While Medicaid doesn't cover room and board in assisted living facilities, Medicaid can cover home care in assisted living facilities. While federal Medicaid law requires states to cover the costs of nursing facilities, including room and board and the costs of care, nearly all home care is optional for states. Many older adults and people with disabilities move to assisted living facilities when they need help with activities of daily living (such as eating and dressing) and instrumental activities of daily living (such as preparing meals and administering medications), as an alternative to nursing facilities. While Medicaid doesn't cover room and board in assisted living facilities, Medicaid may cover home care for residents of assisted living facilities and some states may have policies to defray the costs of room and board (see below).Medicaid doesn't cover the room and board portion of assisted living costs.
However, many states offer Medicaid exemption programs that can help defray the costs of assisted living. These are called Medicaid exemptions for home and community-based services (HCBS) or Medicaid 1915 (c) exemptions. Medicaid coverage for nursing facility services is only available for services provided in a nursing home authorized and certified by the state polling agency as a Medicaid nursing facility (NF). See NF certification and survey requirements.
Medicaid NF services are only available when there are no other payment options available and the person is eligible for the Medicaid program. However, Medicaid does not guarantee that an applicant will receive Medicaid benefits while at home, in an assisted living facility, or at home. Simply put, Florida only guarantees Medicaid to eligible nursing home applicants, not to applicants for assisted living or home care. Medicaid has a long waiting list for those who apply for community Medicaid (that is, the waiting list can take years for older people to receive Medicaid, if they ever do), since the system only accepts the sickest people first through an orderly classification process.
Assisted living is for seniors and people with disabilities who need help with their activities of daily living. It's unknown how many assisted living facilities accept Medicaid, but the National Center for Assisted Living estimates that Medicaid pays for the daily services of about 200,000 people (about one in five residents).Most states offer Medicaid exemptions for home and community services, also called HCBS 1915 (c) exemptions, which allow people to continue living at home or in the community (i). For qualified residents of assisted living facilities, Medicaid will pay for care and products that are part of the healthcare provider's documented care plan. People age 65 and older or who have physical disabilities are the most likely to be eligible for Medicaid home care coverage in assisted living facilities.
Federal law provides some protections against eviction for assisted living residents who are eligible for Medicaid. Medicare doesn't cover assisted living costs, only eligible short-term stays in a skilled nursing facility for each benefit period. While states are prohibited from using Medicaid funds to pay for room and board costs, Paying for Senior Care reports that 47 states (including D.). In some states, people applying for NF residency may be eligible for Medicaid if the eligibility limits are higher for residents of an institution.
For eligible older people, Medicaid will pay for services and products that are part of a documented care plan. Most of the discussion here has focused on Medicaid in the assisted living center, but the state of Florida will provide in-home help to the applicant. Medicare doesn't cover the costs of assisted living, but Medicaid can cover the home care services that residents receive and offer other protections to residents with Medicaid. Using data from the 22nd KFF survey of officials who manage Medicaid home care programs in all 50 states and the District of Columbia (a state for the purposes of this analysis), which the states completed between April and October 2024, this thematic summary describes the circumstances under which Medicaid covers services provided in assisted living facilities and the protections that the Medicaid program offers to residents of assisted living facilities.
For example, all states are required to provide Medicaid-funded nursing home care to all residents of the state who meet the eligibility requirements. This may include personal emergency response systems, adult day care, respite care, home modifications to ensure safety and accessibility, personal care assistance, home health aides, meal delivery, and assistance with household chores.
