Does Medicaid Pay for Assisted Living?
Key takeaways:
Assisted living facilities help older adults and people with disabilities maintain their independence while offering support with daily tasks. These facilities offer a less expensive and less intensive care option compared with nursing homes, typically costing around $5,000 per month.
If you have Medicaid, you may receive coverage for certain assisted living support services, such as medication management. However, Medicaid does not pay for room and board.
Medicaid coverage for assisted living varies from state to state. Check your state’s policies to see if your state offers a Medicaid waiver to help you cover the cost of assisted living support services.
Table of contents
As we age, maintaining independence and avoiding isolation become top priorities. Nearly 1 in 3 U.S. adults age 60 and older live alone. However, this isn't the ideal situation for everyone. If you find yourself needing help with daily activities such as bathing or dressing, you might consider the option of an assisted living facility. This could be the right care option for you if you want to remain independent but do not require the constant care provided in a nursing home.
Although assisted living facilities are generally more affordable than nursing homes, they can still be a significant financial burden, especially if you have a lower income. Assisted living can cost over $5,000 per month, depending on your geographic location, type of accommodation, and other factors.
If you qualify for Medicaid, you may be able to get help paying for some of the costs associated with assisted living. While Medicaid does not pay for room and board, you may be eligible for a Medicaid waiver to help cover additional services.
What is assisted living?
More than 800,000 older adults in the U.S. stay in assisted living facilities to get help with activities of daily living, such as eating and bathing. These community-based support facilities may also provide help with medication and services such as light housekeeping and laundry.
Assisted living facilities vary in size and service offerings. You may have the choice of an assisted living apartment, shared room, or private room in an assisted living building. The type of assisted living facility you choose will impact your monthly costs.
Although many people think of nursing homes and assisted living facilities as being the same, these two residential care facilities offer different types of support and care. If you need more intensive medical care and around-the-clock monitoring, you’ll need to look into a nursing home. Assisted living facilities are not designed to provide 24/7 monitoring and care. These facilities are ideal for someone who needs limited nursing assistance and desires more social interaction.
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Does Medicaid cover assisted living?
Yes. Medicaid may pay for some assisted living costs, depending on the state you live in and the level of care you need. Some states offer home and community-based services (HCBS) waivers to provide funding for services that allow you to live in a community setting, such as an assisted living facility, rather than in an institution. About 1 in 5 assisted living residents rely on Medicaid to pay for their daily services, according to the National Center for Assisted Living (NCAL).
However, Medicaid does not cover costs for room and board in assisted living. These costs can vary significantly from state to state, but the national median cost for assisted living is $5,350 per month, or about $64,200 per year. Many residents pay for some or all of these expenses out of pocket through retirement savings or assistance from family members.
What assisted living costs are covered by Medicaid?
If your state offers Medicaid waivers, you may receive help paying for the following care-related services in an assisted living facility.
1. Personal care assistance
These services typically include support with daily activities, such as:
Bathing or showering
Dressing and undressing
Eating
Moving in and out of bed, a chair, or the shower
Getting on and off the toilet
Bathing is the most common activity of daily living for which people require assistance, with more than 6 in 10 residents needing help.
2. Homemaker services
These services help residents live more independently and comfortably without worrying about doing routine chores. Medicaid may cover services such as laundry, light housekeeping, and meal preparation to help residents maintain a clean and safe living environment.
3. Transportation
If you have medical appointments, Medicaid may pay for transportation to and from your medical team’s office. Medicaid may also cover other necessary travel arrangements, depending on your situation.
4. Case management and care coordination
If you need help navigating your healthcare needs, a case manager or care coordinator may be able to help. Medicaid may pay for services related to working with professionals to develop your personalized care plan, coordinate services with different providers, and monitor your health conditions. Many assisted living communities serve older adults with the following conditions:
5. Personal emergency response systems
If you are living independently, personal emergency response systems can provide a quick and easy way to call for help. These devices are designed to alert emergency services in case of an urgent medical need.
Since state Medicaid programs vary in coverage, it’s important to contact your state’s office to find out what assisted living services are covered.
How Medicaid waivers work
Medicaid HCBS waivers provide resources for individuals in need of substantial care — typically seniors, those with disabilities, or people with chronic health issues. For example, some states limit waivers to people with a certain medical condition, such as schizophrenia, or those with intellectual disabilities. Some common conditions for HCBS beneficiaries include:
If you're someone who needs the kind of support provided in nursing homes but prefers a less institutional, more home-like setting, these waivers could be an option for you. Eligibility requirements and coverage vary by state, so you’ll need to contact your local Medicaid office for more details. Illinois, for example, offers nine HCBS waivers, including the Persons who are Elderly waiver. To be eligible for the waiver, you must meet certain requirements, including being:
Over age 59
Medicaid-eligible
At risk of nursing home placement
Able to be safely maintained in the community-based setting with the services provided in the plan of care
A resident of Illinois
It's important to note that access to the HCBS waiver program isn't guaranteed. Each state has a limited number of spots, and it's common for applicants to be placed on a waiting list. Make sure to verify your eligibility before applying.
Medicaid coverage variations from state to state
Medicaid policies for assisted living vary by state. While some states may offer comprehensive support for services in assisted living facilities, others might limit coverage to specific care-related areas. This means Medicaid's help with assisted living costs can be more or less, depending on the state. To understand how Medicaid can support assisted living costs in your state, consider the following steps:
Contact your state's Medicaid office for the most current and accurate information.
Explore Medicaid waivers available in your state that might cover assisted living services.
Review the eligibility criteria for Medicaid and any specific waivers, including income limits and care requirements.
While Medicaid can significantly offset the cost of personal care and supportive services within assisted living communities, it is important to remember that room and board expenses are not covered. These costs are the resident's responsibility and are billed separately from covered care-related services.
Other ways to pay for assisted living
Assisting living costs can add up to thousands of dollars per month. If you don’t qualify for Medicaid or you need additional help paying for assisted living costs, here are some options to consider:
In addition, many states provide an optional Supplemental Security Income (SSI) Optional State Supplement (OSS). This cash assistance program assists with room and board expenses for assisted living facilities, supplementing the federal SSI payments recipients already receive.
The bottom line
Assisted living can cost over $5,000 per month, depending on where you live, the facility you choose, and other factors. Although Medicaid does not cover room and board, the program may cover certain services, such as memory care or skilled nursing. Since Medicaid coverage varies by state, it’s important to review your plan details and contact your state agency to determine what’s covered.
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References
Administration for Community Living. (2020). Activities of daily living (ADLs). Long-term Care (LTC) Glossary.
American Council on Aging. (2022). Medicaid home & community based services (HCBS): Programs & waivers by state.
AssistedLiving.org. (2023). What is a Medicaid waiver? Your guide to Medicaid home and community-based services.
Ausubel, J. (2020). Older people are more likely to live alone in the U.S. than elsewhere in the world. Pew Research Center.
Centers for Medicare & Medicaid Services. (n.d.). Home & community-based services.
Illinois Department of Healthcare and Family Services. (n.d.). Home and community based services waiver programs.
Illinois Department of Healthcare and Family Services. (n.d.). Illinois persons who are elderly waiver.
Medicaid and CHIP Payment and Access Commission. (2018). Medicaid home- and community-based services: Characteristics and spending of high-cost users.
National Council on Aging. (2024). Does Medicaid pay for independent living?
American Health Care Association-National Center for Assisted Living. (n.d.). Facts & figures.
Social Security Administration. (2024). General Information about state supplementation.
U.S. Department of Veteran Affairs. (2022). VA nursing homes, assisted living, and home health care.
