Table of Contents
Does Medicaid Pay for Assisted Living?
Which Services Will Medicaid Cover?
Eligibility Requirements for Medicaid Assisted Living
Which States Cover Assisted Living
State Medicaid Plan / Community First Choice / 1915(i) HCBS
HCBS Medicaid Waivers / 1115 Demonstration Waivers
Does Medicaid Pay for Assisted Living?
Yes, in most states, Medicaid will pay for long-term services and supports in assisted living, including memory care (Alzheimer’s care units). For persons who meet the eligibility requirements, benefits may include personal care assistance, homemaker services, emergency response systems, and skilled nursing. Medicaid, however, will not pay for room and board.
Medicaid is a federal and state health care program, and the available programs, eligibility requirements, and benefits vary from state to state. This is because each state is permitted to operate its program within parameters set by the federal government. Within each state, there are multiple Medicaid programs with varying pathways towards eligibility. Therefore, whether or not Medicaid will pay for assisted living is not as straightforward as one might think.
Most states offer Home and Community Based Services (HCBS) Medicaid Waivers in addition to their Medicaid State Plan / Regular Medicaid program. All states offer Medicaid-funded personal care assistance, but the avenue through which it is available varies. In some states, it is available solely via Regular Medicaid, in other states, it is available only through HCBS Medicaid Waivers, and yet in other states, it is available through both Regular Medicaid and HCBS Waiver(s). Even so, not all states cover personal care services in assisted living residences.
Note: Based on the state, assisted living residences may go by an alternative name. This may include board and care homes, dementia care homes, adult family care, alternative care facilities, and congregate housing.
Regular State Medicaid
Regular State Plan Medicaid is an entitlement program through which a variety of health care benefits mandated by the federal government are provided. For instance, all states are required to pay for nursing home care for all state residents who meet the eligibility requirements. There are also optional benefits, such as State Plan personal care, which are left to the discretion of each state. Since Medicaid State Plan benefits are guaranteed to eligible persons, if a state offers personal care assistance, and one meets the eligibility criteria, they will receive services. There is never a waiting list for assistance.
There are also Medicaid State Plan options through which assisted living services can be provided. Made possible by the Affordable Care Act, a state can implement a 1915(k) Community First Choice (CFC) program. Via CFC, home and community based services are offered, which may include attendant care services in assisted living residences. Another State Plan option, 1915(i) Home and Community Based Services, allows states to offer supportive services for independent living. Like Medicaid State Plan benefits, participant enrollment cannot be capped and geographic location cannot be limited within a state.
Personal care services via Regular State Medicaid / State Plan options may be provided via managed care. This can be authorized through a 1932(a) State Plan Amendment.
HCBS Medicaid Waivers
Most states offer Home and Community Based Services Medicaid Waivers, also called 1915(c) Waivers, which enable persons to continue to live at home or in the community (i.e., assisted living) rather than be placed in a nursing home. Waivers do this by providing services and supports that aid independent living. This might include personal emergency response systems, adult day care, respite care, home modifications for safety and accessibility, personal care assistance, home health aides, meal delivery, and assistance with homemaker tasks.
Seniors and persons with disabilities enrolled in a HCBS Medicaid Waiver can live in a variety of settings and receive Medicaid-funded benefits. While the specific settings differ based on the state and the specific waiver program, potential settings include one’s home, the home of a relative or friend, an adult foster care home / adult family living home, a residential group home, and assisted living.
Differing from the Medicaid State Plan, waivers may not be available statewide and may target specific populations. For instance, Virginia used to offer assisted living services via a HCBS Medicaid Waiver, but only for persons with Alzheimer’s disease and related dementias. Unfortunately, this waiver expired and was not renewed.
Participant enrollment in a HCBS Waiver is not an entitlement. The number of participant enrollment slots are limited, and therefore, a waitlist for assistance may exist. If it does, the wait for benefits can be years. Some states use a “first come, first served” prioritization system, while others are based on need.
Some states require program participants to receive their long-term services and supports via managed care. It is through 1915(b) Waivers that this type of care is authorized. 1915(b) Waivers are combined with 1915(c) Waivers for mandatory managed care home and community based services.
States can also offer HCBS via 1115 Demonstration Waivers, which also may have waitlists for benefits. These benefits may also be provided via managed care. More about HCBS Waivers.
Which Services Will Medicaid Cover?
Based on one’s state of residence and the specific Medicaid program in which one is enrolled, the benefits Medicaid will pay for vary. The following are typical services that are available for persons living in assisted living residences:
• 24/7 Staff Response
• Personal Care Assistance (help with dressing, bathing, toileting, and eating)
• Homemaker Services (housecleaning, laundry, shopping for essentials such as groceries, and meal preparation)
• Medication Management
• Transportation
• Nursing Services
• Case Management
• Personal Emergency Response Systems
While Medicaid will not pay for the room and board portion of assisted living, some states cap this cost for Medicaid beneficiaries. For instance, in Texas, the room and board fee is based on the current SSI rate ($943 / month in 2024) minus a small monthly personal needs allowance ($85 / month in 2024). Therefore, in 2024, the monthly assisted living room and board cost is $858 / month ($943 – $85 = $858).
Furthermore, many states offer an optional SSI State Supplement (OSS). Sometimes called State Supplementary Benefits, this is a cash assistance program that supplements one’s federal SSI payments. It is intended to help cover the cost of one’s basic necessities, such as room and board costs in assisted living. The administering agency differs based on one’s state, but in most states, it is either the Department of Human Services (DHS) or the Social Security Administration (SSA). A list of all local DHS offices should be found on each state’s Medicaid website. Find the SSA office nearest you.
How Much Does Medicaid Pay?
The amount that Medicaid will pay for long-term care services and supports in assisted living depends on a variety of factors. This includes the state in which one resides, the Medicaid program, and one’s level of care need. For instance, it is common for persons who have a greater need for assistance to be allocated a greater number of caregiver hours each month. The number of Medicaid-funded hours covered is generally based on a needs assessment.
Medicaid will not cover the room and board portion of assisted living costs. This is the responsibility of the assisted living resident.
Eligibility Requirements for Medicaid Assisted Living
One must be a resident in the state in which they are applying for Medicaid. They must be residing (or willing to reside) in an assisted living facility that is licensed by the state and accepts Medicaid. These residences are often called “Medicaid certified”. Furthermore, they must meet the financial and functional eligibility criteria for the Medicaid program for which they are applying. The criteria below is relevant for seniors aged 65+ and adults who are disabled.
Financial Criteria
Income and asset limits usually vary based on if a person is applying for State Plan Medicaid versus a HCBS Medicaid Waiver. In most states, the income limit is more restrictive for Medicaid State Plan services than for HCBS Medicaid Waivers. In 2024, Medicaid State Plans generally set the income limit for an individual at 100% of the Federal Poverty Level ($1,255 / month) or 100% of the Federal Benefit Rate ($943 / month). For HCBS Waiver programs, an applicant’s income is generally limited to 300% of the Federal Benefit Rate (FBR). In 2024, this is $2,829 / month. An applicant’s assets are usually limited to $2,000 for both State Plan Medicaid and HCBS Medicaid Waivers. See state-specific eligibility criteria.
Being over the income and/or asset limit(s) is not automatic cause for Medicaid disqualification. Professional Medicaid Planners are available to assist persons in restructuring finances to meet financial eligibility requirements without jeopardizing Medicaid eligibility. Improperly restructuring finances, such as gifting assets to family members, is a violation of Medicaid’s Look-Back Period and results in a Penalty Period of Medicaid ineligibility. It is recommended persons seek the counsel of a Medicaid Planner, as they are very familiar with planning techniques for Medicaid eligibility. Find a experienced Medicaid Planner.
Functional Need
Applicants must have a functional need for Medicaid-funded assisted living services. However, the level of care required varies based on the program.
For assistance via a HCBS Medicaid Waiver, one must require a Nursing Home Level of Care and/or be at risk of institutionalization if not for the program’s benefits. What constitutes a level of care consistent to that which is provided in a nursing home varies by state. Most commonly, the need for personal assistance with Activities of Daily Living (i.e., removing and putting on clothes, cutting up food and getting it one’s mouth, using the toilet and cleaning up after oneself, transitioning from a bed to a chair) is considered. Some programs require a physician statement indicating that personal care services are required. While behavioral and cognitive issues associated with Alzheimer’s disease or related dementias are often considered, a diagnosis of dementia does not mean one will meet automatically meet the functional need for long-term care Medicaid.
For benefits via the 1915(i) Home and Community Based Services State Plan option, applicants must not require a Nursing Home Level of Care. Instead, an applicant must require a lesser level of care than that which is provided in a nursing home.
For personal care assistance via Regular State Plan Medicaid, a Nursing Home Level of Care is not required. Instead, the need for assistance must be medically necessary. See functional eligibility criteria for state-specific Medicaid Programs & Waivers.
Which States Cover Assisted Living
Some states cover long-term services and supports, such as personal care assistance, through their Medicaid State Plan, others via HCBS Waivers, while others utilize both the State Plan and Waivers. Not all assisted living residences in all states accept Medicaid for payment of care services. In some states, assisted living residences may not accept Medicaid at all. For example, Alabama, Kentucky, and Louisiana do not offer Medicaid-funded services in assisted living. Additionally, Illinois Medicaid will not make payments towards the cost of benefits in assisted living residences, but will pay for care services in supported living facilities.
State Medicaid Plan / Community First Choice / 1915(i) HCBS
The following states offer personal care assistance through their Medicaid State Plan. This does not necessarily mean the state will cover personal care assistance in assisted living facilities. Nor does it mean the assisted living residence in which one resides will allow outside assistance (paid for by Medicaid) to enter the residence and provide care.
• Alaska
• Arkansas
• California
• Connecticut
• Delaware
• District of Columbia
• Florida
• Idaho
• Indiana
• Iowa
• Kansas
• Louisiana (does not offer assisted living services)
• Maine
• Maryland
• Massachusetts
• Michigan
• Minnesota
• Missouri
• Montana
• Nebraska
• Nevada
• New Hampshire
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Oklahoma
• Oregon
• Pennsylvania
• Rhode Island
• South Dakota
• Texas
• Utah
• Vermont
• Washington
• West Virginia
• Wisconsin
HCBS Medicaid Waivers / 1115 Demonstration Waivers
The states named below offer care services and supports in assisted living residences via HCBS Medicaid Waivers or 1115 Demonstration Waivers. Waitlists for assistance may exist.
• Alaska (Alaskans Living Independently)
• Arizona (Arizona Long Term Care System)
• Arkansas (Living Choices Assisted Living Waiver)
• California (Assisted Living Waiver)
• Colorado (Elderly, Blind, and Disabled Waiver)
• Connecticut (Connecticut Home Care Program for Elders)
• Delaware (Diamond State Health Plan Plus)
• District of Columbia (Elderly and Persons with Physical Disabilities Waiver)
• Florida (Statewide Medicaid Managed Care Long-term Care)
• Georgia (1. CCSP 2. SOURCE)
• Hawaii (QUEST Integration Program)
• Idaho (Aged and Disabled Waiver)
• Illinois – not for assisted living, but for supportive living facilities (1. Supportive Living Program 2. MLTSS 3. MMAI)
• Indiana (Pathways for Aging)
• Iowa (Elderly Waiver)
• Kansas (Frail Elderly Waiver)
• Maryland (1. Home and Community Based Options Waiver 2. Increased Community Services Program)
• Massachusetts (Moving Forward Plan – Residential Supports Waiver)
• Michigan (MI Choice Waiver)
• Minnesota (Elderly Waiver)
• Mississippi (Assisted Living Waiver)
• Montana (Big Sky Waiver)
• Nebraska (Aged and Disabled Waiver)
• Nevada (Frail Elderly Waiver)
• New Hampshire (Choices for Independence Waiver)
• New Jersey (Medicaid Managed Long Term Services and Supports)
• New Mexico (Community Benefit Program)
• New York (Assisted Living Program)
• North Dakota (Home and Community Based Services Waiver)
• Ohio (Assisted Living Waiver)
• Oklahoma (ADvantage Waiver Program)
• Pennsylvania (Community HealthChoices Program)
• Rhode Island (Medicaid Long-Term Services and Supports)
• South Carolina (Community Choices Waiver)
• South Dakota (HOPE Waiver)
• Tennessee (CHOICES in Long-Term Supports and Services)
• Texas (STAR+PLUS HCBS)
• Utah (New Choices Waiver)
• Vermont (Choices for Care)
• Washington (COPES Waiver)
• Wisconsin (1. Family Care & Family Care Partnership Programs 2. IRIS Waiver)
• Wyoming (Community Choices Waiver)
Which Assisted Living Residences Accept Medicaid?
Not all assisted living residences accept Medicaid. When choosing a residence, it is important that one ensures that this form of payment is accepted. Furthermore, “Medicaid certified” assisted living residences limit the number of beds for Medicaid-funded residents. In other words, an open bed in the residence does not necessarily mean a Medicaid-funded person can become a resident.
In some cases, even if the residence does not accept Medicaid, or does not have a Medicaid bed available, the facility may allow third party caregivers to provide assistance for their residents. Medicaid would pay the third party caregiver (someone who does not work for the assisted living residence). If considering this option, ask the assisted living residence if they accept outside caregivers.
Unfortunately, there is no nationwide searchable database for Medicaid certified assisted living residences. To find an assisted living residence in your area that accepts Medicaid and has an available bed, contact your local Area Agency on Aging (AAA) office. Most AAA’s keep a list of facilities in their area that accept Medicaid, and if they don’t, they often can direct one to a searchable state database. Learn more about finding assisted living residences that accept Medicaid.
Next Steps
- Take a Medicaid Pre-Screen Test to determine if the candidate might be automatically eligible for Medicaid.
- Discuss the feasibility of using Medicaid as a payment source with a Medicaid Planning Professional. While many Medicaid beneficiaries do receive help in assisted living, many others encounter obstacles that prevent them from doing so.
- Contact current or potential assisted living residences and inquire if they 1) accept Medicaid and have Medicaid “beds” available or 2) allow outside (third party) caregivers to provide assistance for their residents.