Medicaid for Senior Care: Eligibility, Benefits, and Application Process

According to a recent Genworth survey on the cost of long-term care, the national average monthly cost for an assisted living community is $4,500. Those costs vary depending on where you live, the size of the community, the level of care you need, and the types of amenities you choose. 

You may be worried about paying for quality senior care. In that case, you’ll be relieved that financial assistance options are available for individuals and families to help make excellent senior living affordable. 

One of the best public assistance resources to explore is Medicaid. As a national program run jointly by the federal governments and states, Medicaid provides health coverage to millions of Americans annually, including eligible seniors. 

It’s important to note that you must choose a Medicaid-certified community, like Solterra Senior Living communities, to use your Medicaid benefits toward assisted living costs. Not only can you use these benefits to pay some of the costs of assisted living, but many families also choose senior care at Solterra Senior Living because of the outstanding amenities and services available. 

If you’re considering assisted living for yourself or a loved one, keep reading to learn more about who can apply for Medicaid, what benefits they can apply toward senior care, and how the application process works.

Eligibility Requirements for Medicaid

Who can apply for Medicaid? Eligibility for Medicaid is largely income-based, meaning most recipients are families with lower incomes. However, certain groups, such as people with disabilities, pregnant women, children, and seniors, also qualify based on age or medical needs. 

Although the federal government oversees and writes the regulations for the program, each state has some leeway regarding requirements and benefits as they administer the program in the best interests of their residents. For instance, states can adjust some eligibility requirements to serve a broader range of people. As a result of these variations, Medicaid looks slightly different from state to state.

In general, though, eligibility requirements for Medicaid for seniors include:

• Age 65 or older, or permanently disabled or blind
• Live in the state in which they are applying for benefits
• Have an income level under a state-set maximum (e.g., be eligible for Supplemental Security Income)
• Need long-term or continuing care, especially with activities of daily living

Since eligibility requirements vary in different states, the American Council on Aging offers a free Medicaid eligibility test to help better understand if you meet your state’s income and health thresholds. Once you’ve determined your eligibility, it’s always a good idea to talk to a Medicaid planner or check in with the Medicaid office in your state of residence. 

Medicaid Benefits

Although every state’s Medicaid program is different, the federal government does maintain a list of mandatory benefits that all states are required by law to provide through their Medicaid program. In addition to those mandatory benefits, many states also cover some optional benefits.

Several states use a Medicaid waiver system to have the most flexibility possible regarding benefits. Services fall under different waiver categories, and states can choose enrollment levels to cap the maximum number of people that can enroll under each waiver.

Medicaid Benefits for Assisted Living

As Medicaid is a form of health insurance, recipients cannot use benefits toward room and board in an assisted living community. Medical care and associated costs that are often covered however, include:

• Necessary forms of therapy like physical, occupational, or speech
• Assistance with activities of daily living (e.g., bathing, transferring, eating, etc.), which is sometimes known as attendant or personal care services
• Preventative health care like regular doctor’s appointments and diagnostic exams
• Mental health services and cognitive rehabilitation, which are often provided in a memory care community
• Education related to living skills and health maintenance
• Coordination of care assistance
• Medical equipment, supplies, or even specialized furniture that might aid the recipient with activities of daily living
• Help with medication management, which is often provided as a service at assisted living and memory care communities
• Transportation needs when they are related to medical care
• Dental care up to $1,000 per year

Depending on your state’s Medicaid program, these and other health and medical care services might be covered. It’s important to work with your Medicaid case manager to ensure you receive all possible benefits for your situation. Choosing a Medicaid-certified assisted living community, like Solterra Senior Living communities, means you can apply your Medicaid benefits directly to your assisted living expenses.

How to Apply for Medicaid

If you or your loved one is eligible for Medicaid but hasn’t applied for benefits yet, you should start the application process now. Each state’s Medicaid office information is listed on Medicaid’s website. You can apply for yourself or have a close family member do it. 

All state Medicaid offices provide an online application form and a toll-free phone number to speak with a representative who can help you. You can also work with a representative in person if you live near your state’s Medicaid office. In addition to the state Medicaid office, you can apply through the federal Health Insurance Marketplace. 

No matter what your state’s specific eligibility requirements are, it’s a good idea to have some of the following information and resources handy before you start your application process:

• Forms of identification such as a birth certificate, driver’s license, passport, green card, other proof of state residence, immigration status, etc.
• Documentation regarding income sources and assets such as pay stubs, retirement benefits, bank statements, life insurance policies, mortgage statements, car titles, etc.
• Medical information and health history, including official diagnoses, prescriptions, doctor’s healthcare plan of action, insurance cards, etc.
• Contact information for all doctors, insurance agents, or other relevant professionals.

See What Solterra Senior Living Is All About

We believe that the excellent senior care at Solterra Senior Living communities should be available to everyone, so we are Medicaid-certified! We work hard to provide the ideal senior lifestyle you’ve been looking for. We focus on empowering each resident to live well with a holistic approach to health that includes mind, body, and spirit. Whether you’re interested in independent living, memory care, assisted living, or respite care, you can find just the right level of high-quality senior care at Solterra communities. If you have any questions, please contact us today! We would love to speak with you or schedule a tour of one of our beautiful communities!