Author: Sarah Williams
Reviewed By: Kristi Bickmann
No, assisted living facilities aren’t required to take Medicaid. Because no national regulations govern Medicaid acceptance, policies vary between states, regions and individual facilities. Additionally, providers that accept Medicaid have no obligation to continue to do so, and Medicaid-certified communities could fail their surveys and lose standing. Individuals who qualify for Medicaid funding, often through Home- and Community-Based Services Waiver programs, but choose to live in a non-certified facility must find alternative ways to pay for their care.
To accept federal funding, assisted living facilities must hold the relevant state license and be certified as meeting specific criteria. Although licensing rules differ from state to state, they typically cover resident safety and well-being, building design, staffing, care services and facility policies. Similarly, facilities must meet the requirements contained in Title 42 of the Code of Federal Regulations to participate in Medicaid programs.
In most states, the same agency is responsible for issuing operational licenses and renewals as well as conducting Medicaid inspections and ongoing surveys. Following certification inspections, the agency reports its findings and presents recommendations to the Centers for Medicare & Medicaid Services, which makes the final accreditation decision.
Over 800,000 older Americans reside in an assisted living facility, with approximately 18% of those using Medicaid programs to pay for some services. However, as Medicaid generally doesn’t cover room and board costs in assisted living, seniors must also use other payment methods. Seniors who live in facilities that don’t accept Medicaid, don’t meet the strict requirements to qualify for financial assistance or receive partial funding must find alternative means of paying for assisted living. Most assisted living residents use some form of private pay, such as their retirement income or savings, and families sometimes contribute to senior care costs. Other potential options include reverse mortgages, life insurance, long-term care insurance, VA Aid and Attendance allowance, other state programs and charitable grants.
