What costs can you expect to be covered?

 

The answer to that question isn’t necessarily straightforward and depends on several factors, including where you live.

 

Will Medicaid Pay for Assisted Living?

The short answer is… maybe.

Medicaid is a state and federal program designed to assist with the coverage of health care costs for individuals who have both limited income and resources.

Forty-four states and Washington D.C. currently provide some level of assistance for qualifying seniors residing in assisted living facilities.

 

Qualifying seniors.

If you’re considering moving into assisted living, it’s important to learn about eligibility requirements specific to where you live.

It’s also important to note that Medicaid and Medicare are different programs.

 

How Much Will Medicaid Pay For Assisted Living?

Because Medicaid benefits are defined on a state-by-state basis, it’s difficult to say exactly how much Medicaid will pay for assisted living. The coverage amount will vary, based on:

The state where a senior resides

The program a senior is enrolled in

The level of care a senior needs

Still, the majority of state Medicaid programs cover some sort of assisted living cost for residents who meet the eligibility requirements.

Most qualifying seniors will have access to the following Medicaid assisted living services:

Nursing care

Management of medications

Medical exams and medical assessments

Case Management

 

But, you might be wondering “does Medicaid pay for room and board in assisted living?

The answer to this question can be tricky as well.

Not exactly.

That’s because state Medicaid programs cannot directly pay for assisted living room and board. However, several states have optional supplements and assistance programs to help seniors with that expense. These supplements and programs are often administered by either the Department of Human Services (DHS) or the Social Security Administration (SSA).

 

By nature, assisted living facilities are “all-inclusive.” This typically means one monthly senior living fee for your:

Accommodations

Utilities

Meals

Transportation

Activities

And more

However, you may find some “extras” come at an additional cost, especially for those who need additional or specialized medical care.

Thankfully, that’s where Medicaid assistance comes into play.

In many states, Medicaid provides financial assistance with:

Nursing care

Case management

Medication management

Medical assessments and exams

Nursing Care

While the cost of assisted living usually includes assistance with …

ADL’s

Medication management; and

Coordination with health care providers

… more in-depth medical care like skilled nursing is not typically included.

Funding for additional nursing care is often covered by Medicaid for eligible seniors.

Case Management

Assisted living facilities typically communicate frequently with a resident’s health care providers, however, some seniors might need more targeted case management.

In that situation, some (but not all) states provide financial assistance for a Medicaid recipient to utilize a case manager.

Medication Management

At most assisted living facilities, medication management is typically included in the monthly fee.

However, if that isn’t the case at the licensed assisted living facility you’ve selected, you may be able to get those fees taken care of with Medicaid resources.

Medical Assessments and Exams

Medical assessments and exams are generally outside the scope of what an assisted living facility provides through its monthly care fee.

Medicaid, in many cases, does cover:

Preventative check-ups

Medical assessments; and

Diagnostic exams

 

How Do I Determine if I am Eligible for Medicaid Covered Assisted Living?

Medicaid won’t just pay for in-home senior care or assisted living care once you’ve reached a certain age. Seniors must qualify for assisted living resources covered by Medicaid.

First off, a senior must be a resident of the state in which they are applying for Medicaid. Additionally, the assisted living facility must be:

Licensed by the state AND Accept Medicaid

 

Services, benefits, and eligibility requirements vary from state to state, but typically you must demonstrate both functional and financial need to be eligible for Medicaid-covered assisted living.

 

Functional Needs

Certain medical requirements have to be met to qualify for Medicaid benefits.

Some states require that anyone seeking financial assistance for senior care benefits be able to show medical need, such as needing assistance with at least two ADLs.

Depending on the benefit or specific program a senior is applying for, there may be additional medical assessments or requirements to qualify.

Financial Needs

To receive Medicaid benefits, it is typically necessary to meet financial requirements. For these purposes, this is typically a combination of income and assets.

In many states, for a single senior the income limit is $2,382/month and the asset limit is $2000.

Again, details can be subject to change and vary from benefit to benefit.

To find the most dependable and current numbers and information, your best option is to contact an advisor at Heritage Heights to go over the financial assistance options available to you.

 

If Medicaid isn’t an option or if you need to supplement Medicaid to pay for your assisted living care, you may consider a combination of these financial resources:

Veterans benefits

Long-term care insurance

Private funds

 

Veterans Benefits

For qualified veterans and surviving spouses, The U.S. Department of Veterans Affairs offers an Aid & Attendance benefit to help with the cost of assisted living.

This benefit can be used for care in any state-licensed care setting and can provide up to $2,200 a month to a veteran and their spouse or up to $1,900 a month for a veteran without a dependent.

 

Medical Eligibility: The individual must need assistance with at least two Activities of Daily Living (ADLs) within VA guidelines. Details on these needs can be best explained by an expert at your local VA office or by contacting a Veterans Benefits Advisor.

Financial Eligibility: Many assets, including some annuities and pre-paid funeral expenses, may be exempt from consideration in the financial qualification guidelines. For more information regarding financial qualifications, seek the professional advice of a VA-accredited attorney.

Less than 5% of eligible veterans are currently taking advantage of this benefit.

For more information about the Veteran’s Pension Benefit with Aid & Attendance program, visit your local or regional VA center, or visit the VA website.

 

Long-term Care Insurance

At least 70% of people over the age of 65 will need some type of long-term care, such as assisted living. This makes long-term care insurance a good investment.

A long-term care insurance policy removes the burden of having to pay for 100% of care from personal funds by helping to supplement monthly payments to an assisted living provider.

Long term care insurance can cover:

Home care

Assisted living

Adult daycare

Nursing home care

Memory care

Respite care

Hospice care

Many experts suggest investing in this type of coverage before the age of 55 as part of an overall retirement plan. It’s important to note that premiums paid on long-term care insurance policies may be eligible for an income tax deduction.

 

Private Funds

Many families or individuals pay for assisted living with private funds. This is typically a combination of:

Savings

Social Security benefits

Pension payments

Stocks

Retirement accounts

401k

IRA

 

If you’re seriously considering an assisted living facility as your next home, it’s important to find the right facility for you. Not only that, you need to find a facility that accepts your financial benefits.

That’s because some facilities accept Medicaid but can only offer so many rooms to Medicaid recipients, while others do not accept it at all.

That’s where Heritage Heights comes in.

Heritage Heights specializes in Independent living, assisted living, and

memory care.

If you’re looking for that little extra help to make day-to-day life easier and more comfortable, we’re here to help. If you’re worried about the cost of assisted living, our professionals are ready to talk it through with you.

Contact an advisor at Heritage Heights today. We’ll evaluate and work with your specific benefits, including Medicaid to help you find the best living situation for your golden years.

 

The owner of this website has made a commitment to accessibility and inclusion, please report any problems that you encounter using the contact form on this website. This site uses the WP ADA Compliance Check plugin to enhance accessibility.