Many people who receive Medicaid also face medical challenges that require assisted living care. In some cases, this care can be administered at home, but when someone is in need of around-the-clock care, assisted living outside of the home may be recommended in order to maintain health, monitor conditions during convalescence, and provide comfort for individuals facing end-of-life decisions.

While Medicare Part A helps cover the costs of skilled nursing care, Medicare does not typically cover assisted living care that focuses on custodial care. Custodial care is assistance with the activities of daily living, which can include dressing, bathing, eating, cleaning, and more. Medicaid, on the other hand, may help cover the cost of assisted living.  Because Medicaid is administered differently according to the regulations of each state, where you live may determine what benefits are available to you as a recipient of Medicaid.

The Difference Between a Nursing Home and Assisted Living

Before discussing what Medicaid may pay for when it comes to assisted living, it’s first important to draw a distinction between a skilled nursing facility and assisted living care. A skilled nursing facility is usually a medical facility where the staff are medically trained professionals who specialize in different types of rehabilitative care. Assisted living, on the other hand, is care that is meant to help individuals live a life that is as close to independent as possible.

Skilled nursing care is used for when people are facing serious medical conditions that require care 24 hours a day, usually following a hospital stay. Assisted living care services may only be needed once a day or once per week. Someone who is recovering from a medical condition or who is limited by a medical condition may not require 24-hour care, but they may need help doing things that are considered daily functions like bathing, cooking, cleaning, shopping or housework.

Does Medicaid Pay for Assisted Living?

Although Medicaid may help pay for assisted living, it’s important to understand your coverage details. Medicaid services do not pay for room and board directly for people needing care in an assisted living facility, but some states may provide funds to supplement coverage for room and board. Additionally, waivers may be granted to some Medicaid recipients in order to provide additional state coverage for assisted living that is not covered under federal regulations. States may introduce a limit on how much an assisted living facility can charge in order to bring costs in line with program limitations.

Can Someone Receive Medicare Benefits in Addition to Medicaid Services?

There is a small segment of the population that is able to take advantage of dual-eligibility, meaning these individuals are able to receive Medicare and Medicaid coverage. For dual-eligibles, Medicare’s benefits will typically pay the largest portion, and Medicaid will pick up the remainder. This is the case for dual-eligibles who require skilled nursing care that may be covered by Medicare Part A.  Medicaid may help cover Medicare premiums in dual-eligibility situations, but once again, it all depends on the state in which the recipient resides. In order to qualify for dual-eligible status, certain income restrictions and other financial conditions apply.

Other Ways to Pay For Assisted Living

Aside from benefits programs, there may be additional resources available to help cover the cost of things like room and board in an assisted living facility. Many seniors turn to alternative options when income restrictions prevent them from obtaining certain benefits. A number of religious organizations across the country offer financial assistance to individuals and families who are facing difficult choices regarding assisted living care. Additionally, some medical foundations also provide assistance programs, but there may be stipulations involved in these programs that require recipients to meet unique criteria.

If you’re concerned about the possibility of needing assisted living care in the future, or if you have a loved one who is currently in need of assisted living and has been unable to secure government assistance through healthcare programs, now would be a good idea to discuss your needs with an elder care legal professional. Doing so will help you to understand your legal rights and ensure that you or your loved one are receiving the right level of benefits in your state.

Related articles:

How Medicare Can Help Pay for Care in a Skilled Nursing Facility? 

How to Pay for Nursing Home Care