How Much Does Medicaid Pay For Assisted Living?

While searching for assisted living, knowing the financial details is imperative. We’ll explain exactly how much Medicaid pays for assisted living care.

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While searching for assisted living, knowing the financial details is imperative. We’ll explain exactly how much Medicaid pays for assisted living care.

Medicaid pays between $3,000-$4,000 a month for nursing care, medications management, health assessments, exams related to medical care, and a licensed case manager. These costs vary by state, are funded through a variety of programs, and have some qualifications that need to be met for eligibility.

We will discuss the financial requirements generally associated with qualifying for Medicaid assistance when looking for assisted living homes. We will also walk you through the variety of different types of programs and ways that states have set up to help the aging population access Medicaid benefits to assist with long-term care placement needs.

The amount of money that Medicaid will pay for extended care that includes medical oversight varies from state to state. This is also true for exactly how much Medicaid funding is eligible for use in an assisted living facility. Some states have programs known as waiver programs set up to assist with the costs of assisted living communities. We will discuss these in detail so you will have the most up-to-date knowledge of the system for your benefit.

The most important factor in these conversations is to recognize that each state has individual requirements for Medicaid funding use, and that some states have significant limitations on who can utilize these benefits and where they can be directed towards.

As a nurse in the long-term care industry for over a decade, I am equipped to help you navigate the often confusing waters of long-term care placement and the intricacies that this entails. Knowing your Medicaid options, as well as how they can be utilized in the assisted living setting, will be vital for your ability to find the correct fit in an assisted living community.

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Medicaid Income Requirements

Medicaid, unlike Medicare, is not age-based, nor is it guaranteed to anybody after they’ve reached certain benchmarks. Medicaid is an income-based assistance program that will help fund the costs of assisted living and nursing home care should an adult find themselves in need of those services.

Not everybody automatically meets the Medicaid income requirements. Often referred to as the “spend-down” requirement, most adults with financial planning in the past have some assets that are counted towards their income and ability to pay for care. These assets must be adequately dispersed, either into protective trusts, or gifted to trusted family members or a spouse, in order for them to not be counted as assets available for payment of long-term care costs with the Medicaid programs.

Once assets and all income sources have been evaluated, application to Medicaid can commence. For an individual to be eligible for Medicaid in the state of Texas, for example, their solitary income can not exceed $25,503 for the year. For an individual who solely relies on social security for their income, this threshold is usually easy to meet, as the average social security retirement benefit is currently $1,543/mo. or $18,516/year. 

Medicaid Waiver Programs

Many states have special programs designed to help those who have applied, and are eligible, for Medicaid to utilize these benefits in a manner that is not just meant for a nursing home setting. While Medicaid is traditionally reserved for the higher level of skilled nursing care, some states run waiver programs designed to help Medicaid beneficiaries access Medicaid benefits while not having to move into that intensity of long-term care.

These benefits often can be utilized towards keeping a beneficiary inside the home with home care provisions, but they are also able to be utilized at times to spend towards the cost of assisted living environments. Medicaid has stipulations that these funds must be spent on the care, case management, medication oversight, nursing care, and medical examinations in order for the expenses to be eligible.

The specific managed Medicaid waiver program utilized in Texas, for instance, is called the STAR-PLUS plan. You choose a specific managed care STAR-PLUS plan once you have enrolled for Medicaid and have been approved. Once choosing a managed care plan, you are contacted and meet with a service coordinator who discusses each of the benefits you are eligible for under your managed care program. These programs in the state of Texas do pay for assisted living services- an important note, since not all states cover the same items.

Additional items that the STAR-PLUS plans are eligible to cover include emergency response, home-delivered meals, some home modifications if eligible, therapies and more. Meeting with a service coordinator can help you navigate through all of the items and help you determine which managed care programs you may be eligible for and which ones best suit your specific health situation. Again, keep in mind these examples are Texas-specific- each state has their own system for how benefits are set up, so if you are relocating to find your new assisted living community, be sure to reach out to the state in which it is located so you can be best advised on the course of action moving forward for Medicaid requirements in that state.

Medicaid Asset Limits

If you are a married couple looking into assisted living options and you are realizing your assets supersede Medicaid asset limits, don’t become too worried regarding the value of those assets and what that could mean for your spend-down requirements. With Medicaid waiver programs, the spouse applying for Medicaid benefits is not required to live in a “facility” environment- unlike traditional Medicaid requirements. These waiver programs are designed to keep individuals outside of an “institutional” environment, and that can include an assisted living community where your spouse can also reside.

The spouse who does not apply for Medicaid or Medicaid waiver benefits is considered the “community spouse”, and as such has some protection of jointly-held assets. The community spouse can keep a certain amount of assets, determined by individual states, without it being held as a penalty against the spouse applying for Medicaid as assets needing to be spent-down. These thresholds vary greatly from state to state, with some states recognizing hundreds of thousands of dollars in assets that are still allowed to be held by the community spouse, and other states where the community spouse is subject to the same rules and requirements as the Medicaid applicant spouse.

Regardless of your eligibility for Medicaid or the Medicaid waiver programs in your state, meeting with a qualified financial consultant in the state you are seeking assisted living care will be your best bet to finding the way to best fund your assisted living needs. Assisted living communities are also a good resource to help find the many ways you can utilize your assets and benefits to your best advantage. Oftentimes, assisted living communities have designated billing professionals that are specifically assigned to help you best meet your financial goals when seeking assisted living placement.

Overall, an intricate knowledge of the Medicaid system is needed for you to be able to get the most bang for your buck. While spend-down programs and managed care waiver programs seem confusing, the people who have a background in navigating these waters are aware of the specific details that your individual state will require for Medicaid funding to be approved. Whether your care needs are intricate, and whether or not you want to live in a more community-based setting like an assisted living community, these specialized individuals are prepared to help you meet your funding goals.

Remember that state-specific requirements are key, and knowing your assets and income prior to application for Medicaid benefits will be an important step to beginning your application process. If you’re not yet in need of Medicaid funding and are merely exploring options, the best thing you can do is to consult with a financial advisor today and have your estate evaluated. With a few years’ worth of pre-planning, many assets can be sheltered from the Medicaid assets requirements and you can still be eligible for the many benefits that Medicaid and its related programs have to offer.

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