Medicaid's Assisted Living Benefits: Availability and Eligibility

Page Reviewed / Updated - Apr. 2016

In 2016, 46 states and 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's Benefit for Assisted Living

Medicaid is funded in part by the federal government and in part by the states. The federal Center for Medicaid Services sets certain guidelines on how each state must spend their Medicaid dollars but the states are permitted considerable latitude within those guidelines. Therefore, the available Medicaid assistance for assisted living changes with each state.

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, these are used to a much lesser extent than HCBS Waivers. Finally, regular Medicaid (sometimes called State Plan Medicaid) is also used in some states for assisted living services.

From the consumer perspective, there are pros and cons to each of these approaches. Waivers usually allow participants to have much higher income eligibility limits than regular / State Plan Medicaid. In 2016, Waivers usually allow monthly income limits of $2,199 while Medicaid State Plans may limit income to $733 / month. Note these are very general numbers, they vary by state, marital status and with other factors. 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, Waivers almost always 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-six 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, supported living and several other variations. 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 assistance (from general state funds) to cover room and board and paying for meal preparation and serving but not actual food costs.

The past ten years have seen a dramatic increase in the number of states whose Medicaid's programs provide financial assistance for assisted living residents. We expect this trend to continue until all 50 states and D.C. are included.

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.

 Did You Know? Assisted living is referred to by many different names.  There may be subtle differences between the names on this list, they can all be categorized as assisted living residences.

Adult Family Homes
Adult Foster Care
Adult Living Facilities
Board and Care
Domiciliary Care
Eldercare Facilities
Group Homes
Memory Care Facilities
Personal Care Homes
Residential Care Facilities
Senior Living Residences
Sheltered Housing

 

 

State by State Guide to Medicaid Coverage for Assisted Living Benefits

If no program is available in your state, persons interested in adult foster care as an alternative should check our Medicaid and Adult Foster Care page.  

 

2016 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
SAIL Program Waiver
Alabama Personal Choices

 

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. The Older Alaskans Medicaid Waiver is no longer active. Enrollment may be capped and therefore waiting lists for services may exist.

 

Other Financial Assistance
Affordable Care Options
Personal Care Assistance
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.

 

Other Financial Assistance
Affordable Care Options
Self Directed Attendant Care

 

 

Arkansas Arkansas pays for assisted living for Medicaid beneficiaries through the specifically designed Living Choices Assisted Living Waiver.  The ElderChoices Waivercan also be used to cover services in assisted living.

 

Other Financial Assistance
Affordable Care Options
Independent Choices Program

 

California

Medi-Cal (California Medicaid) pays for assisted living via the Assisted Living Waiver (ALW). However, this waiver is not available statewide as of 2016, only in 14 counties.

 

Other Financial Assistance
Affordable Care Options
Multipurpose Senior Services Program
In-Home Supportive Services

 

Colorado Colorado pays for assisted living through the Elderly, Blind and Disabled Waiver. Be aware that assisted living is referred to alternative care facilities.

Other Financial Assistance
Affordable Care Options
Colorado CDASS Program
Old Age Pension
CO Adult Foster Care

 

Connecticut

Medicaid in Connecticut pays for assisted living which it called congregate housing through the Home Care Program for the Elderly. Worth noting is that this program is open to both Medicaid eligible and ineligible persons. There is also a Medicaid demonstration program called the Connecticut Assisted Living Program.

 

Other Financial Assistance
Affordable Care Options
Personal Care Assistance (PCA)
Congregate Housing Services Program
Adult Family Living

Delaware

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.

 

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
Aged and Disabled Adult Waiver Consumer Directed Care Plus

 

Georgia

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.

 

Other Financial Assistance
Affordable Care Options
SOURCE Waiver

 

 

Hawaii

Hawaii offers the QUEST Expanded Medicaid (QExA) Waiver which will pay for an individual's nursing services in assisted living residences. This waiver is due for a major amendment in the next few years and is expected to expand coverage.  Another option is Adult Foster Care which provides assisted living type services in small home-like environments.

 

Other Financial Assistance
Affordable Care Options
Kupuna Care

 

 

Idaho

Idaho Medicaid provides two 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 and the Personal Care Services Program.

 

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
HCBS Waiver for the Elderly

 

 

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
Indiana Choice
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 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 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.

 

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. There is also a non-Medicaid alternative that may provide assistance called Hart-Supported Living. 

 

Other Financial Assistance
Affordable Care Options
Hart Supported Living

 

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
Louisiana LT-PCS Waiver
Permanent Supportive Housing

 

Maine

MaineCare (Medicaid's name in Maine) offers the Older Adults and Adults with Disabilities Waiver which provides for personal care regardless of the location in which the recipient lives.

 

Other Financial Assistance
Affordable Care Options
Consumer Directed Attendant Services

 

Maryland

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).

 

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
Frail Elder HCBS
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.

 

Other Financial Assistance
Affordable Care Options
Home Help Program

 

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.

 

Other Financial Assistance
Affordable Care Options
Personal Care Assistance

 

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
Elderly and Disabled (E&D) Waiver
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 Supplemental Nursing Care Assistance Program also offer financial assistance for both assisted living and nursing home care.

 

Other Financial Assistance
Affordable Care Options

 

 

Montana

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.  

 

Other Financial Assistance
Affordable Care Options
Self-Directed Personal Assistance Services

 

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.  Two former waivers, the WEARC and Assisted Living Waiver, did cover assisted living but are no longer active programs.

Other Financial Assistance
Affordable Care Options
CHIP and COPE

 

 

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
Transitions in Caregiving

 

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'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.

 

Other Financial Assistance
Affordable Care Options
Personal Preference Program
Congregate Housing

New York

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. 

 

Other Financial Assistance
Affordable Care Options
Managed Long Term Care Program

 

North Carolina

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.

 

Other Financial Assistance
Affordable Care Options
Adult Care Home Assistance

 

North Dakota

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 state programs that can provide assistance for room and board. Read more.

 

Other Financial Assistance
Affordable Care Options
Older Americans Act Services

 

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.

 

Other Financial Assistance
Affordable Care Options
Residential State Supplement
PASSPORT Waiver

 

 

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
Personal Care Program

Oregon

Oregon has a Medicaid Waiver called Aged & Physically Disabled Waiver that pays for assisted living. There are a limited number of slots available.

 

Other Financial Assistance
Affordable Care Options
Independent Choices Program
Client-Employed Provider

 

Pennsylvania

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. 

 

 

 

Other Financial Assistance
Affordable Care Options
Department of Aging Waiver
Services My Way

 

Rhode Island

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.

 

Other Financial Assistance
Affordable Care Options
SSI Enhanced Assisted Living
Home & Community Care Co-Pay

 

 

South Carolina

South Carolina Medicaid under the Community Choices Waiver now includes assisted living as a benefit.

 

Other Financial Assistance
Affordable Care Options

South Dakota

Under South Dakota's HCBS Waiver for the Elderly, 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
Elderly and Disabled HCBS

 

 

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 Options

Utah

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. 

 

Other Financial Assistance
Affordable Care Options
The Alternatives Program

 

 

Vermont

Vermont's Global Commitment to Health Waiver has replaced the Choices for CareMedicaid Waiver.  The new program continues to pay for services in non-nursing home, residential care facilities.  Another Medicaid option is Assistive Community Care Services.

 

Other Financial Assistance
Affordable Care Options
Attendant Services

 

Virginia

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.

 

Other Financial Assistance
Affordable Care Options
VA Adult Services
Auxiliary Grant

 

Washington

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 Medically Needy Residential Waiver has expired and therefore it not an option.

 

Other Financial Assistance
Affordable Care Options
Nurse Delegation Program
New Freedom Program

 

 

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
Medicaid Personal Care

 

Wisconsin

Wisconsin, in a limited capacity, provides for services to state residents that live in assisted living communities through the COP-W Medicaid Waiver. Also worth noting are the Family Care and IRIS programs.

 

Other Financial Assistance
Affordable Care Options
Alzheimer’s Family and Caregiver Support

 

Wyoming

Wyoming Medicaid offers the Assisted Living Facility 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
Wyoming HCBS Waiver

 

 

Other Financial Assistance Options

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.

 

Finding Affordable Care

 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 which 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.

 

Assisted Living Family Loans

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.