It’s natural to worry about how you’ll cover the costs

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Whether you’re a senior planning your own future or an adult child who simply wants the best for an aging parent, you’re not alone if you think assisted living seems like the ideal solution. Not every senior who needs help is ready for a full-fledged nursing home, and assisted living can provide much of what they need while allowing them to maintain some independence.

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However, assisted living services don’t come cheaply, so it’s only natural to be concerned about how you’ll cover the costs. According to the Genworth Cost of Care Survey, the average monthly cost of assisted living was around $4,500 in 2021. That’s a steep price tag for nearly any family to cover, but Medicaid can make it possible to afford assisted living.

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That said, Medicaid coverage and qualification criteria vary from one state to another, so it’s crucial to fully understand how the process works where you live. Here’s what you should know.

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Medicaid Coverage for Assisted Living

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Medicaid is a form of government assistance that ensures Americans in need (seniors included) have access to essential care services. In most cases, those services include necessary long-term care, including many of the costs associated with assisted living. However, every state does things a bit differently. Some states, such as Missouri and Florida, directly cover Medicaid costs for those who qualify. Most states, however, administer Medicaid through various waiver programs that come with certain limits and caps.

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Medicaid is similar to Medicare in that it’s considered an entitlement program. This means that, although the criteria for qualification are typically very strict, eligible individuals have a government-recognized right to financial help with services deemed medically necessary. Meanwhile, Medicaid waivers provide additional options for those who might not otherwise qualify for assistance. Examples include individuals who live in certain cities or areas within a state or who belong to specific demographics.

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Benefits Covered by Medicaid in Assisted Living

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Again, every state approaches Medicaid-supported assisted living services differently, so it’s essential to research the rules where you live. However, there are almost always limits to what Medicaid will cover for those who qualify. Typical services that are covered include:

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• Personal care services
• Long-term and extended care, such as that offered by assisted living communities and care homes
• Prescription medication
• Daily essentials such as hearing aids and glasses
• In-home health care services
• Case management
• Domestic services, including meal prep and assistance with basic household duties
• Transportation
• Personal emergency response services
• Additional hospital and medical services not covered by Medicare

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Room and board, which usually constitute about half the costs associated with assisted living, typically aren’t covered.

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Qualifying for Medicaid Assisted Living Coverage

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So, what does it take for a particular senior to qualify for Medicaid coverage for their assisted living costs? First, they must meet their state’s financial requirements. If they don’t meet those requirements when they first begin care, they must pay out of pocket for the resources they need until they do.

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A doctor will also need to confirm that the senior in question medically requires assisted living services in the first place. Certain medical needs can make a senior more likely to qualify for Medicaid assisted living coverage, but every case is different, and there are no guarantees. Even a diagnosis such as dementia won’t guarantee care for a particular individual.

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Furthermore, applicants are subject to various evaluations, including financial assessments, to ensure they’re truly in need. For example, caseworkers will review the senior’s financial history over the prior five years to ensure money and other assets weren’t simply given away to loved ones as a means of qualifying. (This is called a Medicaid look-back.)

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There are other potential obstacles applicants should prepare for, as well. For instance, many state waiver programs have mandatory waiting lists that can make it tough for seniors to receive the care they need right when they need it. Additional issues such as limited provider networks can further complicate the process.

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The Bottom Line

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Thanks to Medicaid, there’s more help out there than many people think when it comes to covering the cost of assisted living for seniors, especially for low-income families and others who are genuinely in need. And while applying and qualifying can be complicated in some cases, it can make all the difference in your quality of life or that of a loved one.

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Start the process with a thorough review of the eligibility criteria and qualification process in your state, and follow it to the letter to ensure you get the help you need.

Rachel Lustbader is a writer and editor with a decade of experience working and writing about healthcare, the last five of which have focused on seniors’ health and seniors’ lives. Prior to joining Caring.com, Rachel worked with websites such as HealthCare.com, BiteSizeBio.com, MedicareGuide.com and BetterHelp.com. She studied Health Sciences as an undergraduate at Boston University and continued her studies in Health Communication at BU in 2019.