Does Medicaid pay for assisted living care? The answer is, unfortunately, a qualified NO. Medicaid benefits do not cover care services in an assisted living facility in the same that Medicaid programs pay comprehensively for nursing home care. For those who meet full financial eligibility requirements (i.e. are under all applicable asset limits) and need full care in a skilled nursing long-term care facility, Medicaid will pay for all expenses to pay for that senior care (over and above the care recipient’s monthly social security and pension co-pay). Enrollment in a nursing facility Medicaid program entitles the recipient to have ALL long-term care services covered by Medicaid pay, with the recipient paying his or her monthly social security and pension as part of their contribution. And Medicare certainly will not cover long term care costs in assisted living, or for a nursing home level of care either, for that matter
Assisted living communities do not qualify to have Medicaid pay for assisted living care needs in this comprehensive way. When a person’s health care needs increase and he or she enters an assisted living facility, they are responsible for the full month’s cost of care. The person can, if qualifying financially for state Medicaid coverage, qualify for a set supplemental amount of financial assistance to help defray the monthly assisted living costs. This amount of monthly assistance, known as Cash Grant Medicaid, usually ranges from $300/month to $500/month. The remaining bill is the responsibility of the assisted living resident.
Because assisted living relies almost exclusively on private pay, pre-planning and Medicaid planning should be employed as soon as possible. Once a person is receiving adult day care, or has moved to a senior independent living facility, or is requiring any level of health services or senior living, or is experiencing difficulties with activities of daily living, family members and loved ones should begin immediately to plan out the coming years of spend down. One commonly used strategy for holders of long-term care insurance is to use the long-term care insurance proceeds on assisted living cost of care, while preparing to initiate the application process and meet Medicaid eligibility requirements when the resident later requires a nursing home level of care. Because a nursing home resident can have Medicaid cover the full cost of care, any long-term care insurance proceeds or private pay spend down can be used for lower levels of care, i.e. adult day care, independent living, other medical care,
Contact QMC and our case management to get ahead of these trickly care situations as early in the journey as possible. Our professional team and our assistance programs have helped thousands of senior families navigate these waters.