Assisted living has become an increasingly popular alternative to nursing care for seniors in the United States. There is a greater degree of autonomy in assisted living than in nursing homes, and the facilities are generally nicer with more amenities. However, for those relying on Medicaid for long-term care assistance, assisted living is not always an option.
Because Medicaid options vary from state to state, and are administered at the state's discretion, the assisted living coverage available varies state to state.
The problem is that it is difficult to discern whether or not a particular state offers Medicaid coverage for assisted living facilities, and even if coverage is available, it might be insufficient for a patient of limited means. Partial coverage, for example, might be offered for certain costs (such as medical treatment) but might also exclude other services (such as room and board).
An assisted living facility is different from a nursing home or skilled nursing facility, so just because a state offers Medicaid coverage for those facilities does not mean assisted living is covered. A nursing home is staffed primarily with nurses and other medical professionals, and is designed for seniors who require around-the-clock medical care.
Assisted living facilities, on the other hand, often have aides rather than nurses, and are designed for practical services rather than medical services. Because they are usually more expensive than nursing facilities, they are often excluded from Medicaid coverage. However, several states do offer limited coverage.
State Medicaid Programs For Assisted Living
Ohio: The Ohio Assisted Living Waiver Program covers the cost of care in assisted living facilities, but leaves the patient responsible for costs associated with room and board. It is available for "certain" Medicaid patients who meet the set criteria.
Texas: Although Texas does not have a waiver for assisted living through Medicaid, it does have a waiver for disabled individuals who require an assisted living environment. Seniors who are also disabled may qualify.
California: The California Department of Health Care Services (DHCS) created the Assisted Living Waiver Pilot Project for those enrolled in Medicaid. The benefits are divided into tiers that go up to $82 per day for each participant.
Maryland: Adults age 50 and older in Maryland may be eligible for the Medicaid Waiver in that state. There is also an Assisted Living Subsidy program for those who do not qualify for the Medicaid coverage.
Vermont: The Choices for Care Medicaid Waiver in Vermont provides assisted living help as well as assistance for those who would rather stay at home and receive respite care.
Even when Medicaid coverage for assisted living is not available, however, many states have additional programs not affiliated with Medicaid that can reduce the costs of these facilities and introduce new options for seniors.
Caregivers should work with their loved ones to develop long-term plans for long-term care. If an assisted living facility seems ideal, you can look up benefits at the Medicare & Medicaid web site to determine where and how you are covered.