Medicaid is a federally controlled, state-administered health insurance program that covers vulnerable Americans at all stages of life. As of September 2023, the program insured over 81 million Americans from birth to age 65 and older. 

Although Medicaid has insured low-income families since 1965, the program is more important than ever due to rising costs of care, which take the biggest toll on children, pregnant mothers, disabled adults, and seniors. 

Medicaid is an excellent resource for seniors as it provides comprehensive coverage and functions hand-in-hand with Medicare. Yet, understanding how Medicaid works, what it covers, and who qualifies can be challenging. In this guide, we’ll explore Medicaid’s functions, costs, and requirements to help you learn about the program and determine your eligibility for coverage. 

What Is Medicaid? 

Medicaid is a federal and state health insurance program available to qualified low-income Americans and other mandatory coverage groups. It pays for more than 60% of the nation’s nursing home residents and more than 50% of long-term care claims nationally. In-home care and personal assistance coverage is also provided through Medicaid home and community-based waivers. Medicaid is a significant part of the federal budget, health care industry and national economy.

What’s The Difference Between Medicare and Medicaid?

Medicaid is a joint federal and state health insurance program that is income-based and available to certain individuals who meet financial eligibility requirements. Medicare is a federal health insurance program and is available to all adults who are aged 65 or older, regardless of income. Younger individuals who have end-stage renal disease, Lou Gehrig’s Disease, or have received Social Security Disability benefits for at least 24 months also qualify for Medicare.

Learn More About The Difference Between Medicare and Medicaid

How Does Medicaid Work? 

Once your coverage is in place, you’ll have access to primary and emergency medical care, as well as long-term services and support. In some states, Medicaid is administered by the government, while other states use care organizations operated by private insurers. This type of coverage gives you access to networks of Health Maintenance Organizations (HMO) or Preferred Provider Organizations (PPO), which should be familiar if you’ve had other types of insurance.

Conveniently, you can become a dual enrollee in Medicare and Medicaid, with Medicaid covering your Medicare copays or coinsurance and handling any charges that aren’t covered by your primary. Medicaid may also pay for prescription medications excluded from your Part D prescription drug coverage or Advantage Plan. Most Medicaid enrollees have no premiums or deductibles. However, some states have share-of-cost requirements, typically based on your income level, which may require you to pay copays, coinsurance, or deductibles on care.

What Does Medicaid Cover? 

Although Medicaid coverage will vary depending on the state, Medicaid agencies are legally obligated to provide certain services, similar to those offered by Original Medicare Parts A and B. In addition, states can offer optional services while coverage exclusions define the services and situations that Medicaid will not cover. The table below gives examples of services that are mandatory, optional, or excluded.

Medicaid Always Covers

Medicaid Sometimes Covers

Medicaid Does Not Cover

Hospital care

Dental

Unreasonable or medically unnecessary services

Skilled nursing

Vision

Services billed through another allowance

In-home care

Hospice

Providers reimbursed through another program

Doctor’s visits

Personal care

Services and tests that are not covered under the plan

Preventative care

Case management

Medical care received outside of the United States, barring certain exceptions

Wellness screenings

Prescription drug coverage

Durable medical equipment replaced through warranty

Medical transportation

Physical and occupational therapy

Health care services provided by another government agency

Diagnostics

Respiratory services

Free health screenings or devices

Birth center services

Podiatry

Personal comfort items, such as TVs or beautician services

Who Qualifies for Medicaid? 

Certain individuals receive mandatory Medicaid eligibility, including low-income families, pregnant women, and adults who are blind or disabled. States may also offer optional coverage to individuals with income at certain levels and with specified care needs. This coverage includes seniors who receive home- and community-based care services, are in hospice, live in a nursing home, or are in poor health. The Medicaid program in each state is unique, and as a result, income limits and medical eligibility guidelines vary.

Financial Eligibility for Medicaid

Individuals receiving Supplemental Security Income (SSI) payments generally qualify for Medicaid, since they are required to have a low income and limited assets. Medicaid has strict asset limits, but does exclude certain assets from these calculations. 

The asset limits for Medicaid are currently $2,000 per applicant and $4,000 for couples. 

Nonfinancial Eligibility

Medicaid only pays for skilled nursing if you require this level of care. Most states include a “functional needs assessment” as part of the application process, which includes questions that gauge the applicant’s functional needs, mobility, overall health, and need for assistance with activities of daily living. 

To qualify, applicants typically must require assistance with at least two activities of daily living. States may also consider the applicant’s medical history since conditions such as Alzheimer’s and Parkinson’s disease may necessitate institutional long-term care regardless of the results of their assessment.

How to Apply for Medicaid 

You can apply for Medicaid through the Healthcare Marketplace or your state’s Medicaid agency. Applications are typically processed by the Department of Human Services or a similar division. Contact information for the program in each state can be found on the Medicaid website. 

If you or someone else in your household might be eligible for Medicaid, the Marketplace will automatically forward your application to your state as long as you select “yes” when asked if you’d like help paying for coverage. You can also call the Marketplace Call Center at 1-800-318-2596 to apply.  

Medicaid Coverage of Residential Senior Care

Staying in a nursing home costs $7,908 per month on average for a semi-private room and $9,034 for a private room, according to Genworth. Fortunately, Medicaid picks up the slack once Medicare beneficiaries have exhausted their 100 days of skilled nursing facility (SNF) coverage, and it covers individuals who need nursing home care but don’t qualify for Medicare.

Today, Medicaid funds 57% of home and community-based services. The ways that Medicaid can help you pay for care include:

  • Nursing Homes: In addition to providing regular medical care, Institutional Medicaid pays for skilled nursing, personal care, room and board, and specialized rehabilitative services provided in nursing homes.
  • Assisted Living: The costs of care received at an assisted living facility may be covered by Medicaid Home and Community-Based Services (HCBS) waivers or 1915(c) waivers. However, residents will still be responsible for room and board in most cases.  
  • Community Housing: Nearly all Medicaid waivers will pay for the cost of personal care, home modifications, and supportive services provided at home or in a residential setting, such as subsidized senior apartments.

To receive these benefits, the results of your functional needs assessment must demonstrate that you require assistance with activities of daily living and you must meet your state’s income and asset limits. Fortunately, many states offer spend-down programs for adults who use excess income to pay for qualifying medical bills.

Additionally, most states offer a medically needy qualification pathway and may allow residents to establish a Qualified Income Trust, also called a Miller Trust. With this option, excess money is diverted into an irrevocable trust to help you meet your state’s income threshold for nursing home benefits. 25 states provide this qualification option to help residents who need long-term care.

Medicaid Waivers

Home & Community-Based Services (HCBS) waivers are a useful resource for seniors. Waivers were first introduced in 1983 through section 1915(c) of the Social Security Act, and many programs still bear this title. Today, hundreds of waiver programs cover the costs of care for more than 3 million seniors and disabled adults while giving them the freedom to age in place and avoid institutional care.

Waivers are important because under normal circumstances, Medicaid only covers long-term services and supports that are provided in licensed health care institutions, such as nursing homes. Waivers let beneficiaries receive these services at home or in another community-based setting, such as an assisted living facility.

There are several types of HCBS waivers:

Waiver

Explanation

1915(c)

Traditional HCBS waivers cover medical and nonmedical services, such as respite care and adult day care, to prevent or delay the need for institutional services.

1915(i)

Available to targeted groups, State Plan Home & Community-Based Services cover acute care, as well as long-term supports like home modifications and case management.

1915(j)

Some states opt to provide Self-Directed Personal Assistance Services. Participants receive funding to hire, train, and pay qualified caregivers, including relatives.

1915(k)

Introduced in 2011, Community First Choice waivers allow states to cover home & community-based attendant services.

1115

Demonstration waivers give participating states greater flexibility in providing aid as long as they can show that government spending won't increase.

How to Use Medicaid to Pay for Assisted Living in Every State

Individuals who need help with assisted living costs can use Medicaid waivers if they meet eligibility requirements. Although most states don’t cover the cost of housing for assisted living, some run their own licensed assisted living facilities, which are paid for in-full or in-part by Medicaid. Waivers like the ones mentioned above provide care services within an individual’s home or community residence, such as an assisted living environment. However, each state is responsible for choosing which waivers they will provide to their Medicaid members.

Therefore, coverage and assistance will vary from state to state. Continue reading for a summary of every state’s position on Medicaid waiver programs:

State

Waiver Program

Alabama

Alabama does not offer programs that pay for the cost of room and board in an assisted living residence, but they do provide care services in those environments through Medicaid waivers. The Elderly and Disabled (E&D) Waiver provides a selection of services to eligible Medicaid members over 65 and disabled individuals. These services can be received in a home or community residence. The Alabama Community Transition (ACT) waiver helps individuals transition out of institutions and into a home or community residence. The Personal Choices Program is similar to the E&D waiver with a focus on self-directed care.

Alaska

Eligible Alaskan Medicaid members looking for support with assisted living have two waiver options. The state provides assistance with the costs residential living through the Alaskans Living Independently (ALI) waiver and the Intelectual and Developmental Disabilities (IDD) waiver, which accepts only 50 applicants per year.

Arizona

The Arizona Long Term Care System (ALTCS) is a program offered to eligible Medicaid members through a program contractor who works with a number of providers, including assisted living facilities. The state also allows qualifying members to choose their care providers through the Self Directed Attendant Care (SDAC) option. 

Arkansas

The Living Choices Assisted Living waiver allows eligible Arkansans to receive 24-hour care services while living in an assisted living facility independently, though room and board is not covered. The state also provides the AR Choices in Homecare waiver, providing eligible seniors with assistance in their daily life in the environment of their choice.

California

California’s Assisted Living Waiver (ALW) program pays for care coordination, care development, residential habilitation, and transition care for adults over 65 who live in or plan to live in an assisted living facility within the 15 approved counties. There is also the Multipurpose Senior Services Program (MSSP) and Home and Community Based Alternatives (HCBA) waiver for qualifying seniors to receive services in their home or community residence.

Colorado

The Elderly, Blind and Disabled (EBD) waiver offered to eligible Colorado Medicaid members provides a wide range of care services, including the ability to stay in an “alternative care facility” which is a form of assisted living. However, the individual must pay for the cost of room and board and some services. The Consumer Directed Attendant Support Services (CDASS) option under the EBD waiver allows members to select and hire their own attendants.

Connecticut

The Connecticut Home Care Program for Elders (CHCPE) covers assisted living services for qualifying individuals who live in one of the state’s participating facilities. While this program pays for care received within a facility, it does not pay for room and board.

Delaware

Delaware Medicaid members who are covered under the Diamond State Health Plan - Plus (DSHP-Plus) initiative can receive coverage for long-term care services within the community. This includes individuals residing within an assisted living facility.

Florida

Florida offers coverage for assisted living services through their Statewide Managed Medicaid Care - Long-Term Care (SMMC-LTC) Program. The state no longer offers HCBS waivers but provides assistance under this long-term care plan, which includes a long list of additional benefits.

Georgia

The HCBS Community Care Services Program (CCSP) is offered to eligible Medicaid members. It provides a variety of services, including “alternative living services” at state-licensed assisted living facilities. Additionally, the Service Options Using Resources in Community Environments (SOURCE) waiver program provides care to seniors, including assisted living services.

Hawaii

Hawaii’s QUEST Integration (QI) Program serves their Medicaid members through Long-Term Services and Supports. This plan includes coverage for assisted living services, allowing eligible individuals who are not institutionalized to receive the same level of care. 

Idaho

The Idaho HCBS Aged and Disabled (A&D) Waiver allows eligible Medicaid members to receive services based on their individual needs, including care within their assisted living residence. The Idaho Home Choice Program aims to help people transition from an institution into a residence like an assisted living facility. These programs do not pay for the cost to reside in an assisted living facility.

Illinois

Illinois provides their eligible Medicaid members with an HCBS Waiver for Persons who are Elderly, offering services to individuals in assisted living facilities and homes. The Illinois Supportive Living Program (SLP) covers the cost of care for residents of assisted living facilities but not the cost of room and board.

Indiana

The Aged and Disabled (A&D) Waiver is an HCBS program for eligible Medicaid members who would otherwise need to be institutionalized. This waiver allows individuals to receive care in state-certified assisted living facilities or in their own homes. However, this program does not pay for the cost of room and board.

Iowa

Iowa offers two waiver programs for aging and disabled adults wanting to remain in their own homes or communities. The first is the HCBS Elderly Waiver, designed to prevent institutionalization for adults over 65 years old. The second is the Health and Disability (HD) Waiver for adults under 65 years old. These waivers pay for care but do not cover room and board.

Kansas

Kansas offers the Frail Elderly (FE) Waiver for individuals over 65 who would otherwise need to be medically institutionalized but wish to receive care in an environment other than a nursing home. The waiver does not pay for the cost to reside in an assisted living facility. 

Kentucky

Eligible Medicaid members over 65 years old can use Kentucky’s Home and Community Based (HCB) Waiver to receive coverage for a variety of services in their residence of choice, including assisted living facilities. The program does not pay for room and board.

Louisiana

Louisiana’s Adult Day Health Care (ADHC) Waiver provides community-based daytime care for senior or disabled adults to avoid institutionalizing them. In addition, the Community Choices Waiver (CCW) provides care services for eligible Medicaid members in their home and community, which can include an assisted living facility.

Maine

Maine provides the Elderly and Adults with Disabilities Waiver and the HCBS for Adults With Other Related Conditions program for adults over 65 years old. These state-approved services are available to help eligible Medicaid members with chronic conditions receive care in the residence of their choice. For those who desire in-home care, Maine also has the Consumer Directed Attendant Serviances Program.

Maryland

Maryland Medicaid covers the cost of assisted living through their Home and Community Based Options Waiver (HCBOW) for eligible Medicaid members. The Community First Choice (CFC) and Community Personal Assistance Services (CPAS) programs cover approved care services received in the eligible individual’s residence of choice.

Massachusetts

The Massachusetts MassHealth Medicaid program offers two waivers. The Frail Elder Waiver (FEW) program provides health care services to seniors in their homes or community residences who would otherwise need to be institutionalized. The state also offers a Personal Care Attendant (PCA) program that provides funding for seniors to hire an attendant to help them with their daily activities in their homes or community residences. These waivers do not cover the cost of room and board. MassHealth may provide subsidies to go toward assisted living expenses, but individuals must apply and qualify for these supplements.

Michigan

The Michigan Medicaid Choice Waiver and the Health Link Waiver provide adults over 65 years of age and adults with disabilities coverage for nursing home-level care services within their homes or community residences. The state does not have programs that pay for room and board costs.

Minnesota

Minnesota’s Elderly Waiver is provided to eligible Medicaid members who need a nursing home level of care but wish to remain in their home or community residence. While this waiver does not cover the cost of room and board, individuals may qualify for housing cost support through the Housing Support program. 

Mississippi

The Mississippi Division of Medicaid offers the Assisted Living (AL) Waiver to eligible members. The waiver does not pay for room and board but does pay state-approved facilities for the services that Medicaid members receive during residency. Mississippi also provides the Elderly and Disabled (E&D) Waiver for qualifying individuals to receive care services in their own homes or community residences. 

Missouri

Missouri’s Aged and Disabled Waiver (ADW) provides a small list of care services for eligible Medicaid members living in their homes or community residences. This waiver does not cover housing costs. The MO HealthNet Nursing Home Coverage program offers eligible adults over 65 a monthly cash payment to go toward the cost of living (including room and board) in a nursing home or assisted living facility. The Missouri Care Options (MCO) program offers assistance to adults in need of long-term care services in their home or community residence of their choice.

Montana

The Montana Big Sky Waiver (BSW) offers a long list of services to adults over 65 and adults with disabilities. These services are provided to eligible Medicaid members who would otherwise need to be placed in a medical institution to receive care, allowing them to be cared for in their own home or in a community residence. Adult residential living may be paid for in part or whole, depending on the individual’s eligibility for state aid. Montana also provides a Community First Choice/Personal Assistance Program for self-directed care within a qualifying individual’s home or community residence, not including room and board.

Nebraska

Nebraska’s Aged & Disabled (AD) Waiver provides a variety of services to eligible Medicaid members to be received in their own home or community residence. The list of services includes assisted living care but does not include payment for room and board.

Nevada

Nevada’s Waiver for the Frali Elderly (FE) is available for eligible individuals over 65 and individuals with disabilities, providing care services in the environment of their choice. The state also offers a Personal Care Services (PCS) Program and Adult Day Health Care (ADHC) coverage.

New Hampshire

New Hampshire’s Choices for Independence (CFI) Waiver provides care services for individuals over 65 and adults with disabilities, including the option to recieve care in their own home or community residence of choice. The list of services includes “adult family care,” which is similar to assisted living but on a smaller scale. They also offer a Personal Care Attendant Services (PCAS) Program.

New Mexico

New Mexico provides assisted living service coverage under their new managed care plan called Centennial Benefit (CD) Program, though room and board costs are not covered. The state also offers a Medically Fragile Waiver for individuals who qualify as medically frail to receive services in their homes and community residences. 

New Jersey

Although New Jersey doesn't offer any individual HCBS waivers, the Managed Long Term Services and Supports (MLTSS) Program acts as a home and community-based program. Services are available for eligible members to receive in the residence of their choice. Depending on availability and income caps, the state may cover some or all assisted living room and board costs. They also offer Personal Care Assistant Services in the form of their Personal Preference Program (PPP).

New York

New York provides the Managed Long Term Care/ Consumer Directed Personal Assistance Program (CDPAP), which allows ill or disabled state residents to recieve long-term services without eing placed in a nursing home. Their Nursing Home Transition and Diversion Waiver also allows for care to be received in a community-based setting. The state may allow for subsidies to help pay for room and board, though this is not part of the waiver service. The Assisted Living Program (ALP) will pay for the cost of room, board, and a variety of assisted living services for eligible members.

North Carolina

The Community Alternatives Program for Disabled Adults (CAP/DA) offered by the North Carolina Medicaid agency allows for a long list of care services to aged individuals over 65 and adults with disabilities who wish to stay in their own home or community residence. The North Carolina Personal Care Services (PCS) Program provides personal care to eligible members living in a private home, a state-licensed residential facility, a combination home, or a group home. These options do not pay for room and board.

North Dakota

North Dakota provides a Home and Community Based Services (HCBS) Waiver, which includes homemaker services, adult residential care, adult day care, and more. These services are available within an eligible Medicaid member’s home or community residence. The state also offers a Medicaid State Plan Personal Care (MSP-PC), providing services within the member’s residence of choice.

Ohio

The Assisted Living Waiver provided by the state of Ohio covers the cost of care received in an assisted living residence. The eligible individual is still responsible for paying room and board. The state also offers a few HCBS waivers to provide assistance to eligible individuals wanting to receive care in their own homes or community residence, including the PASSPORT Waiver and MyCare Ohio Plan. 

Oklahoma

The ADvantage Waiver Program provides care services, including assisted living services, to eligible individuals over 65 who are living in their own homes or community residences. The Sooner Home Health program provides personal care services and therapies for adults age 65 and older with chronic conditions in the residence of their choice. The State Plan Personal Care (SPPC) Program is another option for self-directed care, allowing the eligible member to choose where to receive their services.

Oregon

The Oregon Aged and Physically Disabled (APD) Waiver provides case management, transition services, and housing support services for adults over 65 and adults with disabilities. The state also offers the Oregon K Plan under the Community First Choice option, which provides care services to eligible Medicaid members in the residence of their choice. These programs do not pay for assisted living housing costs. Additional waivers include the Independent Choices Program (ICP), Spousal Pay Program, and State Plan Personal Care (SPPC) Program.

Pennsylvania

Pennsylvania’s Community HealthChoices (CHC) Program provides a wide variety of care services to eligible Medicaid members over 65 and disabled adults. Qualifying participants can receive these services in their own home or community residence, but the state does not cover room and board.

Rhode Island

Rhode Island offers the Comprehensive Demonstration Waiver to provide HCBS services to seniors through Long Term Services and Supports (LTSS). There is a list of services eligible Medicaid members can choose from within the program that include homemaker services, transitional services, residential supports, respite care, personal care assistance, and more. A senior’s eligibility changes based on income, location, and their proven need for care assistance. The state also offers the SSI Enhanced Assisted Living Program, providing a monthly stipend to disabled adults with a monthly income of $1,212 or less to go toward the cost of an assisted living facility.

South Carolina

South Carolina’s Community Choices Waiver gives eligible Medicaid members the option to receive care services in their own home or community residence. This waiver covers the cost of services but does not pay for room and board within assisted living facilities.

South Dakota

The Assistive Daily Living Services (ADLS) Program provides eligible Medicaid members with personal care services in the home or community residence of their choice. The state also has a Home and Community-Based Options and Person Centered Excellence (HOPE) Waiver. This waiver is similar to the ADLS waiver but provides further services in coordination with assisted living facilities, not including the cost of room and board or facility maintenance.

Tennessee

Tennessee offers their seniors and adults with disabilities the TennCare CHOICES in Long-Term Services and Supports program. This option provides care services that enable eligible individuals the option to receive care in their home or community residence. Tennessee residents interested in the program should contact their local Area Agency on Aging and Disability (AAAD) to learn more about the program.

Texas

The STAR+PLUS Home and Community Based Alternatives (HCBS) Program gives eligible Texas Medicaid members who would otherwise need to be institutionalized the ability to receive care services in their own home or community residence. The program covers the cost of services but does not pay for assisted living room and board. Other waivers include Community First Choice (CFC), Primary Home Care (PHC) Program, Day Activity and Health Services (DAHS), and Community Attendany Services (CAS).

Utah

Utah offers a selection of waivers for eligible Medicaid members over 65 and disabled adults who would like to receive care services in their own home or community residence instead of an institution. Those waivers include the Aging Waiver, the New Choices Waiver (NCW), and State Plan Personal Care Service. In most cases, individuals must be transitioning from an institution to a community-based setting to receive these benefits.

Vermont

Vermont’s Global Commitment to Health demonstration provides the Choices for Care program, which serves eligible Medicaid members who require a nursing home level of care. The program allows individuals to receive care in the home of their choice, an enhanced residential care facility, an adult family care home, or nursing facility. The state also provides a Medicaid benefit called the Assistive Community Care Services (ACCS) program. Eligible members residing in assisted living residences or licensed level III residential care homes are able to receive care services within their residence. The program does not cover the cost of room and board. Additionally, Vermont’s Attendant Services Program (ASP) allows eligible individuals with severe and permanent disabilities to hire and direct their own attendant care service in their residence of choice.

Virginia

The Commonwealth Coordinated Care Plus (CCC Plus) Waiver Program provides care services to eligible Medicaid members who would otherwise need to be placed in a nursing home. The waiver covers things like transition services, adult day health care, and personal care services to individuals in their home or community residence. It does not cover housing costs. The state also offers a Choices for Care Program for members who qualify, which allows individuals to direct their own care through companion services, personal assistance/care, and respite care in the residence of their choice.

Washington

Washington’s Residential Support Waiver provides services like enhanced residential and community services, day health, and training to eligible Medicaid members needing care within their own home or community residence. The New Freedom (NF) Waiver offers fewer but similar services and allows individuals to choose where they receive their care. The Washington Community Options Program Entry System (COPES) Waiver is another state program that offers services to eligible individuals who wish to receive care in the residence of their choice. The program does not cover the cost of room and board but may reimburse qualifying individuals for expenses incurred when establishing basic housing like security deposits, utility set-up fees, and moving expenses. The state’s Community First Choice (CFC) and Medicaid Personal Care (MPC) programs are additional options for individuals looking to receive care services in a residential setting.

West Virginia

The Aged and Disabled Waiver (ADW) provided by West Virginia’s Medicaid program provides case management, personal care services, transition services, and more to individuals over 65 and disabled adults in their home or community residence. The West Virginia Personal Care Program is also available to eligible Medicaid members who need help with activities of daily living in their own residence. These programs may provide services within assisted living facilities but do not pay room and board expenses.

Wisconsin

Wisconsin offers its eligible Medicaid members three waivers for individuals over 65 and disabled adults to receive a wide variety of care services in their own homes or community residences. Those waivers include the Family Care & family Care Partnership Programs, the Include, Respect, I Self Direct (IRIS) Waiver Program, and Medicaid Assistance Personal Care (MAPC) program. These services enable seniors with disabilities to determine and direct their own care through a budget provided by the state. While these services can be provided in an assisted living setting, Medicaid does not cover the cost of housing.

Wyoming

The Community Choices Waiver (CCW) provided by Wyoming Medicaid provides care services, case management, skilled nursing, and more to eligible individuals. Members are able to choose where they receive care, whether it’s in their own home or within an assisted living facility.

Medicaid In Your State

Click on your state below for information about your state’s Medicaid office and program.

Frequently Asked Questions 

Is Medicaid free?

Yes, Medicaid is usually free. Although states are permitted to require a share of cost, there are usually no premiums, deductibles, or copays with Medicaid since this program is intended for low-income families and individuals with very high medical bills. Cost sharing may be required for some higher-income target groups, and you may incur out-of-pocket expenses when requesting certain name-brand, non-preferred medications. If you qualify for Medicare, Medicaid may even pick up some excess charges.

Does Medicaid pay for assisted living?

Yes, many Medicaid programs cover assisted living and personal care through waivers or managed care organizations. At least 34 states have Community First Choice Waivers, and 39 states have HCBS waivers or managed care organizations that cover personal care, household assistance, transportation, meal delivery, case management, emergency response systems, and related supports. There may be restrictions on where participants can receive these services, and seniors still have to pay for room and board unless they qualify for an SSI stipend. Waivers are also subject to waiting lists.

Can I get paid by Medicaid to be a caregiver? 

It’s possible for informal family caregivers to receive compensation for the services that they provide through Medicaid. Consumer-directed or self-directed waivers may grant seniors a needs-based stipend that they can use to hire their own caregivers. A handful of states, including Arizona, Florida, Kentucky, New Jersey, and Wisconsin, even compensate caregiving spouses. The caregiver must register as a provider with the state’s Medicaid program and meet certain other requirements to qualify.

How do you qualify for Medicaid?

Medicaid eligibility is based on your income, assets, and medical need. Requirements may vary, depending on your age and whether you have a disability. The state will also consider your health care expenses if you are medically needy and earn too much to qualify through regular eligibility pathways. You can see if you qualify by contacting a Certified Medicaid Planner, completing a Medicaid eligibility test, or applying through your state’s Medicaid agency.

Works Cited

“Medicaid Eligibility Income Chart by State.” American Council on Aging, Mar. 2021, https://www.medicaidplanningassistance.org/medicaid-eligibility-income-chart. Accessed 23 May 2021. 

“National Health Expenditure Data, Historical.” Centers for Medicare & Medicaid Services, Dec. 2020, https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical. Accessed 23 May 2021. 

“November 2020 Medicaid & CHIP Enrollment Data Highlights.” Medicaid.gov, Nov. 2020, https://www.medicaid.gov/medicaid/program-information/medicaid-and-chip-enrollment-data/report-highlights/index.html. Accessed 24 May 2021. 

“Who Pays for Long-Term Care in the U.S.?” The SCAN Foundation, Jan. 2013, https://www.thescanfoundation.org/sites/default/files/who_pays_for_ltc_us_jan_2013_fs.pdf. Accessed May 23 2021. 

“Cost of Care Survey.” Genworth Financial, Feb. 2021, https://www.genworth.com/aging-and-you/finances/cost-of-care.html. Accessed 24 May 2021. 

“Medicaid State Fact Sheets.” Kaiser Family Foundation, Oct. 2019, https://www.kff.org/interactive/medicaid-state-fact-sheets. Accessed 23 May 2021. 

“Institutional Long Term Care.” Medicaid.gov, https://www.medicaid.gov/medicaid/long-term-services-supports/institutional-long-term-care/index.html. Accessed 23 May 2021. 

“Mandatory & Optional Medicaid Benefits.” Medicaid.gov, https://www.medicaid.gov/medicaid/benefits/mandatory-optional-medicaid-benefits/index.html. Accessed 23 May 2021. 

“Items & Services Not Covered Under Medicare.” Centers for Medicare & Medicaid Services, https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnproducts/downloads/items-and-services-not-covered-under-medicare-booklet-icn906765.pdf. Accessed 23 May 2021. 

“List of Medicaid Eligibility Groups.” Medicaid.gov, https://www.medicaid.gov/sites/default/files/2019-12/list-of-eligibility-groups.pdf. Accessed 23 May 2021. 

“Eligibility.” Medicaid.gov,  https://www.medicaid.gov/medicaid/eligibility/index.html. Accessed 23 May 2021. 

“Spousal Impoverishment.” Medicaid.gov, https://www.medicaid.gov/medicaid/eligibility/spousal-impoverishment/index.html. Accessed 23 May 2021. 

“2021 SSI and Spousal Impoverishment Standards.” Medicaid.gov, https://www.medicaid.gov/medicaid/eligibility/downloads/ssi-and-spousal-impoverishment-standards.pdf. Accessed 23 May 2021. 

“Medicaid Payment Policy for Out-of-State Hospital Services.” Medicaid and CHIP Payment Access Commission, Jan. 2020, https://www.macpac.gov/wp-content/uploads/2020/01/Medicaid-Payment-Policy-for-Out-of-State-Hospital-Services.pdf. Accessed 23 May 2021. 

“10 Things to Know about Medicaid: Setting the Facts Straight.” Kaiser Family Foundation, Mar. 2019, https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight. Accessed 23 May 2021. 

“Medicaid Eligibility Through the Medically Needy Pathway.” Kaiser Family Foundation, June 2019, https://www.kff.org/other/state-indicator/medicaid-eligibility-through-the-medically-needy-pathway. Accessed 23 May 2021. 

“Spend Down Procedures.” New York State Department of Education, http://www.oms.nysed.gov/medicaid/resources/medicaid_spend_down.pdf. Accessed 23 May 2021. 

“Access to Long-Term Services and Supports: A 50-State Survey of Medicaid Financial Eligibility Standards.” AARP Public Policy Institute, Sept. 2010, https://assets.aarp.org/rgcenter/ppi/ltc/i44-access-ltss_revised.pdf. Accessed 23 May 2021.

“Home & Community-Based Services 1915(c).” Medicaid.gov, https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c/index.html. Accessed 23 May 2021.

“Home & Community Based Services Authorities.” Medicaid.gov, https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/index.html. Accessed 23 May 2021.

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“Cost Sharing.” Medicaid.gov, https://www.medicaid.gov/medicaid/cost-sharing/index.html. Accessed 24 May 2021.

“Differences Between Medicare and Medicaid.” MedicareInteractive.org, Mar. 2018, https://www.medicareinteractive.org/get-answers/medicare-basics/medicare-coverage-overview/differences-between-medicare-and-medicaid. Accessed 24 May 2021.

“Medicare Coverage for People with Disabilities.” Center for Medicare Advocacy, https://medicareadvocacy.org/medicare-info/medicare-coverage-for-people-with-disabilities/. Accessed 24 May 2021.

“How Medicaid Can Help Seniors Cover the Cost of Assisted Living.” American Council on Aging, Jan. 2021, https://www.medicaidplanningassistance.org/assisted-living. Accessed 24 May 2021.

“How to Receive Financial Compensation via Medicaid to Provide Care for a Loved One.” American Council on Aging, Jan. 2021, https://www.medicaidplanningassistance.org/getting-paid-as-caregiver. Accessed 24 May 2021.

“Self-Directed Services.” Medicaid.gov, https://www.medicaid.gov/medicaid/long-term-services-supports/self-directed-services/index.html. Accessed 24 May 2021.”Medicaid Eligibility Test / Pre-Screen for Long Term Care.” American Council on Aging, Mar. 2021, https://www.medicaidplanningassistance.org/medicaid-eligibility-test. Accessed 24 May 2021.

“Medicaid Eligibility Test / Pre-Screen for Long Term Care.” American Council on Aging, Mar. 2021, https://www.medicaidplanningassistance.org/medicaid-eligibility-test. Accessed 24 May 2021.

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