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Do Medicaid Waivers Pay For Assisted Living?
Date Updated: July 26, 2024
Written by:
Rachel Lustbader is a writer and editor with a background in healthcare and technology. Her work has been published on websites including HealthCare.com, BiteSizeBio.com, BetterHelp.com, Caring.com, and PayingforSeniorCare.com. She studied health science and public health at Boston University.
Both of Rachel’s grandmothers had very positive experiences in senior living communities, and Rachel saw firsthand the impact that kind, committed caregivers and community managers can have on seniors’ and their family members’ lives. With her work at Caring, Rachel hopes to help other families find communities, caregivers, and at-home products that benefit elderly loved ones and make life less stressful for family caregivers
Reviewed by:
Kristi Bickmann, a licensed Long-Term Care Specialist, represents top-rated "Traditional" & "Hybrid" LTC companies. Serving associations such as the American Nurses Association, she's a licensed insurance agent in 27 states. Specializing in insurance products for seniors, Kristi helps hundreds of families every year protect assets, retirement, and loved ones. She understands aging concerns firsthand, having assisted her own parents. Kristi ensures accuracy on topics about senior long-term care and its consequences.
Medicaid waivers help seniors pay for assisted living. Although regular Medicaid may cover services such as medication management, personal care assistance and therapy, it doesn’t pay for the everyday expenses of bed and board.
Older adults moving into assisted living face average annual fees of $54,000. So, to cover more of the expenses involved with residential care, low-income seniors need to look to Medicaid waivers for help.
What is a Medicaid waiver?
Medicaid waivers allow states to assist elderly residents with paying for care that wouldn’t normally be covered by Medicaid. Classified as Medicaid Long-Term Services and Supports (LTSS), these programs provide the care and support seniors need to live in their own homes or within a residential care community and avoid entering a nursing home.
Around 18% of assisted living residents rely on Medicaid to help cover the costs, and it’s estimated that 1.6 million people used LTSS in 2020 to pay for services, such as assistance with the activities of daily living and bed and board.Types of Medicaid waivers
Medicaid waivers, what they cover and the eligibility criteria vary by state. To help identify which programs are available in their region, seniors can find a full list on the Medicaid website.
For senior care, these programs usually fall under sections 1115 and 1915 of the Social Security Act.
Home and Community-Based Services (Section 1915c)
Demonstration Waivers (Section 1115)
States use Demonstration waivers to temporarily test new ways to deliver Medicaid funding. They’ve become popular with states attempting to utilize the additional funding they receive under the Affordable Care Act. All programs must be budget-neutral, so the Federal government’s contribution doesn’t exceed the amount it would spend if the waiver didn’t exist.