What Are the Features of Assisted Living that Accept Medicaid?

Over 800,000 people in the United States call an assisted living community home. High-quality assisted living communities make it easy for seniors to maintain their independence and pursue the healthy, active, and social lifestyle they want with resort-like amenities while providing just the right amount of assistance. 

In general, assisted living communities can offer help with medication management, personal care, including bathing and dressing, and transportation. You might wonder, “Does Medicaid cover any of these features?” The answer is “yes” if you choose an assisted living community that accepts Medicaid. 

Although this might sound obvious, it’s essential to check with your chosen assisted living community to make sure they accept Medicaid for payments. For instance, all BridgeWater Assisted Living communities are Medicaid-certified and work with families to ensure they receive all appropriate benefits.

How does it work? This article will provide information about Medicaid and specific assisted living services that might be covered for yourself or a loved one. 

Medicaid Programs

Medicaid is a national program that helps provide health coverage for millions of Americans annually, including families with lower incomes, people with disabilities, pregnant women, children, and seniors. The federal government writes and oversees the regulations that govern it. However, the state governments work with the federal government to fund the program, and every state is responsible for administering the program to its residents. As a result, each state has some leeway with requirements and benefits, and Medicaid varies a little from state to state.

Medicaid in Arizona

For instance, Medicaid in Arizona is called the Arizona Health Care Cost Containment Systems, or AHCCCS. As one of the most popular states for seniors when they retire, Arizona has a robust Medicaid program. Arizona residents over 65 who require additional medical care, including some assisted living care, can apply for health insurance within AHCCCS, known as Arizona Long Term Care Services (ALTCS).

Many states use a Medicaid waiver system, which provides the flexibility to waive certain requirements and to include a wide variety of services eligible for coverage. Under the waiver system, the states can also choose the maximum number of people allowed to enroll. 

Arizona’s ALTCS is not a waiver system and does not cap enrollment. As a managed care model, ALTCS treats needed services and benefits as an entitlement. Anyone who meets the eligibility requirements set by the state can receive assistance. The eligibility requirements for ALTCS include that the recipient: 

• Be a U.S. citizen (U.S. national and qualified immigrants are also eligible)
• Live in Arizona
• Be 65 or older OR blind or disabled
• Have a social security number or apply for one
• Require a certain level of care or assistance, according to AHCCCS’ definition
• Live in an approved living arrangement (e.g., assisted living community, nursing facility, or in-home care when certified through AHCCCS)
• Apply for all available cash benefits, including Veterans’ Assistance, unemployment, social security, etc.
• Have a gross monthly income under the limit set by AHCCCS. The income limits vary for different eligible groups. Applicants with income over the limit can still qualify if the applicant allocates the excess income to an income-only trust. 

Once a candidate’s ALTCS application is accepted, an assigned case worker helps determine the type of long-term care needed and the appropriate plan and benefits.

What Assisted Living Features Does Medicaid Cover?

Since Medicaid is a form of health insurance, certain medical care is covered, but room and board costs are not included. Other services that an assisted living community provides, however, are often eligible for coverage, including:

• Physical, occupational, or speech therapy
• Behavioral health care, such as mental health services, cognitive rehabilitation, living skills, and health promotion education, including for issues related to medication management
• Assistance with the coordination of care
• Personal care services, also known as attendant care services (i.e., assistance with activities of daily living like bathing, using the toilet, transferring, etc.)
• Dental Care – up to $1,000 per year
• Purchasing certain medical equipment, medical supplies, and specialized furniture that might be necessary for assistance with activities of daily living
• Medication management
• Diagnostic exams
• Doctor’s appointments, such as regular preventative check-ups
• Transportation assistance when it is related to medical care
• Dental services – up to $1,000 annually

Other health and medical care services might also be covered, and your ALTCS or Medicaid case manager can help ensure you receive all possible benefits. When you choose a Medicaid-certified assisted living community, they can apply your Medicaid benefits directly to your assisted living expenses.

How To Apply For Medicaid

If you are considering a move to assisted living for yourself or a loved one but do not yet have Medicaid, you should start the application process as soon as possible. You can find your state’s Medicaid program office’s online link and toll-free phone number on the Medicaid website. You can apply directly through your state’s Medicaid program office or the Health Insurance Marketplace. 

Starting the application process for yourself or a close family member can be done online, over the phone with a representative, or in person at your state Medicaid office.

How to apply for ALTCS

For Arizona residents specifically, you can:

1. Call ALTCS toll-free at (888) 621-6880
2. Visit one of ALTCS’ offices in person
3. Fill out and submit a form electronically by emailing it to altcsregistration@azahcccs.gov 

AHCCCS provides a helpful guide online so you can gather information as soon as possible, such as medical records, a list of medical providers, financial records related to monthly income, and a list of the everyday activities you need assistance with. ALTCS representatives will also work with you to determine the appropriate documentation. Generally speaking, the ALTCS application process takes about 45 days.

BridgeWater Assisted Living Communities are Medicaid-certified! If you are looking for assisted living that accepts Medicaid, we would love for you to consider one of our BridgeWater Assisted Living communities in Arizona or Colorado. At BridgeWater, we believe that excellent senior living should be affordable. We have Community Benefits Advocates who work closely with our residents and their families on financial solutions available to them, including using Medicaid or ALTCS benefits. Contact us 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!