Finding Assisted Living That Accepts Medicaid
If youre looking for Medicaid-approved assisted living communities, first review information online about Medicaid Waiver programs available in your state.
You can also contact your local Medicaid office, Department of Aging, Department of Elder Affairs, or local social service agency. Be sure to request a list of all Medicaid programs in your state that your loved one may be eligible for.
Here are some other questions to keep in mind when speaking with an agent:
- What is the process for applying for Medicaid?
- Can you assign a case worker to assist with the application process?
- Is there a waiting list? If so, how long is the waiting list? Are they currently adding individuals to the waiting list?
- What are the income and asset qualifications for Medicaid Waiver programs?
- Are there any programs that would provide services in your loved ones home?
- Are there any programs that would provide services in assisted living?
If your loved one is currently in a skilled nursing facility under Medicaid, ask about Medicaids program called Money Follows the Person. It provides states with federal funding to help seniors move out of facilities like nursing homes and back into their own home or a loved ones home.
Reviewed by:
Samantha L. Shepherd is a certified elder law attorney and former president of the Missouri chapter of the National Academy of Elder Law Attorneys . She is the managing attorney of Shepherd Elder Law Group in Overland Park, Kansas, and Hutchinson, Kansas.
How Do You Qualify For Medicaid To Pay For Assisted Living
Medicaid eligibility varies depending on the state, but federal law requires each state to cover certain populations. For instance, while the eligibility process differs, people with disabilities and low-income families are mandated to be eligible for Medicaid in each state.
To qualify for Medicaid to pay for assisted living, you must meet the following requirements:
- You must either have U.S. citizenship or be a permanent resident of the United States
- You must be a resident of the state where you wish to receive benefits
- Your income must fall below your states Medicaid income and countable assets limit
What Is Assisted Living Care
Assisted living describes a residential community wherein older adults receive help from skilled providers with tasks like dressing, bathing, eating, taking medication, going to appointments, and more. They offer considerable freedom, often providing residents with private apartments and plenty of privacy, but they also emphasize socializing.
Its different from senior living communities in that assisted living care provides more services. For instance, residents might not be able to bathe on their own. In a senior community, residents live much like people who live in regular apartment communities.
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The Bottom Line For Using Medicaid And Medicare For Senior Living Costs
It is common knowledge that the cost of living in an assisted living community can stretch a family’s budget, even to the breaking point. Unfortunately, the alternative is to allow seniors to live in an environment that is lacking the much-needed assistance required for them to thrive. Over time, the cost of spot treatments for accidents, declining health and in-home assistance will often surpass the cost of living in a monitored facility.
Though Medicaid and Medicare wont cover all of the costs associated with moving to an assisted living home, it can cover many of the supplementary services associated with it. These programs not only will pay for medical cost but in some cases, they can pay for part of the stay at a residential long term care facility such as an assisted living home. Every state has different rules that regulate eligibility, so it is critical that you speak with your State Medical Assistance Office for more information.
Other resources that seniors can use to help pay for assisted living expenses can be found in your local Area on Aging department or other programs. Many assisted living communities will offer guidance from case managers and intake workers to help you navigate the Medicaid/Medicare process.
Optional State Social Security Supplements
In some states, some seniors living in assisted living may qualify for Optional State Supplements . These are benefits, based on income, available for people living in assisted living facilities or adult foster care, to help pay the room and board costs at those facilities. If a senior qualifies for Supplemental Security Income benefits, or SSI benefits, they might be eligible for OSS benefits. OSS benefits are distributed on top of SSI benefits. Recipients dont get the payments, though, like they do with Social Security and SSI. The money from OSS payments goes straight to the assisted living facility.
Both eligibility rules and amounts of available OSS benefits vary by state. If a state offers the OSS benefits, the state sets its own eligibility requirements. The requirements are usually based on income. In most states that offer OSS, if a seniors income level is below the federal requirements for receiving SSI benefits, they probably meet the states requirements for OSS benefits, too. In 2019, to qualify for the federal SSI benefit, individuals had to have an income of less than $771 per month.
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How Do I Pay For Assisted Living Services Not Covered By Medicare Advantage
At this time, Medicare Advantage doesnt cover assisted living costs, and no intent to do so has been publicized. Instead, seniors have several other options for paying for long-term care, including state-funded programs like Medicaid and Medicaid waiver programs, long-term care insurance, asset liquidation and selling a life insurance policy for cash.
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Kancare 20 Waiver Proposal Initially Called For A Work Requirement And 36
The KanCare Medicaid program operates with a waiver from CMS that must be periodically extended. The state was given a temporary extension, through the end of 2018, but was in need of a longer-term renewal by the end of 2018. The states initially proposed KanCare renewal, dubbed KanCare 2.0, called for a work requirement for able-bodied, non-exempt adults, and would also have imposed a 36-month limit on Medicaid eligibility for adults who were subject to, and in compliance with, the work requirement .
In May 2018, CMS notified Kansas that the 36-month cap on Medicaid eligibility would not be allowed. The federal government was still considering the rest of the states proposal at that point, but the letter indicated that CMS was likely to approve the states proposed work requirements, and reiterated the fact that CMS has been willing to approve lock-out periods for people who dont comply with work requirements, which was part of Kansas proposal.
But the KanCare extension approval, granted in late 2018 by CMS, noted that the state had asked CMS to defer consideration of the work requirement. The Colyer administration clarified that the state legislature had determined that a work requirement would need to go through the budget process, and would thus not be implemented as part of the KanCare extension that took effect in 2019.
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Q: Does The Wentworth Of Las Vegas Accept Medicare Or Medicaid
The Wentworth of Las Vegas is not able to accept Medicare or Medicaid as a non-medical community. Their services are not designed to replace skilled nursing care, and are not covered by insurance programs like Medicare and Medicaid.
Families with long-term care insurance may be able to pay for their care with their benefits. Programs like VA benefits and Medicaid waivers may be an option for qualifying residents who meet the individual eligibility requirements. Private pay is commonly used to cover the cost of The Wentworth of Las Vegas. Families are welcome to get more information about paying for long-term care by chatting with us below.
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What Are Assisted Living Services
Assisted living services are provided on a continuum of care depending on your need and level of independence. Each facility has its own system and number or types of levels of care that generally follow this formula:
- Level One: Lowest level of care if you are mostly independent but need minimal assistance or supervision with daily tasks.
- Level Two: Moderate or medium level of care if you require hands-on assistance with some of your daily activities.
- Level Three: Highest, most comprehensive level of care if you have needs that require multiple staff to help you.
If you reside in an ALF, you will have an apartment or suite and access to general services, such as:
- Meals and snacks
- Opportunity to have a pet
- Wellness and exercise programs
- Transportation to and from medical appointments
If you need it, you may have assistance with your medications and health assessments conducted by health care professionals. ALF regulations limit the type of care that can be provided. If your health condition warrants the need for more skilled care than an ALF can provide, staff may recommend transfer to a nursing home.
Some ALFs have memory care units designed for people who have cognitive impairment. These units are secure and staffed with specially trained employees to maintain a safe and calm environment.
Monetary Benefits For Assisted Living Medicaid
Medicaid for assisted living or in-home benefits has its limitations. This Medicaid program does not pay for all of the assisted living facilitys cost, for instance, nor does it pay for 24/7 in-home care. In Florida, Medicaid will generally help with assisted living costs by reducing the by $1,100-$1,500/month. Medicaid does not pay for the room and board for the ALF, but only can pay for the medical portion. Practically, not every facility will apply the Medicaid subsidy the same way, so be sure to talk to the assisted living facility about what expected costs would be. If the elder has low income, for instance, the family may need to assist with assisted living costs. Our law firm could help protect assets above the bare minimum, which can happen even when the elder is already in the nursing home.
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What Is The Difference Between Home Health Care Services And An Assisted Living Facility
| Home health care services | Assisted living facilities |
| Home health care services are provided in your home by skilled medical professionals who are operating in accordance with physicians orders. Home health care services are limited in scope and short-term in duration. The goal of these services is to restore you to your previous level of functioning after an illness or injury or at least help maintain your level of functioning or slow your decline.
Medicare covers medically necessary home health care services. Federal and state entities regulate home health care, which is provided through Medicare-certified home health agencies. |
ALFs are residences geared toward housing people who are unable or unwilling to be at home, but dont require skilled care. Medicare does not cover ALFs. ALFs are governed by state rules and regulations and may be Medicare and Medicaid certified. ALFs provide a lower level of care, and are thus less expensive, than nursing homes. |
When Does Medicare Cover Assisted Living
Medicare only pays for long-term care if you require skilled nursing services for support in daily living and need occupational therapy, wound care, or physical therapy, which are found in a nursing home, following a hospital admission. Stays at these facilities are typically only covered for a short time .
Assisted living facilities are different from skilled nursing facilities. People in assisted living are often more independent than those in a nursing home but are still provided 24-hour supervision and help with activities like dressing or bathing.
This type of nonmedical care is called custodial care. Medicare doesnt cover custodial care. However, if youre staying at an assisted living facility, there may be some things Medicare will still cover, including:
- some necessary or preventive medical or health-related services
- your prescription medications
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Assisted Living In Kansas
We conducted research for 20,000 assisted living communities in the U.S. and 181 assisted living facilities in Kansas that house senior citizens. According to our research, the average monthly cost of an assisted living facility in Kansas is $4,556.
Kansas is known as one of the best states for senior citizens owing to its affordable cost of living, general quality of life, and access to healthcare facilities and Medicare. Kansas also has several programs and services to accommodate the need of every senior like the Senior Care Act, Home and Community Based Services, Senior Health Insurance Counseling, and Senior Medicare Patrol Act.
Does Medicaid Pay For Memory Care
Though not all communities accept Medicaid, the program does pay for 24-hour dementia care in many memory care facilities as well as memory-related care in skilled nursing communities. This usually includes all costs associated with room and board. Under Medicaid policies, seniors must forfeit most of their available income including Social Security checks toward their care and can retain only a small monthly personal allowance. Allowance amounts differ by state but typically are less than $75.
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What Are Assisted Living Coinsurance Costs Deductibles And Copayments
As mentioned above, your Medicare Supplement insurance plan might cover certain costs related to medical care at an assisted living facility. The out-of-pocket costs youll owe will depend on your plan.
For instance, Medigap Plan F covers your Part B deductible. This means that you wont have to pay out-of-pocket for physician care. You might go to the doctor while youre living in an assisted facility, so youll want to consider healthcare costs you might incur.
Similarly, if you need medical assistance at the care facility, your Medicare Supplement insurance might cover part or all of your expenses. Coinsurance payments are expenses you owe out-of-pocket as a percentage of the total cost of care, while copayments are the fixed fees you pay at the time of healthcare service.
Since assisted living facilities dont provide high-level medical care, your expenses will mostly relate to personal services, room, and board.
How Much Does Assisted Living Cost In Las Vegas
While the cost of nursing home care and homemaker services in Nevada is higher than the national average, Las Vegas has generally more affordable rates for senior care than the rest of the state. According to the 2018 Genworth Cost of Long Term Care Study, assisted living in Las Vegas is over $300 less expensive than the state average.
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What Medicare Pays For In Assisting Living
Medicare covers a substantial range of medical treatments, medications, and other costs related to short- and long-term care. But there are still plenty of treatment options that arenât included. Unfortunately, assisted living facility costs are one of them. If you were hoping to use your parentsâ medicare plan to offset the cost of assisted living, you wonât be able to.
There are several reasons why Medicare doesnât cover assisted living facilities. The primary reason is that Medicare considers assisted living communities as custodial and personal care facilities, rather than hospitals or other medical service providers. Since many of the services that assisted living facilities provide do not require skilled medical professionals, they are not included in Medicare Part A or B coverage.
There is hope, however, for those who are looking to use Medicare for assisted living costs, but with a caveat. Medicare covers assisted living costs relating to medical expenses, which can help when a resident needs specific medical treatment. These types of costs are considered in-home Medicare health services, and are therefore different than the living expense payments that arenât covered.
If you or your loved ones are concerned about financing long-term care, there are options aside from Medicare and personal savings. To understand more about your care-related financial needs, use our cost of care tool.
Does Medicare Advantage Cover Skilled Nursing Facilities
While none of the Medicare plans cover the cost of living in nursing homes or assisted living facilities, Medicare Part A and Medicare Advantage do cover a stay in a skilled nursing facility.
When Would You Need Skilled Nursing Care?
Skilled services are often needed for an illness or an injury that requires daily, inpatient care. You receive these services until doctors clear you to return home or to a long-term care facility. Examples of a long-term care facility include a nursing home or an assisted living facility.
Conditions that require a stay in a skilled nursing facility include strokes, broken bones, wound care or post-surgery care. You may also need to transition to a skilled nursing facility after being hospitalized for an illness so that you can work with nurses, physical therapists and occupational therapists before you return home.
When Does Medicare Advantage Cover Skilled Nursing Care?
Medicare Part A and Medicare Advantage will cover a skilled nursing facility stay for up to 100 days as long as you meet a list of criteria.
Those criteria include:
- Skilled nursing services and/or therapy services that are required on a daily basis as ordered by a doctor.
- Care for a medical condition that was treated during a three-day hospital stay.
- Your skilled nursing facility is a Medicare-approved facility.
Work with your doctor, your healthcare providers, your social worker and your family to find the right facility to meet your needs.
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