Introduction: Will Medicaid Pay for Assisted Living?
Assisted living is for seniors and persons with disabilities who require assistance with their daily living activities. This housing option offers an alternative to nursing home care for those who cannot live independently, yet do not require extensive medical care. A type of residential facility, assisted living residences vary. Some offer private or shared apartments, while others provide bedrooms with shared living spaces. Assisted living services commonly include supervision, meals, personal care assistance, homemaker services, and social and recreational activities. Furthermore, some facilities provide “memory care”, which is care specific to persons with Alzheimer’s disease and related dementias.
While an attractive living option for many who require care assistance and / or supervision, paying out of pocket for assisted living is expensive. Per Genworth’s 2024 Cost of Care Survey, the nationwide average cost of assisted living is $5,900 / month, or put differently, $70,800 / year. And memory care is even more costly! According to NIC (National Investment Center) in December of 2023, the average cost of a memory care unit is $7,899 / month, or $94,788 / year. How can families afford this long-term care cost? Does Medicaid pay for assisted living?
The simple answer is “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 financial and functional eligibility requirements, long-term services and supports, such as personal care assistance, homemaker services, emergency response systems, and skilled nursing, may be available. While Medicaid will never pay for room and board, most states try to make this cost affordable for Medicaid beneficiaries. Learn more.
Medicaid Coverage of Assisted Living
While Medicaid will pay for assisted living services and supports (not room and board), the answer to “Will Medicaid pay for assisted living” is more complicated than one might think. 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 Medicaid program within federally set parameters. Furthermore, within each state, there are multiple Medicaid programs with varying pathways towards eligibility.
Most commonly, assisted living benefits are provided via Home and Community Based Services (HCBS) Medicaid Waivers, which limit the number of program participants. Personal care assistance however, may also be available via a state’s Medicaid State Plan / Regular Medicaid program. All states offer Medicaid-funded personal care assistance, but some states offer it only via Regular Medicaid, other states offer it only through HCBS Medicaid Waivers (which potentially could have a waitlist), and yet in other states, it is offerred through both Regular Medicaid and HCBS Waiver(s). Even so, not all states cover personal care services in assisted living residences.
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 provide Medicaid-funded 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 services, and one meets the eligibility criteria, they will receive assistance without being placed on a waiting list.
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) HCBS 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 they 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 never 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 months, or even years. Some states use a “first come, first served” prioritization system, while others are based on need.
Some states require HCBS Waiver participants to receive their benefits via managed care. It is through 1915(b) Waivers that this type of care is authorized. These 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 through which one is enrolled, the assisted living benefits for which Medicaid will pay vary. The following are typical services that are available to persons living in assisted living residences:
• 24/7 Staff Response
• Personal Care Assistance (i.e., dressing, mobility, bathing, toileting, and eating)
• Homemaker Services (i.e., housecleaning, laundry, shopping for essentials such as groceries, and meal preparation)
• Medication Management
• Non-Medical Transportation
• Nursing Services
• Case Management
• Personal Emergency Response Systems
While memory care may provide the same benefits as listed above, specialized care and supports for persons with Alzheimer’s disease and related dementias is specific to memory care. Staff are trained in dementia-specific care and are equipped to handle behaviors commonly associated with dementia (i.e., wandering, confusion, agitation, inappropriate behavior). Memory care units / floors tend to be designed to make navigation easy and decrease confusion. There are also generally safety and security features (to prevent wandering), such as a secure outdoor area, locked entrances and exits, and doorbells that signal when someone enters or exits. Furthermore, activities to stimulate memory / cognitive functioning (i.e., looking at photographs, making art, playing games) are available.
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. Learn more about paying for room and board costs.
Eligibility Requirements for Medicaid Assisted Living
To be eligible for Medicaid-funded assisted living, an applicant must be a resident in the state in which they are applying. They must be residing (or willing to reside) in a “Medicaid certified” assisted living facility. This means that the facility is licensed by the state and accepts Medicaid as payment. An applicant must also meet the financial and functional eligibility criteria for the Medicaid program for which they are applying. General Medicaid criteria relevant for seniors aged 65+ and adults with disabilities follow. Furthermore, for memory care, one must generally be diagnosed with a cognitive impairment. As an example, Washington Medicaid’s Specialized Dementia Care Program requires that applicants be diagnosed with Alzheimer’s disease or another type of irreversible dementia (i.e., Pick’s disease, Lewy body dementia, vascular dementia).
Financial Criteria
Medicaid 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 2025, Medicaid State Plans generally set the income limit for an individual at 100% of the Federal Poverty Level ($1,304.17 / month) or 100% of the Federal Benefit Rate ($967 / month). For HCBS Waiver programs, an applicant’s income is generally limited to 300% of the Federal Benefit Rate (FBR). In 2025, this is $2,901 / 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. There are a variety of planning strategies available to assist one in becoming Medicaid-eligible. However, improperly restructuring finances, such as gifting assets to family members, may be a violation of Medicaid’s Look-Back Period, resulting in a Penalty Period of Medicaid ineligibility. Professional Medicaid Planners can assist in implementing strategies to meet financial eligibility requirements without jeopardizing Medicaid eligibility. Find a Certified 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 memory care, however, one must have a need for specialized dementia care.
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.
It is worth noting that Medicaid-funded assisted living residents’ needs can also exceed the level of care available. This can be a cause for an assisted living eviction.
Which States Cover Assisted Living
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 and Kentucky do not offer Medicaid-funded services in assisted living. Nor does Louisiana Medicaid. However, one residing in an assisted living facility in LA could request Medicaid-funded Home and Community Based Services through the Community Choices Waiver and it would be reviewed on a case-by-case basis. See state-specific Medicaid programs that cover assisted living.
Additionally, not all assisted living facilities offer memory care. According to AHCA (American Health Care Association) / NCAL (National Center for Assisted Living), 18% of assisted living facilities have a floor, wing or unit designated to care specific to Alzheimer’s disease or other dementias. Of this percentage, it is unknown how many are Medicaid certified.
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 one 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.