Wednesday, April 19, 2017

Using Medicaid to pay for Assisted Living

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.

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