4.300, any financial support and assistance are greatly appreciated.

With that in mind, you should be aware that most states will also provide Medicaid Waivers for Home and Community-Based Services. These Waivers can assist persons in receiving the assistance they require while remaining in the comfort of their own homes. 

Furthermore, the income restrictions for the Waivers are often significantly higher, however, as is customary, each state sets its regulations and there are waiting lists included.

Which states cover assisted living?

Currently, 44 states will fund a portion of the cost of Assisted Living through Medicaid, but not all will do so in the same way. 

Keep in mind that this service may be referred to differently in various states, such as board and care homes, adult family care, alternative care facilities, dementia care homes, and congregate living.

The following states allow Medicaid to cover Assisted Living:

  1. Alaska
  2. Arizona
  3. Arkansas
  4. California
  5. Colorado
  6. Connecticut
  7. Delaware
  8. Florida
  9. Georgia
  10. Hawaii
  11. Idaho
  12. Illinois
  13. Indiana
  14. Iowa
  15. Kansas
  16. Maryland
  17. Massachusetts
  18. Michigan
  19. Minnesota
  20. Mississippi
  21. Missouri
  22. Montana
  23. Nebraska
  24. Nevada
  25. New Hampshire
  26. New Jersey
  27. New Mexico
  28. New York
  29. North Carolina
  30. North Dakota
  31. Ohio
  32. Oklahoma
  33. Oregon
  34. Rhode Island
  35. South Carolina
  36. South Dakota
  37. Tennessee
  38. Texas
  39. Utah
  40. Vermont
  41. Washington
  42. West Virginia
  43. Wisconsin
  44. Wyoming

Although your state might be on this list, bear in mind that each has its own set of rules and restrictions. The greatest thing you can do is call your local AAA or Area Agency on Aging for further information.

Furthermore, you may always call your Medicaid representative and ask them directly about anything that concerns you.

Who is eligible for Medicaid Assisted Living?

Now that we’ve covered the fundamentals, we can look at who is qualified for this program. In addition to locating a service that takes Medicaid, the individual must fulfill financial and functional standards to be eligible.

  • Financial criteria – Financially, you’d need a minimal salary and nearly no assets, in addition to devoting all of your present assets to care. States’ Medicaid plans to limit applicant income to 100% of the Federal Poverty Level or 100% of the Federal Benefit Rate. 
  • Functional necessity – There are a few factors that must be considered before accepting an application. For example, the individual must require nursing level care as specified by the state. If you or a loved one has difficulty dressing, eating, or moving and need assistance, you may be eligible.

Who is not eligible for Assisted Living?

To clarify, there are specific circumstances under which a person might be ineligible for Assisted Living. 

Here are a couple of such examples:

  • Have behavioral issues, such as wandering off
  • Have considerable medical requirements
  • Have a significant cognitive impairment
  • Daily nursing services are required

How to find an assisted living residence?

Finding a nice facility for Assisted Living may be more challenging than you think. Because of the poor reimbursement rates, most homes will not take Medicaid. Furthermore, these facilities often have a restricted number of beds accessible for Medicaid patients.

The best thing you can do is contact your local AAA or Area Agency on Aging, or your Medicaid help agent, and get a list of residences that take Medicaid.

Final Thoughts

If you or a loved one requires assisted living, Medicaid may be one of the finest options. While Medicaid cannot legally pay for room and board, the cost will be reduced or limited to assist needy families.

David Duford
Author: David Duford