Financial Assistance: Using Medicaid for Assisted Living Expenses

In 2023, Genworth surveyed senior care providers nationwide to determine the average costs for every state. According to the survey data, the national monthly average cost for an assisted living community is $5,350. Costs vary by region, size of community, available services and amenities, and the level of care required, among other things.

Most families rely on various financial resources to help cover assisted living costs, including personal savings and retirement funds, veteran’s benefits, long-term care insurance, and Medicaid. If you’re interested in using Medicaid for assisted living, the guide below outlines eligibility requirements, the application process, and the types of assisted living services that Medicaid can help with. 

The first step is to confirm your chosen assisted living community is Medicaid-certified, like all Solterra Senior Living communities. Otherwise, you will not be able to use your Medicaid benefits for assisted living expenses.

Keep reading for tips on leveraging Medicaid for your assisted living costs, what it covers, and how to apply. 

Eligibility Requirements for Medicaid

The federal and state governments work together to provide the Medicaid program. Who is eligible to receive Medicaid benefits? Although eligibility for Medicaid is largely income-based, some states have leeway to include certain groups, such as people with disabilities and seniors based on age or medical needs.

While the federal government writes the regulations for the program and oversees it, each state administers the program in the best interests of its residents. For instance, states sometimes adjust eligibility requirements to be able to serve a wider range of their residents. Since the Medicaid program looks slightly different from state to state, it’s important to check with your state of residence to see if you qualify.

Generally speaking, though, for seniors to be eligible for Medicaid, they should: 

• Be 65 or older, or permanently disabled or blind
• Be a resident of the state in which they are applying for benefits
• Have an income level that falls below the state-set maximum 
• Require long-term or continuing care, especially with activities of daily living

The American Council on Aging provides a simple online tool, a Medicaid eligibility test, to help seniors better understand income thresholds. Questions cover the candidate’s and spouse’s (if applicable) income and other financial resources. The test does not cover health or other care needs but can be used to help determine immediate eligibility related to financial criteria. 

After taking the test, if you determine that you are eligible for Medicaid, talking to a Medicaid planner or checking with the Medicaid office in your state of residence would be excellent next steps. For additional information about the application process, see the next section, “How to Apply for Medicaid,” below.

How to Apply for Medicaid

After taking the Medicaid eligibility test and talking to a Medicaid planner or your state’s Medicaid office, if you determine you or your loved one is eligible for Medicaid, it’s a good idea to start the application process as soon as possible. Individuals can request and fill out forms and apply for themselves or have a close family member do it on their behalf. 

Each state Medicaid office has a toll-free phone number to call if you want to speak with a representative who can help you. Online application forms are also available. If you prefer to speak to someone in person, you can also visit your state’s Medicaid office to work directly with a representative. Since Medicaid is a federal program, applications are available through the federal Health Insurance Marketplace. 

Applying for Medicaid often requires a lot of detailed financial information related to proof of assets, income, financial resources, care needs, and medical information and documentation. In some cases, you might also be interviewed by a representative. Each state’s eligibility requirements vary, but gathering and organizing certain documentation beforehand will help the process go more smoothly. 

Make sure you have acceptable forms of identification and can prove your state of residence. These most often include birth certificates, driver’s licenses, passports, green cards, ID cards, etc. 

Any documentation about income sources and assets, such as pay stubs, bank statements, mortgage statements, life insurance policies, and car titles, should be readily available. 

In addition to the identification and financial information, you will also be asked about your medical and healthcare needs. Put together a file with any doctor’s notes, prescriptions, official diagnoses and therapy recommendations, health insurance cards and statements, contact information for all relevant healthcare professionals involved in your care, and anything else you think might be helpful to demonstrate your care needs.  

Medicaid for Assisted Living

Medicaid is a form of health insurance that provides many benefits to recipients. Although those benefits cannot be used toward room and board at an assisted living community, they can be used to cover some of the costs of certain other assisted living services. Again, every state’s Medicaid program is slightly different. All states are required to offer certain federally mandated benefits, but many also include optional benefits. Generally speaking, medical care and associated costs in assisted living that might be covered include:

• Physical, occupational, or speech therapy, as needed
• Personal care services, sometimes also called attendant care or assistance with activities of daily living. Includes help with bathing, grooming, transferring, eating, dressing, etc.
• Transportation needs related to medical care, like getting to a doctor’s appointment or running essential errands
• Regular doctor’s appointments, checkups, and diagnostic exams that fall under the category of preventative health care
• Continuing education about maintaining health
• Medication management assistance, including reminders and administration of medication, which most assisted living and memory care communities like Solterra provide to their residents
• Dental care costs of up to $1,000 annually

You and your family need to work closely with your Medicaid planner and case manager to ensure you receive all potential benefits for which you are eligible. 

Medicaid-certified assisted living communities, like our Solterra Senior Living communities, understand how to work with families to apply appropriate benefits toward assisted living costs. Contact the team at Solterra Senior Living today to discuss Medicaid for assisted living and schedule a tour of one of our beautiful communities to learn more.