Can Medicaid and Medicare Pay For Assisted Living Facilities

Assisted living facilities are costly, frequently costing more than $50,000 a year. Fortunately, a few financial assistance opportunities help with assisted living care expenses. When looking for financial assistance, many families wonder if federal and state programs like Medicare and Medicaid can support assisted living services.

Continue reading to learn more about assisted living communities such as Vivante luxury senior apartments, prices, the roles Medicaid and Medicare play in long-term personal care, and if they may help you reduce out-of-pocket expenses.

What qualifies you for an assisted living community?

To be eligible for assisted living, you must be a generally independent senior who requires assistance with no more than three daily living tasks (dressing, bathing, going to the toilet, etc.). You also need to be able to move around on your own using a walker, cane, or wheelchair.

You must also be able to handle any chronic diseases or medical conditions with regular medical services and not demand round-the-clock skilled medical care.

Can Medicaid pay for assisted living services?

Medicaid in the United States offers healthcare coverage to qualifying low-income individuals, children, pregnant women, older adults, and persons with disabilities. Medicaid benefits vary by state and are financed jointly by the federal and state governments.

Personal care services and laundry services are among the many services typically covered in states that provide some Medicaid support to assisted living residents. Some states additionally cover transportation, individual counseling, and medical care.

Most states provide eligible seniors with Medicaid coverage for assisted living fees, but don’t expect all your bills to be covered because you reside in the right area.

Despite state flexibility, the federal government does not allow states to pay for assisted living care services like private apartments. However, states are continually finding methods to make rehabilitation services more accessible.

Some governments limit seniors’ private pay for assisted living facilities by establishing a legal maximum that many assisted living communities can charge residents or by providing extra Social Security from the general state fund to meet the monthly cost. Some jurisdictions get inventive with how prices are branded and classified, allowing them to pay for services like meal preparation but not paying the cost of the food itself.

If you want to utilize Medicaid to pay for your assisted living cost, remember that not all assisted facilities accept Medicaid. Most states also limit the number of exceptions available to seniors, and requests for one might result in lengthy waits.

Benefits of using Medicaid for assisted living communities

Currently, 46 states and the District of Columbia provide some Medicaid coverage for assisted living expenses. Alabama, Kentucky, Louisiana, and Pennsylvania are the only states that do not.

Because each state is responsible for its programs, state Medicaid administrators’ language may confuse older persons and their family members. If you’re looking for assisted living options in your state’s Medicaid benefits list, check for words like supported independent living, residential care, alternative care facilities, memory care, adult foster care, and nonprofit personal care homes.

Assisted living seniors with incomes above the maximum permitted for Medicaid beneficiaries may still be eligible for Medicaid financial assistance through several exemptions available in each state. The allowance for additional income in several states is three times the average.

The 1915b Managed Care waivers and the 1915c Medicaid Home and Community Based Services are two of the most well-known and widely used, but their availability varies substantially by state.

Some assisted living accommodations that Medicaid does not pay, regardless of whether you qualify for Medicaid by financial eligibility or a waiver. If you’re lucky, you could reside in a state that limits the amount independent living communities can charge for services not covered by government programs.

Can you pay for an assisted living facility using Medicare?

Most of the time, Medicare will not cover the expense of long-term care, such as an assisted living facility or nursing homes. However, Medicare will fund your stay in a skilled nursing facility for up to 100 days after a catastrophic injury or major surgery. This is so you can get skilled nursing care as part of your doctor-ordered rehabilitation. You must pay for any stay longer than 100 days on your own or through another source of financial support.

Medicare does not cover your residential facility fees, food, or any other expenditures associated with assisted living.

How can you qualify for assisted living Medicaid benefits?

Long-term senior care Medicaid is a joint federal-state program that assists low-income elderly adults and people with disabilities in receiving their required care. Membership income and asset restrictions vary based on criteria such as the type of care sought, health problems, geography, and marital status. A doctor must also certify that the care provided to an elderly person in an assisted living facility is medically essential.

If you meet all the financial and functional qualifying standards, you’ll still need to find a Medicaid-accepting facility. Locate the best assisted living communities that accept Medicaid through your local Area Agency on Aging.

You should allow yourself plenty of time to choose a new location because Medicaid-certified assisted living facilities are scarce owing to extremely low reimbursement rates. There are still possibilities if you can’t find a Medicaid-certified independent living community. Most assisted living facilities accept Medicaid on a limited basis, which means that only a few beds are available at a given time for Medicaid recipients.

If you don’t want to move and establish residency elsewhere, you might want to check into options for assisted living that your state will fund under Medicaid. If you reside in a state where Medicaid does not cover assisted living, you may substitute alternative forms of long-term care. These states can use Medicaid funds to finance in-home care or senior daycare.

As you examine how you will pay for assisted living — including the percentage of room and board that Medicaid will not cover. Make allowance for a 3% to 6% increase in pricing each year. Remember to prepare for expenditures typically ignored, such as move-in deposits, relocation charges, and rising costs over time due to raised care requirements. By preparing even a few years ahead, you may find strategies to save money and avoid being startled when the bills arrive.

Read Also: 5 Types of Senior Living Careers That Might Be Right for You


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