4 Common Questions About Medicaid Benefits For Assisted Living

Paying for assisted living doesn’t all have to be from your own pocket. One preferred way to pay is through Medicaid.

Medicaid is a state-administered public health insurance program that gives health care coverage to families or individuals with low incomes. It is the leading government-assistance program for long-term care and assisted living.

Here are 5 common questions people ask about Medicaid and helping to pay for assisted living.

1. Does Medicaid Pay for Assisted Living?

Medicaid will help cover the cost of assisted living, including memory care, or Alzheimer’s care. Eligibility requirements must be met (see below for more). Such requirements, available programs and benefits vary based on your state of residence.

The cost of skilled nursing and emergency response systems also may be covered. Medicaid will not, however, cover room and board, which usually accounts for approximately half the cost of assisted living.

Most states have a regular state Medicaid program along with Home and Community Based Services (HCBS) Medicaid Waivers. Although states offer personal care assistance through Medicaid, some offer only through state plans, some through the waivers, and some through a combination.

2. How Much Does Medicaid Pay For Assisted Living?

The amount Medicaid will pay depends on several factors, including:

  • State of residence
  • The state Medicaid program
  • Level of care needed

A needs assessment is usually required to calculate the number of hours that Medicaid will cover. For example, those with a greater need for assistance can get a greater amount of caregiver hours per month.

3. How Do I Find Out If I’m Eligible For Medicaid?

Eligibility criteria will vary by state. The general requirements are that individuals:

  • Spend almost all of existing assets toward care
  • Are low-income earners or have medical-related care expenses that exceed income
  • Live in the state where they are receiving benefits
  • Be a permanent resident or U.S. citizen

Financial need

In general, state Medicaid plans limit applicant income to 100% of the Federal Poverty Level or 100% of the Federal Benefit Rate. For the Medicaid Waiver, an applicant’s income must not be more than 300% of the Federal Benefit Rate. Assets are usually limited to $2,000 for both state plans and Medicaid Waivers. Find out more about state criteria.

Functional need

Applicants generally must require a nursing level of care or be facing institutionalization. The definitions vary by state.

Some states may require applicants to need assistance with two activities of daily living, such as:

  • Dressing and undressing
  • Cutting up their food and eating
  • Using the toilet and cleaning up
  • Moving from a bed to a chair

Some programs require a physician statement. Also, a diagnosis of Alzheimer’s disease isn’t an automatic qualifier for benefits.

Visit the Medicaid website for more on eligibility. It provides information about:

  • Eligibility and how to apply
  • How to locate a Medicaid office
  • How to use Medicare and Medicaid at the same time (dual enrollment)

Also, contact a State Medical Assistance Office for more details.

4. Which Services Will Medicaid Cover?

The types of services covered by Medicaid will vary based on state programs. But the typical services paid for by Medicaid for those in assisted living include:

  • Personal care assistance, which includes help with dressing, bathing, toileting and eating
  • Specialized home care services, including house cleaning, laundry, shopping for groceries and other essentials, and meal preparation
  • Transportation
  • Case management
  • Personal emergency response systems

Medicaid will not pay for the room and board portion of assisted living.

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