Introduction – Why It is so Difficult
Trying to find assisted living residences near you that accept Medicaid is so common, yet so challenging. The reasons for this are many and this article will go into them in depth. First, readers should know there is no centralized, national database of assisted living residences that accept Medicaid.
Some, but not all, states have centralized databases of assisted living residences, but those databases are of little use to families searching for Medicaid assisted living for one or usually more of the following reasons.
1) They don’t track Medicaid licensure.
2) They don’t publish that information.
3) They don’t allow users to filter results by forms of payment accepted.
4) They don’t track the number of “beds” allocated to Medicaid.
5) They are not current with the availability of Medicaid “beds”.
6) Medicaid can be used to pay for care in assisted living even if the residence does not accept Medicaid as a form of payment.
No Help from Assisted Living Placement Agencies such as A Place for Mom and Caring.com
Assisted living referral agents, such as A Place for Mom, provide free services to families to help them find assisted living residences. These “placement agencies” are compensated by the assisted living residence when a new resident moves in. However, the assisted living residences will not compensate placement agencies for Medicaid beneficiaries. Therefore, the placement agencies will not help families that are looking to use Medicaid to pay for assisted living.
There are hundreds of websites that offer to help families find assisted living. One will notice most of their forms will ask if the individual intends to use Medicaid or subtle variations on that question like asking their budget or if they will use “public assistance”. Persons hoping to use Medicaid to pay for assisted living are, at best, ignored or worse, their contact information is sold to businesses preying on lower income seniors such as reverse mortgage brokers or credit card debt consolidators. To be clear, not all companies do this, but some do.
Should you call a placement agency to request assistance, you will discover one of their first questions is “Are you planning to use public assistance to pay for assisted living?” or “What is your monthly budget?”. Should you answer these questions with a response that indicates you have a low budget or will be looking for public assistance, you will find the phone representative will be quick to terminate the call.
What You Need to Know Before Your Search for Medicaid Assisted Living
Prior to beginning the labor-intensive search for assisted living residences in which you can use Medicaid, there are 4 things you need to know that will save you significant time and frustration.
1) Medicaid will only pay for care services in assisted living. Medicaid does not pay for room and board (“rent”). A ballpark estimate is 50% of the monthly cost of assisted living (avg. $4,300 / mo. in 2021) is care services and 50% for room and board. More on what Medicaid covers in assisted living.
2) There are different ways to use Medicaid funds in assisted living. Residences either have a direct relationship with Medicaid where the program pays them directly for care or Medicaid pays the beneficiary / resident, and the beneficiary pays the caregiver. This is a very important distinction because if you ask an assisted living residence if they accept Medicaid, they may say “no” but that does not mean you cannot use Medicaid to pay for care while you live in that same assisted living residence. When they say no, it simply means they do not have a direct relationship with Medicaid. In this situation, the Medicaid recipient hires their own outside caregiver (someone is not employed by the assisted living residence) and that caregiver comes to the residence and provides care assistance (such as bathing, grooming and medication management) and the beneficiary pays the caregiver directly.
3) There are different types of Medicaid programs that provide assistance for assisted living. And important nuances within these programs. There are two different types of Medicaid programs that provide financial assistance for personal care in assisted living. These programs offer different benefits, have different limitations, and have different eligibility requirements.
A) Home and Community Based Services Waivers – HCBS Waivers are intended for individuals who have nursing home level care needs. Financial eligibility criteria are similar to the criteria for institutional Medicaid. These criteria are both specific to the state and the waiver. HCBS Waivers are not entitlements and often have wait-lists. More on waivers.
B) “Regular” or Aged, Blind and Disabled Medicaid – This type of Medicaid has very different eligibility criteria than Waivers or Institutional “Nursing Home” Medicaid. Additionally, regular Medicaid is an entitlement. There are never wait-lists. If you qualify, the program must provide benefits.
4) Know whether you or your loved one is currently eligible for Medicaid. And if so, what type of Medicaid? You have a few options to determine eligibility.
How to Find Assisted Living Residences that Accept Medicaid
1. Read “what you need to know” first
2. Determine the type of Medicaid you hope to use (Regular Medicaid or HCBS Waivers) and if that program allows for “consumer direction”.
3. Know that you will have to contact every residence individually and ask them specific questions.
4. Make a list of residences in your area to contact. It is advised that you use Google Search and not an assisted living placement website to develop this list. Google will provide you with a list of assisted living residences in your desired area. The placement websites will eventually provide you with a list but will force you to complete lengthy forms and surrender personal information before they provide the list. Simply search Google for “assisted living + your city” and avoid clicking on the advertisements in the results.
5. Contact Sales or Marketing at each residence ask the following questions.
a. Does your residence have Medicaid beds?
b. If so, how many?
c. Are any of those beds available?
d. If not, is there a wait-list?
e. Can non-residents be on the wait-list or is the wait-list limited to current residents only?
f. Does your residence permit outside caregivers to help residents with their activities of daily living?
6. Refine your list and schedule visits.
Other Important Things to Know When Looking for Medicaid Assisted Living
– While Medicaid will not pay for room and board in assisted living, some states offer non-Medicaid financial assistance to Medicaid beneficiaries to help pay for room and board. This assistance might come from separate programs or might be in the form of increased social security benefits. Typically, if it is an increased SS benefit, that benefit may go directly to the assisted living residence.
– For the exact same care, Medicaid will pay the assisted living residence less than an individual who private pays will be charged. Therefore, private-pay residents are more profitable for the assisted living residence. This impacts Medicaid beneficiaries in many subtle ways through out their assisted living experience.
– There are limited protections for assisted living residents who run out of money while living in the residence. These protections are different in every state. An assisted living contract will explain how they handle this situation, but in short, most residents can expect to be kicked out if they run out of money or if they switch to using Medicaid as a payer.
– It is estimated that 17% of all assisted living residents have some of their daily care costs covered by Medicaid.
– Nursing homes can receive retroactive payments while a resident who is applying for Medicaid is awaiting a designation decision, assisted living residences cannot.