How to Pay for Assisted Living with Medicaid
If you are researching senior living options for yourself or for a loved one, you might be pleasantly surprised at the wide range of choices available. Retirement communities, in-home care, independent living senior apartments, assisted living, and memory care all have different benefits and costs, depending on your needs.
For seniors who require assistance with daily living activities like bathing, transportation, or medication management, in-home care or assisted living communities are great options. Many seniors choose an assisted living community with all its amenities. Assisted living makes it easy for seniors to maintain a healthy, active, and social lifestyle, stay independent, and have access to assistance when needed.
Although the costs can seem daunting at first glance, many families are relieved to realize that they can pay for many of the costs associated with assisted living with Medicaid, long-term care insurance, savings, retirement funds, Veterans Affairs (VA) benefits, and personal funds.
If you plan to pay for assisted living with Medicaid, make sure the community you’re considering is Medicaid-certified, like BridgeWater Assisted Living communities.
Most people are at least a little bit familiar with the Medicaid program. Working together, the Federal and state governments jointly fund this program that helps provide health coverage for millions of Americans every year.
Although the Federal government establishes the overall regulations, each state is individually responsible for administering the program. As a result, Medicaid looks a little different in each state.
Medicaid in Arizona
Arizona is one of the most popular states for seniors when they retire. Medicaid is known as the Arizona Health Care Cost Containment System (AHCCCS) in Arizona. Seniors over 65 who live in Arizona and who require additional medical care can apply for health insurance within AHCCCS, known as Arizona Long Term Care Services (ALTCS).
Coverage under ALTCS includes some of the medical costs associated with assisted living. Management of medication, regular preventative check-ups with a doctor, diagnostic exams, and some nursing care are a few examples of the types of services ALTCS helps pay for.
Who Is Eligible For Medicaid?
Because Medicaid programs vary from state to state, eligibility rules vary. You can check eligibility by state here. Another helpful resource for determining whether you might be eligible to receive Medicaid is working with a Medicaid planner. The American Council on Aging provides a free service to help you locate a Medicaid planner who can walk you through eligibility requirements and benefits in your state.
In general, eligibility is based on medical needs, income, and family size. Every state offers some health coverage to seniors with limited incomes, people with disabilities, and families with reduced incomes. To be eligible for full benefits, each individual must be a citizen of the United States, a U.S. national, or possess satisfactory immigration status.
Who Is Eligible For ALTCS Coverage?
For Arizona residents, the ALTCS program has been designed to help seniors on a fixed income and other groups with limited financial resources afford necessary long-term medical care. To be eligible to receive ALTCS coverage, individuals must meet several general, financial, medical and health requirements, including the following:
- Be a U.S. citizen, U.S. national, or qualified immigrant
- Reside in Arizona
- Be age 65 or over OR blind or disabled
- Have a social security number or apply for one
- Require a certain level of care or assistance as determined by AHCCCS
- Live in an approved living arrangement (including AHCCCS-certified assisted living community, nursing facility, or their own home)
- Apply for all available cash benefits, including Veterans’ Assistance benefits, unemployment, social security, etc.
- Have a gross monthly income under the limit set by AHCCCS. The income limits vary for different eligible groups.
How To Apply For Medicaid
Once you’ve determined you are eligible for Medicaid, you can apply directly through your state’s Medicaid office or the Health Insurance Marketplace. You can find toll-free phone numbers and online links to each state’s Medicaid program on Medicaid.gov.
Whether you apply for yourself or have another person, such as a close family member, act on your behalf, there are a few different ways to start the application process. You can choose to fill out the application and other forms online, over the phone with a representative, or visit a Medicaid office in person.
How to apply for ALTCS
If you meet the eligibility requirements for ALTCS coverage outlined above, the following options are available to you to apply:
- Call ALTCS toll-free at (888) 621-6880.
- Visit one of ALTCS’ offices in person.
- Fill out and submit a form electronically by emailing it to email@example.com.
AHCCCS provides a helpful guide online to give you a better idea of the type of information you will need to provide, such as medical records, a list of medical providers, financial records related to monthly income, and a list of everyday activities with which you need assistance. ALTCS representatives can help you determine the appropriate documentation that is necessary. The complete ALTCS application process takes about 45 days.
What Long-Term Care Services Does Medicaid Cover?
So how do you pay for assisted living with Medicaid? You should first know what services are eligible for coverage.
Since Medicaid is a form of health insurance, you generally cannot use these funds for room and board. However, other services provided in assisted living are eligible for coverage, including:
- Physical, occupational, or speech therapy
- Personal care services (i.e., assistance with activities of daily living like bathing, using the toilet, transferring, etc.)
- Medication management
- Diagnostic exams
- Dental services – up to $1,000 annually
Other necessary health and medical care services might also be covered. It’s important to discuss your individual situation with your Medicaid case manager to ensure you are receiving all possible benefits. When you choose a Medicaid-certified assisted living community, they are able to apply your Medicaid benefits directly to your assisted living expenses.
Because BridgeWater Assisted Living is committed to making excellent senior living affordable, Community Benefits Advocates are ready to discuss financial solutions with you, including how to pay for assisted living with Medicaid. Give us a call today or schedule a tour of one of our outstanding communities to see why so many seniors are happy to call BridgeWater Assisted Living home!