In most but not all states, there are special Medicaid programs that can help pay some of the costs of an assisted-living facility. Although assisted living is not part of
basic Medicaid coverage, Medicaid now recognizes that for many people it's a better and less expensive alternative than a nursing home. So, in partnership with the states, Medicaid has recently been expanding its coverage of assisted living.
If you live in one of the following states, the Medicaid program might cover some but not all of the costs of assisted living:
California (very limited three-county pilot program in Los Angeles, San Joaquin, and Sacramento counties)
District of Columbia (under development)
Oklahoma (under development)
Virginia (Alzheimer's patients only)
The rules are different for each state. And in every state that offers Medicaid coverage, there are significant restrictions on whether Medicaid will pay, as well as limitations on how much it will pay. The restrictions and limitations might include any of the following:
- Services but not room and board. Many programs will pay for some personal care services provided by the facility but not for room and board. Other state programs will pay a part of room and board costs.
- Tiered payments. The amount the program pays may depend on the level of services needed.
- Income-based payments. In some programs, the amount paid depends on the resident's income.
- Cap on payments. Some states have a monthly cap on payments, regardless of how much a person's care actually costs.
- Nursing home-eligible only. Some programs cover only those people who would require nursing home care if they were not in assisted living.
- Limited number of participants. In some states, only a small number of people are covered by the program at any one time. These states usually have a waiting list for coverage.
- Participating facilities only. Coverage is not necessarily available in every assisted-living facility. Most states limit their coverage to facilities with certain specific types of licenses. And even if an assisted-living facility could qualify under the state's rules, not all facilities choose to participate in the program.
To find out more about Medicaid coverage -- often called the Medicaid Home and Community-Based Services (HCBS) waiver -- in a particular state, contact the state's Medicaid office or the state department of health (which oversees assisted-living facilities). To find a state's Medicaid website, go online to any search engine and enter Medicaid and the name of that state. Or you can call the Eldercare Locator toll-free at (800) 677-1116 and ask for contact information for the state's Medicaid office. To find the website for a state department of health, enter health department and the name of the state.