Medicaid and Medicare Assisted Living Coverage

Does Medicare Cover Assisted Living?

While Medicare doesn’t cover rent at an assisted living facility (ALF) or help with activities of daily living (ADLs) provided in the facility, you can still use Medicare for covered medical expenses at an assisted living facility. It's no different than using Medicare for medical services at a doctor’s office or hospital.

You may even be able to use Medicare Part A and Part B for covered home health services while living in an assisted living facility.

Covered home health services include1:

• Physical therapy
• Occupational therapy
• Speech therapy
• Medical social services
• Part-time home health aid services (only if skilled nursing care is given at the same time)
• Occasional skilled nursing care
• Injectable osteoporosis drugs for women
• Durable medical equipment

Only those with Medicare Part A or Part B who are homebound, under the care of a doctor who’s overseeing your plan of care, and who need one of the services outlined above are eligible for assisted living coverage. Visit Medicare’s website for more eligibility criteria.

Does Medicaid Cover Assisted Living?

Those with Medicaid coverage might have better luck finding financial assistance, depending on where you live. Medicaid coverage for assisted living varies by state because Medicaid is jointly funded by the state and the federal government. Currently, the majority of the 50 states offer some sort of financial assistance through Medicaid for assisted living services.

Assisted Living Services Covered by Medicaid

While each state covers specific services, what that coverage looks like is entirely dependent on the state itself. Typically, states cover nursing and personal care services either in the senior’s home or in an assisted living facility.

Some states enact restrictions, so you’ll want to read your state’s policies fine print carefully. For example, Ohio only offers a limited number of slots, making coverage competitive while Maine’s Medicaid programs provide services to seniors living at home, but not to those who live in assisted living facilities.

Legally, states cannot use Medicaid funds to cover assisted living room and board, which is why you’ll need to use other funds to pay for your housing and your food at an assisted living facility.

Some states use non-Medicaid programs to help older adults with these costs. For example, in Rhode Island, qualifying seniors can receive Supplemental Security Income (SSI) for assisted living costs through the state’s SSI Enhanced Assisted Living program.2

States with Little to No Medicaid Assisted Living Coverage

The following states offer minimal or no Medicaid coverage for assisted living or assisted living services:

• Alabama
• Louisiana
• Pennsylvania
• Virginia
• Kentucky
• New York

If you live in one of the above states, check the state’s website to see if they offer other financial assistance programs.

How Do I Find Assisted Living That Accepts Medicaid Near Me?

Even if you live in a state where Medicaid covers assisted living, an assisted living facility can decide not to take Medicaid.

Here are a few ways you can find covered assisted living facilities:

1. Call Assisted Living Facilities Directly

Do you already have an assisted living community in mind? Give them a call to see if they accept Medicaid. If they don’t, you may want to have a couple of other options to consider. Assisted living can be expensive, so finding a location that takes Medicaid insurance is a priority for many seniors. On the other hand, if you have other means of paying for assisted living (which we will cover later), this may not be a major concern.

2. Visit Your State’s Medicaid Website

Log into your online Medicaid portal or visit your state’s Medicaid website. From there, you can speak with a customer service representative to ask about local services. You might also be able to search on the website for a list of providers that accept Medicaid.

3. Use Our Find Senior Housing Tool

Our senior housing tool makes it easy to find nearby assisted living facilities. Just input your ZIP code, and we’ll filter out the results by payment method to ensure you’ll get a list of nearby assisted living facilities that accept Medicaid. From there, seniors can learn about the different facilities, compare their features and costs, and set up some phone calls or visits if one catches your interest. Talk about simple!

How Can I Pay for Assisted Living?

No luck with Medicaid? There are other ways to pay for an assisted living facility or in-home services you need. Before deciding how to pay, carefully review your personal finances, determine if your family can assist, and weigh the pros and cons. To help, we’ll briefly touch on some popular ways that older adults and their loved ones pay for care.

Long-Term Care Insurance

Long-term care (LTC) insurance is a policy that covers expenses like staying in a nursing home, home health care, or even assisted living. What’s tricky with long-term care insurance, though, is that you need to purchase it before you plan on using it. If you already have a disability or need help with ADLs, it’s likely too late to buy a policy.

Consider these pros and cons when thinking about LTC insurance:

Before deciding to purchase an LTC insurance policy, be sure to do your research, and check what services are covered. For example, many policies only cover assisted living care if you physically live in a facility; they do not cover in-home assisted living services. If navigating insurance seems daunting, don’t be afraid to ask your trusted loved ones for help.

Pay Out of Pocket

Seniors or their families often pay for assisted living costs out of pocket, especially for home-based care. That doesn’t mean you have to drain your savings, though. Families often use a mix of personal savings, retirement accounts, annuities, Social Security payments, and pensions. Some older adults sell their homes and use the profits to move into an assisted living facility.

Here are some pros and cons to consider:

Before choosing to pay out-of-pocket, check with your state to see if you’re eligible for Medicaid and if that would help with coverage. You should also carefully review your finances, talk to your family, and create a budget. You’ll want to choose service providers that you can afford long-term if you think you’ll need ongoing care.

Veteran’s Benefits

Are you a veteran or married to a veteran? If so, call the Department of Veterans Affairs (VA) or visit a nearby VA medical center to learn about senior living options for veterans. The VA won’t cover room and board at an assisted living facility, but they might pay for extra services like nurse visits within the facility.4

Consider these pros and cons: