Page Reviewed / Updated - Apr. 2018
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 regarding how they assist persons residing in assisted living residence.
Adding to this complexity is the fact that there are multiple types of Medicaid programs that pay for services in assisted living. Most commonly, states use their Medicaid HCBS Waivers (Home and Community Based Services). Other types of waivers employed are 1115 Waivers, 1915 Waivers or Demonstration 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 2018, most waivers allow monthly income limits of $2,250 while Medicaid State Plans may limit income to $750 / month. Note these are very general numbers, 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 and therefore 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 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 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 such as by capping the amounts the residences can charge, offering Medicaid eligible individuals supplemental Social Security assistance to cover assisted living room and board (from general state funds) and paying for meal preparation and serving but not actual food costs.
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.
Medicaid Policies and Programs for Assisted Living
Other Options for Residents
Alabama has several Medicaid programs that help individuals remain living in their homes but does not currently provide assistance for those in assisted living.
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.
The Older Alaskans Medicaid Waiver is no longer active.
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.
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. The ElderChoices Waiver did pay for assisted living but is now expired.
Medi-Cal (California Medicaid) pays for assisted living via the Assisted Living Waiver (ALW). This waiver is not available statewide as of 2018, only in 15 counties, however, persons not living in those counties can choose assisted living residences in those counties.
Colorado allows program participants to choose their own care providers under Consumer Directed Attendant Support Services (CDASS). Therefore, state residents can choose to receive personal care from an assisted living residence in which they reside. Be aware that assisted living is referred to alternative care facilities. Another option is the Elderly and Disable Waiver.
Medicaid in CT pays for care in assisted living (which it calls congregate housing) through the Home Care Program for the Elderly. There is also a small, Medicaid demonstration program called the Connecticut Assisted Living Program. Adult Family Living is another option, although it is analogous to adult foster care, not assisted living.
Through the Diamond State Health Plan Plus program Delaware provides assistance to individuals in assisted living. The Medicaid Amended Elderly and Disabled (E&D) Waiver is no longer a valid option.
The District of Columbia Medicaid program offers the Elderly and Persons with Disabilities Waiver which now covers assisted living in limited situations.
Florida has eliminated its HCBS Waivers and now covers assisted living through the Statewide Managed Medicaid Care - Long Term Care.
Under Georgia's Community Care Services Program, a version of assisted living referred to as Community Living Homes is included. The Georgia SOURCE Waiver also includes this benefit, however this waiver is not available statewide.
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.
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
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.
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.
|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 name of the program that provides funding. Another option for adults under 65 is the Health and Disability Waiver.|
Medicaid in Kansas offers payment for nursing services regarding of the location in which an individual resides, be that at home or in assisted living. Funding is provided by the HCBS/ FE Waiver.
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 physical challenges developed prior to the age of 22. There is also a non-Medicaid alternative that may provide assistance called Hart-Supported Living.
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.
MaineCare (Medicaid's name in Maine) offers the CDAS or Personal Care option which helps pay for personal care regardless of the location in which the individual resides.
For Medicaid (called Medical Assistance in Maryland) eligible individuals who are assessed as requiring a higher level of care but 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.
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.
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 the state’s Medicaid managed care program called MSC+ & MSHO.
Mississippi has a Medicaid Waiver specifically designed to help individuals reside in assisted living residences. Read more about the Assisted Living Waiver.
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.
Montana Home and Community Based Services Medicaid Waiver will cover the cost of assisted living for its participants. Note that this waiver refers to assisted living as Adult Residential Living.
Nebraska offers residents the Aged and Disabled Medicaid Waiver. Under this waiver, assisted living is an included benefit.
Nevada HCBS Waiver covers "augmented personal care" or in more common language, the program covers personal care in assisted living residences. Two former waivers, the WEARC and Assisted Living Waiver, did cover assisted living but are no longer active programs. Another option for disabled adults of any age is the WIN Waiver.
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.
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.
New Jersey's Global Options Waiver which did cover assisted living is no longer an option. However, the state's new Medicaid managed care program called Managed Long Term Services and Supports (MLTSS) now includes assisted living as an option.
New York offers the Assisted Living Program (ALP), which provides approximately 5,500 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 does the Consumer Directed Personal Assistance program.
North Carolina, through the CAP/ DA Medicaid Waiver, pays for personal care for participants regardless of the type of housing or assisted living community in which they reside. Like most Medicaid Waivers, the exception to this is if they live in a nursing home. Another option is Adult Care Home Assistance. Finally the same benefit is available under the Medicaid State Plan Personal Care option.
North Dakota has a somewhat unique model when it comes to Medicaid funding of assisted living. Individuals can receive personal care services from Medicaid provided to them in an assisted living community, but not money for room and board. However, there are other non-Medicaid state programs that can provide assistance for room and board. This is available through the Waiver for Home and Community Based Services. Another option is State Plan Personal Care which is provided regardless of the living situation (excluding nursing homes).
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, the AL Waiver has been replaced with a Managed Medicaid program called MyCare Ohio.
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.
Oregon, under the K Plan (part of Community First Choice) 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.
Pennsylvania does not provide financial assistance or care services funded by Medicaid to residents that live in assisted living communities, however there is a non-Medicaid program called PA Dom Care (Domiciliary Care Program). Additionally, PA offers a supplement to Supplemental Security Income (SSI) to persons who are living in non-nursing residential care.
Rhode Island has a program called SSI Enhanced Assisted Living Program that provides up to approximately $1,200 / 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 residential environment but not in assisted living communities. Finally, the state's Global Consumer Choice Compact Waiver also covers assisted living.
South Carolina Medicaid under the Community Choices Waiver now includes assisted living as a benefit.
Under South Dakota's HCBS Waiver for the Elderly, (now called the HOPE Waiver) services in assisted living communities are covered.
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.
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.
Utah Medicaid pays for services in assisted living residences as a benefit of several of its waivers. Most relevantly, the Aging Waiver for Individuals Age 65 or Older. Worth noting is that this benefit may be referred to as adult foster care. Also, the New Choices Waiver is relevant to some seniors.
Vermont's Global Commitment to Health Waiver has replaced the Choices for Care Medicaid Waiver. The new program 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.
Virginia does pay for assisted living but not through the primary EDCD Waiver. Instead, individuals with Alzheimer's have a specific waiver called the Alzheimer's Assisted Living (AAL) Waiver. Unfortunately, the AAL Waiver expires in 2018.
Washington has Medicaid waivers and programs that provide help for residents in assisted living or adult family care. The COPES Program and Medicaid Personal Care program. The second of which offers personal care services but does not distinguish the location in which they can be provided other than to specify it cannot be in a nursing home. The new Community First Choice program has an assisted living option as does the New Freedom Program.
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.
Wisconsin, in a limited capacity, provides for 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.
Wyoming Medicaid offered the Assisted Living Facility Waiver. However, this waiver was absorbed by the newer 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.
Medicaid is not the only financial assistance option for assisted living. Many states offer alternative programs and there are federal, non-profit and private assistance options 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.
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 multiple 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.