Will Medicaid pay for assisted living?
Yes, Medicaid may cover some, but not all, of the costs associated with assisted living or long-term care for seniors and people who are disabled and need help with day-to-day tasks.
Depending on the state you live in, additional state funding and Medicare could help fill the gaps not covered by Medicaid.
Propel is the #1-rated EBT balance checking app
Medicaid coverage for assisted living or long-term care#medicaid-coverage-for-assisted-living-or-long-term-care
Medicaid will pay for many of the services associated with assisted living, including nursing and medical care.
However, Medicaid does not cover room and board, which can easily cost as much as $10,000 a month at many assisted living or long-term care facilities.
But many states have additional programs to help cover costs associated with assisted living care. These are often called Home and Community-Based Services (HCBS) waivers or 1915(c) Medicaid waivers, but will vary depending on your state.
HCBS and 1915(c) waivers can cover some or all of the cost of:
- Daily services (bathing, dressing, toileting)
- Medical supplies
- Skilled nursing care
- Mental health services
- In-home nursing or home assistance
- Case management and medication management
- Transportation services
- Senior or drop-off adult care centers
- Caregiver support
Bottom line, Medicaid will cover the nursing and medical treatments associated with assisted living, but it’s unlikely to cover the cost of room and board, which still leaves a lot left to pay for.
Contact your state Medicaid office to learn more about waivers that may help cover the remaining cost of care.
Will Medicare pay for assisted living?#will-medicare-pay-for-assisted-living
Medicare is a federal health insurance program for people 65 and older, as well as those with qualifying disabilities.
Medicare coverage can include medications, preventative care, some home health services, and some qualifying skilled nursing facilities.
Similar to Medicaid, Medicare will not cover the cost of room and board at assisted living facilities. This can be confusing because Medicare covers short-term stays in skilled nursing or rehab after qualifying hospital stays.
However if you qualify for both Medicare and Medicaid, participating in both programs can help you access more care and get more coverage than just Medicare or Medicaid alone.
What Medicaid does (and doesn’t) cover#what-medicaid-does-and-doesnt-cover
Under Medicaid, you won’t pay a monthly premium for coverage, and Medicaid doesn’t pay you directly—instead, it reimburses care providers when you see doctors and other medical providers that accept Medicaid.
You can expect Medicaid to cover the cost of many services, including:
- Hospital stays
- Outpatient doctor visits
- Preventative care
- Prenatal care
- Nursing facility services
- Home health services
- Coverage for children
Depending on your state, you may have small copays for some treatments, including:
- Prescription medications
- Emergency room visits
- Inpatient stays
The cost of a Medicaid copay is capped under federal law, meaning that even when you have to pay them, these copays are likely to be only a few dollars.
