Are Assisted Living Costs Considered Medical Costs for Medicaid Application?

Some assisted living costs are considered medical costs for Medicaid applications, depending on the state, while other costs aren’t. For example, Medicaid doesn’t cover room and board, although many states offer waiver programs to help pay for long-term care services, including those offered in assisted living, to delay or prevent seniors from moving to a nursing home.

Individuals must meet certain income requirements and demonstrate the need for a level of care aligning with the state’s eligibility requirements to receive the waiver. Because states operate their own Medicaid programs, covered services vary depending on place of residency.

Medicaid covers assisted living services based on each state’s rules and regulations, but it often pays for assistance with daily living activities, including dressing, bathing or grooming. Ultimately, Medicaid serves as health insurance and covers most health care costs. Since some assisted living communities offer limited medical care, Medicaid benefits extend to services including:

• Physical, occupational or speech therapy
• Medication management
• Prescription drugs
• Hearing aids and eyeglasses
• Home health services
• Hospitalization and skilled nursing care co-pays not covered by Medicare

Not all assisted living facilities accept Medicaid, and many that do only accept a certain number of residents using benefits. Some facilities choose not to participate in the program due to administrative requirements or reimbursement rates but accept other forms of financial assistance. Contact your local Area Agency on Aging to determine which facilities accept Medicaid. Additionally, ask facilities about payment policies, including whether they accept Medicaid and what services are covered, when researching options.