Overview of Assisted Living
Assisted living provides residential care for seniors who aim to live independently but require help with daily tasks such as household chores, medication management, meal preparation, and activities of daily living (ADLs) like bathing, dressing, or transferring. Those needing extensive help or skilled medical care might need nursing home care instead. The Genworth Cost of Care Survey found that the national median cost for a private one-bedroom unit in an assisted living community was about $5,350 per month in 2023, while Seniorliving.org estimated the median cost of assisted living in the U.S. to be $5,511 per month, as of 2024, making it financially challenging for many seniors and their families.
Medicaid Coverage in Assisted Living
Medicaid offers some financial assistance for assisted living, but coverage varies by state. Generally, Medicaid does not cover room and board costs in assisted living facilities as it does in nursing homes. Instead, Medicaid helps with specific personal care services. The fundamental services that Medicaid programs typically cover in an assisted living facility include:
- Personal Care Services: Helping with ADLs such as bathing, dressing, and mobility.
- Homemaker Services: Help with meal preparation, laundry, and light housekeeping.
- Case Management: Coordination of care and services.
- Transportation: Rides to medical appointments and other necessary travel.
- Personal Emergency Response Systems: Devices and systems to alert emergency services.
If a state’s Medicaid program does not offer financial assistance with residential assisted living, seniors might find comparable personal care options through Medicaid waiver programs, which support in-home care and adult day care to help seniors avoid nursing home placement. However, these programs often have enrollment caps and waiting lists.
Medicaid and Dementia Care
Medicaid can assist seniors with dementia in paying for assisted living, but eligibility is not automatic. State functional assessments, which determine Medicaid eligibility, might not fully account for cognitive impairments from dementia. These assessments often emphasize physical impairments, potentially overlooking the need for verbal cues and monitoring.
Eligibility and Application Process for Medicaid-Covered Assisted Living
To qualify for Medicaid-covered assisted living, seniors must meet strict financial and functional criteria, which vary by state. Key factors include the type of care required, medical diagnosis, residence, and marital status. A doctor must certify that assisted living is “medically necessary” for the senior.
Seniors typically need to spend down their countable assets and income to meet eligibility requirements, often paying out of pocket until they qualify. Funding sources for assisted living costs include savings, Social Security benefits, pension payments, and retirement funds. Medicaid’s “look-back period” reviews financial history to prevent asset transfers intended to qualify for benefits, with penalties for such actions within five years of applying.
Given the complexity of Medicaid planning, working with an elder law or Medicaid planning attorney is advisable to avoid costly mistakes and ensure a successful application.
Finding Assisted Living That Accepts Medicaid
Finding Medicaid-certified assisted living facilities can be challenging due to low reimbursement rates and limited availability. Just under half of all assisted living communities are Medicaid-certified. Contacting the nearest Area Agency on Aging can be a helpful first step. Understanding different terms for assisted living in your state (e.g., adult foster care, board and care homes, memory care facilities) can also ease the search.
A Senior Living Advisor from services like A Place for Mom can provide additional guidance on available options.
Paying for Room and Board in Assisted Living
Since Medicaid only covers seniors with limited financial resources, paying for room and board in assisted living can be difficult. Some states limit how much assisted living facilities can charge Medicaid beneficiaries, often aligning costs with federal Supplemental Security Income (SSI) benefits. In 2024, the maximum monthly SSI payment is $943 for an individual. SSI provides monthly payments to people with disabilities and older adults who have little or no income or resources. In the alternative, the estimated average monthly Social Security retirement benefit for January 2024 is $1,907.
To further assist, some states offer optional supplements to federal SSI payments, which vary based on living arrangements. Veterans and surviving spouses might also qualify for VA pensions to help cover long-term care costs.
Comparing Medicaid and Medicare in Assisted Living
Medicare does not cover assisted living or other long-term care costs, making Medicaid the primary public funding source for these services. However, Medicare remains crucial for medical services within an assisted living community. Seniors with both Medicare and Medicaid (dually eligible) have Medicare paying first for covered services, with Medicaid covering remaining eligible costs.
Understanding these distinctions and the specific benefits and limitations of Medicaid can help seniors and their families navigate the complexities of financing assisted living care.
The foregoing is a brief and general overview of the topic.
If you have any additional Questions regarding the foregoing or have any legal issue or concern, please contact the law firm of CASERTA & SPIRITI in Miami Lakes, Florida.
