Before individual state governments passed much-needed legislation, many assisted living facilities were only private pay situations. Fortunately, for many older Americans facing housing dilemmas, Medicaid waiver programs have taken up much of the slack that Medicare did not. Providing funds for placement in assisted living facilities as well as a number of other helpful services, Medicaid helps lower-income, elderly individuals receive the care they need.
All states accept funds from Medicaid waiver programs for placement within a nursing home, which are normally more expensive than assisted living facilities. While many states do not recognize funds from Medicaid waiver programs for assisted living, those that do offer many options to aging Americans needing assistance with daily living activities. After searching high and low, finding a general overview of states that offer the Medicaid waiver program for assisted living was rather nonexistent, but my research is your gain.
Medicaid Waiver Programs State Line-Up
As of publication, there are no definitive lists that outline states with Medicaid waiver programs for assisted living facilities. At best, the government (via the Centers of Medicare and Medicaid Services) has created an online list of all Medicaid waiver programs,1 meaning visitors have to spend time finding the desired information. Although I've outlined the states that do accept Medicaid waiver programs, certain impediments may be in place to securing a Medicaid-covered bed in an assisted living facility. Be aware that some states may offer the program on a trial basis, follow limited participation quotas, or are just introducing the program to state residents. As always, verify eligibility requirements with the Centers for Medicare and Medicaid Services.
- Arkansas - Aged and disabled program participants are provided with adult residential care, assisted living, and medication assistance and consulting till death.
- California - Beginning in 2003, California began offering Medicaid waiver programs to aged individuals.
- Delaware - Program participants with Alzheimer's, dementia, physical disabilities, or needing assistance with activities of daily living (ADLs) are provided with funds for assisted living facilities.
- Florida - There are quite a few Medicaid waiver programs for the state of Florida, including a broad waiver for all individuals aged 65 or older; individuals with Alzheimer's disease and dementia; case management services; assisted living; incontinence supplies to frail, elderly, and disabled individuals aged 60 or older; and a home and community based waiver that offers mental health services to seniors in specific areas of the state.
- Illinois - A pre-admission screening process must be completed to qualify. Individuals with primary or secondary diagnosis of developmental disability, a serious and persistent mental illness or concurrently participating in any other federal home and community-based services waiver program are ineligible for the program.
- Iowa - Many assisted living facilities across the state accept money from Medicaid waiver programs; however, the number of residents in a facility using these funds is limited.
- Indiana - Aged and disabled individuals are provided with case management, transportation, assisted living, medical equipment, congregate care, home delivered meals, nutritional supplements, and much more. The state also offers a targeted assisted living waiver program that focuses on therapeutic social and recreational programming.
- Maryland - Program participants are assessed and, if deemed eligible, are offered either services in the home or placement in an assisted living facility.
- Mississippi - Medicaid waiver programs for this state cover individuals requiring assisted living services due to disabilities, Alzheimer's disease, and dementia as well as individuals aged 65 and older needing adult residential care.
- Missouri - Program participants aged 65 and older needing assisted living services are eligible.
- Nebraska - Individuals aged 65 or older who agree to participate in medical and health care evaluations are eligible for home services or can be placed in an assisted living facility.2
- New Jersey "“ Under the Enhanced Community Options waiver,3 individuals can either remain at home to receive assistive services or be placed in an assisted living facility.
- Ohio - The Ohio Department of Aging is responsible for determining applicants' waiver eligibility, evaluation of disabilities, prognoses, and financial assets for proper placement within assisted living facilities.
- Rhode Island - Aged and disabled individuals are provided with assisted living services, case management, and specialized medical equipment.
- Vermont - Eligible Medicaid recipients are provided with assisted living services under Choices for Care, 1115 Long-Term Care Medicaid Waiver, as well as a number of other care options.
- Virginia - This state's Medicaid waiver programs apply only to individuals with Alzheimer's disease or dementia who require the services of assisted living facilities. Depending upon the medical circumstances, age limits may be in effect.
- Washington - The waiver program provides for aged and disabled residents at assisted living facilities.
- West Virginia - Aged and disabled program participants are provided with adult residential care and assisted living services.
Additionally, some states offer details on restrictions and eligibility that can be downloaded by navigating to each respective state's Medicaid waiver informational link.
What to Look for in the Future
State governments determine eligibility based on income, giving lower-income seniors an opportunity to be placed in a facility that will look after their needs and supervise daily activities. With the baby boomers retiring as we speak and well into the coming years, will we continue to see growth in the number of Medicaid-eligible assisted living facilities in other states? Perhaps the thirty-three or so other states will realize the incredible benefits to both seniors and society in general.