How Long Does Medicaid Pay for Assisted Living?

How long Medicaid pays for assisted living services varies by state, as the program is a joint federal and state collaboration. It also depends on your needs and the policies of the state program. Medicaid doesn’t usually cover room and board in assisted living facilities, but it may cover personal care and some health care services. Supplemental Security Income can step in where Medicaid falls short, and you may need to utilize other payment options for assisted living if coverage ends.

Some states have waivers or specific programs that pay for assisted living services if you’re eligible. Contact your state’s Medicaid office to get information on coverage and duration. Your local Home and Community Based Services office also has details on specific programs. Just remember, Medicaid operates on the assumption your medical condition will improve, so ongoing coverage requires a designation of services received in assisted living being a qualified medical expense.

The basic services covered by Medicaid include personal care with activities of daily living (ADL’s), housekeeping and meal prep, transportation to and from medical appointments, case management and connection to a personal emergency response system.

To be eligible for Medicaid assistance for long-term care, you need to be a U.S. citizen aged 65 or older. Additionally, you must satisfy the income criteria set for traditional Medicaid recipients. Each state offers a waiver, such as a supplement to the basic Medicaid coverage, but there is often a waiting list to receive benefits.

Long-term care coverage also requires meeting specific care criteria, as determined by your state. This typically involves a qualified professional medical evaluation of functional, cognitive and medical capabilities, which will guarantee services in your assisted living facility, thereby ensuring Medicaid coverage.