In 2019, 44 states and Washington DC offer some level of assistance for individuals in assisted living or other forms of non-nursing home, residential care through their Medicaid programs.
Medicaid assistance for assisted living changes by state. This is because Medicaid is partly funded by the federal government and partly by the states. The federal government sets guidelines on how each state must spend their Medicaid dollars. But the states are permitted considerable latitude within those guidelines. This allows states to set their own policies on how they assist persons residing in assisted living residences.
Adding to this complexity is the fact that there are many types of Medicaid programs that pay for services in assisted living. Most commonly, states use 1915c Medicaid HCBS Waivers (Home and Community Based Services). Other types of waivers employed are 1115 Demonstration Waivers and 1915b Managed Care Waivers. However, the types of waivers are simply names with which family members need not concern themselves. Finally, regular Medicaid (sometimes called State Plan Medicaid) is also used in some states for assisted living services.
From the family’s perspective, there are pros and cons to each of these Medicaid options. Waivers usually allow participants to have higher income eligibility limits than regular / State Plan Medicaid. In 2019, most waivers allow monthly income limits of $2,313 while Medicaid State Plans may limit income to $771 / month. Note that these are very general numbers, and they vary by state, marital status and with other factors. It is recommended families review their state specific information in the table below. Waivers are almost always enrollment capped. They have a limited number of “slots” available and waiting lists are common. Regular / State Plan Medicaid is an entitlement, so these programs cannot limit enrollment. Finally, in most states Waivers require the participant to have “nursing home level of care needs”. Regular Medicaid can be less restrictive with the care requirements of program participants.
Forty-four states and the District of Columbia now provide some level of financial assistance to individuals in assisted living. However, the term “assisted living” is not used consistently across these states, nor are their definitions or benefits the same. Other terms which are used include: residential care, adult foster care, personal care homes, and supported living to name a few. Some states pay only for personal care services received in assisted living. Others include nursing services. Coverage for medication administration, chore and homemaker services, and even recreational activities, varies by state. No state is permitted to pay for room and board costs in assisted living. But states have other means of controlling these costs. They can:
It is important to recognize that Medicaid may not be the best source of funding for assisted living for every family. As Medicaid payment rates for assisted living (in Medicaid language called “reimbursement rates”) are not high, not every assisted living community accepts Medicaid. Also, given the limited range of services for which Medicaid provides assistance and the enrollment caps and waiting lists for Medicaid waivers, many families might benefit by finding affordable assisted living outside of the Medicaid system.
2019 State Medicaid Assisted Living Benefits
|State||Medicaid Policies and Programs for Assisted Living||Other Options for Residents|
|Alabama||Alabama has several Medicaid programs that help individuals remain living in their homes, but does not currently provide assistance for those in assisted living.||Other Financial Assistance Affordable Care Options|
|Alaska||The state of Alaska will pay for assisted living or “Residential Supported Living Services” through the Alaskans Living Independently Waiver, as well as Adults with Physical Disabilities Waiver. Enrollment may be capped, and therefore, waiting lists for services may exist.||Other Financial Assistance
Affordable Care Options
Pioneer Homes (State subsidized assisted living)
|Arizona||Arizona, through the Arizona Long Term Care System (ALTCS) will pay for services for individuals residing in an assisted living community, provided there is space available in the program. Self Directed Attendant Care offers ALTCS program participants the option to choose their own care providers||Other Financial Assistance Affordable Care Options|
|Arkansas||Arkansas now offers two options that help pay for assisted living for Medicaid beneficiaries. The specifically designed Living Choices Assisted Living Waiver is a great option. Personal Care under the state’s regular Medicaid program can be provided to assisted living residents, and via this program, program participants can self-direct their own care through the Independent Choices Program.||Other Financial Assistance Affordable Care Options|
|California||Medi-Cal (California Medicaid) pays for assisted living via the Assisted Living Waiver (ALW). This waiver is not available statewide, and as of 2019, assisted living residences are available in only 15 counties. However, persons not living in those counties can choose assisted living residences in those counties.||Other Financial Assistance Affordable Care Options|
|Colorado||Colorado has an Elderly, Blind and Disabled Waiver (EBD) that allows program participants to receive care services in an assisted living residence. Be aware that assisted living is referred to alternative care facilities. Via the Consumer Directed Attendant Support Services (CDASS) option, EBD program participants can choose and hire their own care providers.||Other Financial Assistance
Affordable Care Options
Old Age Pension CO Adult Foster Care
|Connecticut||Medicaid in CT pays for care in assisted living (which it calls congregate housing) through the Home Care Program for the Elderly (CHCPE). The Connecticut Assisted Living Program further explains the assisted living services under CHCPE. Adult Family Living is another option, although it is analogous to adult foster care, not assisted living.||Other Financial Assistance
Affordable Care Options
Congregate Housing Services Program
Adult Family Living
|Delaware||Through the Diamond State Health Plan Plus program Delaware provides assistance to individuals in assisted living.||Other Financial Assistance Affordable Care Options|
|D.C.||The District of Columbia Medicaid program offers the Elderly and Persons with Disabilities Waiver which now covers assisted living in limited situations.||Other Financial Assistance Affordable Care Options|
|Florida||Florida has eliminated its HCBS Waivers and now covers assisted living through the Statewide Managed Medicaid Care – Long Term Care.||Other Financial Assistance
Affordable Care Options
Optional State Supplementation
Alzheimer’s Disease Initiative
|Georgia||Under Georgia’s Community Care Services Program, assisted living services, also referred to as alternative living services, are provided. The Georgia SOURCE Waiver also includes this benefit||Other Financial Assistance Affordable Care Options|
|Hawaii||Hawaii offers Med-QUEST (Medicaid managed care), which will pay for an individual’s nursing services in assisted living residences. Another option is Adult Foster Care which provides assisted living type services in small home-like environments.||Other Financial Assistance Affordable Care Options Kupuna CareCommunity Care Foster Family Home|
|Idaho||Idaho Medicaid provides three programs that pay for participants’ personal care regardless of the location in which they reside (at home or in assisted living) provided they do not live in a nursing home. These programs are the HCBS Aged & Disabled Waiver, Personal Care Services Program and the Idaho Medicare Medicaid Coordinated Plan.||Other Financial Assistance Affordable Care Options|
|Illinois||Illinois offers the HCBS Waiver for Supportive Living Facilities. While there is an enrollment cap on the program, the state does offer a large number of slots and has many more residences under development.||Other Financial Assistance Affordable Care Options|
|Indiana||Indiana includes assisted living as a benefit under its Aged and Disabled Waiver (A&D) provided participants reside in Medicaid approved assisted living communities. The waiver also offers an alternative to assisted living called Structured Family Caregiving.||Other Financial Assistance Affordable Care Options Residential Care Assistance Program|
|Iowa||Iowa allows residents to consumer direct their attendant care. Attendant or personal care can be provided at home or in assisted living. The HCBS Elderly Waiver is the name of the program that provides funding. Another option for adults under 65 is the Health and Disability Waiver.||Other Financial Assistance Affordable Care Options|
|Kansas||Medicaid in Kansas (KanCare) offers payment for nursing services regardless of the location in which an individual resides, be that at home or in assisted living. Funding is provided by the HCBS/ FE Waiver.||Other Financial Assistance Affordable Care Options Senior Care Act|
|Kentucky||Kentucky Medicaid has the Supports for Community Living Waiver, which covers adult foster care. However, it is not available to most seniors as it is for persons whose intellectual or developmental challenges developed prior to the age of 22.||Other Financial Assistance Affordable Care Options|
|Louisiana||Louisiana Medicaid does not currently provide assistance to individuals to help with the cost of assisted living. However, under the Community Choices Waiver, there is a benefit called Monitored In-Home Caregiving, which is similar to adult foster care.||Other Financial Assistance Affordable Care Options Permanent Supportive Housing|
|Maine||MaineCare (Medicaid’s name in Maine) offers two Medicaid programs that help persons remain living in their homes, but does not currently provide assistance for those residing in assisted living facilities.||Other Financial Assistance Affordable Care Options|
|Maryland||For Medicaid (called Medical Assistance in Maryland) eligible individuals who are assessed as requiring a higher level of care, but do not have a need so great that it would be less expensive for them to live in nursing home, Maryland Medicaid will pay for assisted living under the Community Options Waiver (formerly the Waiver for Older Adults). Another option with different eligibility criteria is the Increased Community Services (ICS) Program. Finally, Community First Choice, under the state Medicaid plan, will provide care services in assisted living.||Other Financial Assistance Affordable Care Options Assisted Living Subsidy Congregate Housing|
|Massachusetts||In Massachusetts, Medicaid is called MassHealth. MassHealth pays for personal care for individuals living in assisted living through the Personal Care Attendant program. Massachusetts also has a program called Caregiver Homes in which participants receive a similar level of 24/7 care as they do in assisted living but instead live in the private homes of caregivers. Finally, Group Adult Foster Care covers personal care but not rent.||Other Financial Assistance Affordable Care Options Supportive Senior Housing Initiative|
|Michigan||Through the Michigan Choice Waiver Program, the state will pay for assisted living. However, the state may refer to it as adult foster care or homes for the aged. Another option is Health Link.||Other Financial Assistance Affordable Care Options|
|Minnesota||Minnesota pays for assisted living through the Medicaid Waiver called the Elderly Waiver. As with most waivers, participation is limited. A second option is the Community Access for Disability Inclusion (CADI) Waiver. A third option is the state’s Medicaid managed care program called MSC+ & MSHO is available via all programs above.||Other Financial Assistance Affordable Care Options Housing Support Program|
|Mississippi||Mississippi has a Medicaid Waiver specifically designed to help individuals reside in assisted living residences. Read more about the Assisted Living Waiver.||Other Financial Assistance Affordable Care Options Group Residential Housing|
|Missouri||Missouri Medicaid covers the cost of personal care for qualified individuals through its Aged and Disabled Waiver. The waiver does not specifically designate the residential location of the care recipient other than to exclude personal care from being provided in a nursing home. The same rules apply to the State Plan Personal Care option. The Supplemental Nursing Care Assistance Program also offer financial assistance for both assisted living and nursing home care. Finally, Medicaid Care Options provides long-term care services in assisted living.||Other Financial Assistance Affordable Care Options|
|Montana||The Montana Home and Community Based Services Medicaid Waiver will cover the cost of care services in assisted living for its participants. Note that this waiver refers to assisted living as Adult Residential Living.||Other Financial Assistance Affordable Care Options|
|Nebraska||Nebraska offers residents the Aged and Disabled Medicaid Waiver. Under this waiver, assisted living is an included benefit.||Other Financial Assistance Affordable Care Options Assistance to the Aged, Blind, or Disabled|
|Nevada||Nevada HCBS Waiver covers “augmented personal care” or in more common language, the program covers personal care in assisted living residences. Another option for disabled adults of any age is the WIN Waiver.||Other Financial Assistance Affordable Care Options|
|New Hampshire||New Hampshire, through the Choices For Independence Medicaid program pays for assisted living. However, it is referred to as adult family care in the list of the program’s benefits.||Other Financial Assistance Affordable Care Options|
|New Mexico||New Mexico now has a managed Medicaid program for long term care. Under this program, titled Centennial Care Community Benefit, assisted living is an included benefit.||Other Financial Assistance Affordable Care Options|
|New Jersey||New Jersey has a Medicaid managed care program called Managed Long Term Services and Supports (MLTSS), which includes assisted living as an option.||Other Financial Assistance Affordable Care Options Congregate Housing|
|New York||New York offers the Assisted Living Program (ALP), which provides approximately 4,200 units statewide in licensed assisted living communities. However, this program is not strictly open to Medicaid participants. Personal care provided under Managed Long Term Care can be provide to persons residing in assisted living, as can the Consumer Directed Personal Assistance program.||Other Financial Assistance Affordable Care Options|
|North Carolina||North Carolina’s Medicaid State Plan Personal Care option provides personal care assistance in assisted living.||Other Financial Assistance Affordable Care Options Adult Care Home AssistanceAdult Care Home Special Care Unit|
|North Dakota||North Dakota’s State Plan Personal Care is provided regardless of the living situation (excluding nursing homes).||Other Financial Assistance Affordable Care Options SPED and Ex-Sped|
|Ohio||Ohio offers a Medicaid waiver specifically for assisted living called the Assisted Living Waiver Program. This program pays for care services in residential care communities but does not pay for the room and board cost. There are a limited number of slots available and participants must select from approved providers. In certain counties, for persons eligible for both Medicaid and Medicare, the AL Waiver has been replaced with a Managed Medicaid program called MyCare Ohio.||Other Financial Assistance Affordable Care Options Residential State Supplement Elderly Services Program|
|Oklahoma||Through Oklahoma Medicaid’s ADvantage Program Waiver, services in assisted living communities are covered. Under the Medicaid State Plan Personal Care can also be provided to persons living in assisted living.||Other Financial Assistance Affordable Care Options|
|Oregon||Oregon, under the K Plan (part of the Community First Choice state plan option), offers attendant care services as a benefit regardless of the location in which the beneficiary lives (except for nursing homes). Eligible locations include at home, in adult foster care, independent living or assisted living communities.||Other Financial Assistance Affordable Care Options|
|Pennsylvania||Pennsylvania does not provide financial assistance or care services funded by Medicaid to residents that live in assisted living communitie. However, the Department of Aging Waiver does provide personal care assistance in domiciliary care homes, which can be thought of as adult foster care. There is also the Community HealthChoices Program, a managed care program, which provides personal care assistance in domiciliary care homes. Additionally, PA offers a supplement to Supplemental Security Income (SSI) to persons who are living in non-nursing residential care.||Other Financial Assistance Affordable Care Options PA Dom Care (Domiciliary Care Program)|
|Rhode Island||Rhode Island has a program called SSI Enhanced Assisted Living that provides up to approximately $1,500 / month to be put toward the cost of assisted living. However, this is not a Medicaid program. RI does have a Medicaid program called RIte @ Home, which offers 24/7 personal care in a caregiver’s home, but not in assisted living communities. Finally, the state’s Global Consumer Choice Compact Waiver covers supported services in assisted living.||Other Financial Assistance Affordable Care Options Home & Community Care Co-Pay|
|South Carolina||South Carolina Medicaid under the Community Choices Waiver includes assisted living as a benefit.||Other Financial Assistance Affordable Care Options|
|South Dakota||Under South Dakota’s HCBS Waiver for the Elderly, (now called the HOPE Waiver) services in assisted living communities are covered.||Other Financial Assistance Affordable Care Options|
|Tennessee||TennCare CHOICES in Long-Term Care Program helps participants that wish to reside in assisted living communities by paying for nursing and personal care services in those communities. Room and board however are not considered eligible expenses for the Medicaid Waiver.||Other Financial Assistance Affordable Care Options|
|Texas||Texas Medicaid will cover the cost of services provided in an assisted living community through the state’s STAR PLUS program. The cost of room and board is not included.||Other Financial Assistance Affordable Care OptionsCommunity Care for Aged/Disabled|
|Utah||Utah Medicaid pays for services in assisted living residences via the New Choices Waiver.||Other Financial Assistance Affordable Care Options|
|Vermont||Vermont’s Choices for Care Medicaid Waiver operates under the Global Commitment to Health Waiver and continues to pay for services in non-nursing home, residential care facilities. Another Medicaid option is Assistive Community Care Services. Finally, there is the Attendant Services program.||Other Financial Assistance Affordable Care Options Home Sharing Program|
|Virginia||Virginia does not currently have a Medicaid program that helps to pay for assisted living. However, while the VA Adult Services program does not provide care services in assisted living, it does provide assisted living assessments.||Other Financial Assistance Affordable Care Options Auxiliary Grant|
|Washington||Washington has Medicaid waivers and programs that provide help for residents in assisted living or adult family care. Two of the options, the Medicaid Personal Care program and the Community First Choice program, are state plan options that provide care assistance. The COPES Program also has an assisted living option, as does the New Freedom Program. Finally, the Nurse Delegation Program is a unique program that trains non-medical caregivers to assist with some medical related tasks||Other Financial Assistance Affordable Care Options|
|West Virginia||West Virginia, through its Medicaid Personal Care option will pay for personal care for state residents if they live at home or in assisted living, but does not cover rent.||Other Financial Assistance Affordable Care Options|
|Wisconsin||Wisconsin, in a limited capacity, provides services to state residents that live in assisted living communities through Family Care program which is designed to replace COP-W. Another option is Personal Care, provided under the general Medicaid program. Finally, persons can receive care assistance in assisted living residences via IRIS.||Other Financial Assistance Affordable Care Options SSI-E|
|Wyoming||Wyoming Medicaid offers the Community Choices Waiver. This program will pay for a variety of personal care and nursing services for residents in assisted living, but notably does not pay for their room and board costs.||Other Financial Assistance Affordable Care Options services.html”>Wyoming HCBS Waiver|
Medicaid is not the only financial assistance option for assisted living. Many states offer alternative programs. Federal, nonprofit and private assistance options are available. Use our Resource Locator Tool to find other programs and options for which you or your loved one is eligible. Answer specific questions about your circumstances and receive a customized list of options in your geographic area. Start here.
Alternatively, read our article about paying for assisted living with non-Medicaid sources of assistance.
Assisted living costs can vary as much as 50% even in the same town.
For persons not eligible for Medicaid or wait-listed for their state’s Medicaid waiver that offers assisted living benefits, finding quality, affordable care is critical. As care costs can vary by as much as 50% in the same city, state or town, it is helpful to contact multiple care residences. Our organization provides a free service to help families find the most affordable care that meets their needs. Find affordable care now.
There are short and long term loans available designed specifically to help families afford the cost of assisted living. These loans are designed to bridge a funding gap. For example, while waiting for a home to sell or to be approved for a veteran’s pension. One of these loans will allow many family members to share the cost of assisted living for their loved ones. More information on eligibility, fees and the application process is available here.