Author: Sarah Williams
Reviewed By: Kristi Bickmann
Medicaid doesn’t pay for room and board in assisted living communities, although provisions vary between states. In many states, Medicaid doesn’t directly cover any assisted living services. Instead, seniors who meet eligibility criteria can receive funding through Home- and Community-Based Services Waiver programs to help them pay for assisted living, but most such waiver programs still don’t cover room and board costs. Unlike traditional Medicaid, many waiver programs don’t operate on an entitlement basis, meaning qualifying seniors may be wait-listed for financial assistance.
Federal funding for assisted living care, whether via traditional Medicaid or waivers, usually covers essential care services to help seniors stay in a community setting rather than needing to move to a nursing home. Such services typically include help with activities of daily living, such as ambulation and transferring, and personal care, including bathing and grooming. Financial support also covers instrumental activities of daily living, such as transportation, housework and laundry.
Medicaid or waivers pay for case management, counseling and medication management where facilities are licensed to provide such services. They also commonly pay for nursing oversight, although not all assisted living facilities offer this service. Additionally, aid pays for access to facility amenities, such as gardens, lounges and fitness centers, as well as engagement, enrichment and wellness programs.
Seniors who receive Medicaid or waiver funding must pay costs associated with room and board out of pocket. Payment options include using income and savings, and sometimes seniors sell assets to help pay for care. Those who own a property may consider a reverse mortgage. Long-term care insurance may help relieve the financial burden, and family members sometimes help seniors pay for their long-term care.
