Medicaid's Benefits for Assisted Living Facility Residents

Takeaways

• Nearly all state Medicaid programs will pay for at least some assisted living costs for those who are eligible.

Assisted living facilities are a housing option for people who can still live on their own but who need some assistance with activities of daily living.

Costs can range from $2,000 to more than $6,000 a month, depending on location. (According to 2023 data, the median monthly cost for these types of facilities in the United States is $5,350. For a semi-private room in a nursing home, the monthly median cost currently exceeds $9,000.)

Medicare will not cover this type of care, but Medicaid might. Almost all state Medicaid programs will cover at least some assisted living costs for eligible residents.

What Is Medicaid?

This government assistance program helps low-income individuals, including older adults, pay for their health care. For seniors, it may help cover the costs of services such as long-term care.

Because Medicaid is jointly run by the federal government and state governments, the criteria you must meet to be eligible can differ widely depending on where you live. Other aspects of the program can vary by state as well, such as what benefits are covered and how much the state spends per enrollee.

Medicaid Coverage for Assisted Living Varies by State

Unlike with nursing home stays, there is no requirement that Medicaid pay for assisted living. In addition, no state Medicaid program can pay directly for a Medicaid recipient’s room and board in an assisted living facility. But with assisted living costs roughly half those of a semi-private nursing home room, state officials understand that they can save money by offering financial assistance to seniors who are trying to stay out of nursing homes.

As of 2024, 46 states and the District of Columbia provided some level of financial assistance to individuals in assisted living, according to the website Paying for Senior Care, which features a State by State Guide to Medicaid Coverage for Assisted Living Benefits that gives details on each state’s programs. According to the website, the Medicaid programs in the following states are the only ones that do not provide coverage for assisted living at this time:

• Alabama
• Louisiana
• Pennsylvania
• Virginia

However, non-Medicaid assistance may be available.

Nevertheless, the level and type of support varies widely from state to state. Prevented from paying directly for room and board, some states have devised other strategies to help Medicaid recipients defray the cost of assisted living. This includes capping the amount that facilities accepting Medicaid can charge or offering Medicaid-eligible individuals supplemental assistance for room and board costs paid for out of general state funds.

States typically cover other services provided by assisted living facilities. Depending on the state, these may include:

• coverage of nursing care
• coverage of personal care
• case management
• medication management
• medical assessments and exams

In many states, this coverage is not part of the regular Medicaid program but is delivered under programs that allow the state to waive certain federal rules, such as permitting higher income eligibility thresholds than regular Medicaid does. To qualify for one of these waiver programs, applicants almost always must have care needs equivalent to those of nursing home residents.

Medicaid Waiver Programs May Come With Waiting Lists

Keep in mind that these waiver programs often have a limited number of enrollment slots, meaning that waiting lists are common. In some states, the support programs may cover only certain regions of the state. In addition, one state’s definition of “assisted living” may differ from another’s, or other terms may be used, such as “residential care,” “personal care homes,” “adult foster care,” and “supported living.”

Other Potential Resources

If your state does not cover room and board at an assisted living facility, help may be available through state-funded welfare programs or programs run by religious organizations.

A long-term care insurance policy could also be helpful in covering the costs of certain assisted living expenses if its terms include these types of facilities. Read more about what a good long-term care insurance policy should include in a related article. However, keep in mind that purchasing a long-term care insurance policy does rely on you planning in advance. Waiting until you actually need long-term care to shop around for insurance may be too late – or too expensive.

If the resident is a veteran or the surviving spouse of a veteran, the resident’s long-term care may be covered. (Note that a recently passed law seeks to improve access for veterans to home- and community-based care as well.)

Work With an Elder Law Attorney

To learn more about the options that may be available to you and to determine whether you are eligible for Medicaid, connect with an experienced elder law attorney in your area. They will have an understanding of the ins and outs of navigating the Medicaid program. For instance, they will be able to explain the specific requirements you must meet to qualify for coverage in your state, assist you with applying for Medicaid, and guide you through the often complex rules regarding what Medicaid covers.

They also can advise you on planning strategies, how to choose between different care options, and how to structure your finances to maximize your benefits. With their expertise, you can help ensure that you receive the long-term services and supports that you need while minimizing your financial risk.

For further reading about assisted living facilities as well as other long-term care options, check out the following articles:

• What Are Assisted Living Facilities and What Do They Cost?
• What Is ‘Nursing Home Level of Care’ According to Medicaid?
• States With the Highest and Lowest Assisted Living Costs
• How to Evaluate an Assisted Living Facility
• Skilled Nursing vs. Nursing Homes: What’s the Difference?
• How to Get Medicaid Coverage for Care at Home