Does Medicaid Cover Assisted Living?
People considering a move to an assisted living community typically have many questions and concerns. These include questions and concerns pertaining to how to pay for residency in an assisted living community. In this regard, people oftentimes want to know whether Medicaid will pay the costs for assisted living.
Threading the Needle: Medicaid Funding and Assisted Living
In states that do permit Medicaid to pay costs for assisted living, there can be something of a technical dance going on. In other words, if you are wondering whether Medicaid will pay some of the costs associated with residing in an assisted living community, you must understand your coverage details clearly.
For example, technically speaking, Medicaid does not pay for room and board at an assisted living facility directly. However, some states do provide funds to supplement coverage for assisted living room and board through their Medicaid programs. California is one such state.
In addition, there are situations in which waivers can be provided to some Medicaid recipients. Through these waivers, people living in an assisted living community (or people moving to such facilities) are able to obtain addition state financial coverage for costs associated with assisted living that is not provided through federal regulations.
Seek Guidance on Medicaid and Assisted Living Communities
Nearly all assisted living communities have an admission staff or staff person that can assist in accessing available programs that can help pay the costs to reside in this type of facility. This includes determining what funds might be available via Medicaid-associated programs.
As part of undertaking due diligence, consulting with admissions coordinators at different assisted living communities can be a wise course to take. You will want to visit more than one assisted living facility as a means of determining which one is best suited to you (or your older parent, if you are an adult child assisting in the search). When touring different facilities, you can meet with the admissions coordinator or similar staff member to obtain information, including in regard to payment and accessing different financial resources, including programming associated with Medicaid.
Medicaid, Medi-Cal, and Assisted Living Waiver in California
As mentioned a moment ago, some states maintain waiver programs associated with Medicaid that can result in money being available to assist in defraying costs associated with assisted living. In California, the Medicaid program is known as Medi-Cal. Medi-Cal does provide a waiver to certain people who reside in assisted living.
You need to bear in mind that not all geographic locations in California offer this Medi-Cal waiver. That will be discussed further in a moment.
In some locations in California, Medi-Cal offers what is known as the Assisted Living Waiver Program of ALWP. According to the State of California:
Medi-Cal offers the Assisted Living Waiver Program (ALWP). It helps individuals who are eligible for nursing home care but would prefer to live in an assisted living community. While room and board are not covered, several supportive services are available. These can include personal care assistance, medication administration, and prepared meals.
California Counties Where the Medicaid Assisted Living Waiver Program Is Available
The Medicaid Assisted Living Waiver Program of ALWP is available at this time in these California countries:
- Alameda
- Contra Costa
- Fresno
- Kern
- Los Angeles
- Orange
- Riverside
- Sacramento
- San Bernardino
- San Diego
- San Francisco
- San Joaquin
- San Mateo
- Santa Clara
- Sonoma
Benefits Available Through Med-Cal Assisted Living Waiver Program
As discussed earlier in this article, the Assisted Living Waiver Program associated with Medicaid in California does not pay the costs for room and board at an assisted living community. With that said, it does pay a variety of costs associated with an assisted living community that include:
- Assistance with activities of daily living, such as bathing, grooming or toileting, eating, and mobility
- Assistance with the instrumental activities of daily living, such as transportation and medication administration
- Health related services, including skilled nursing if necessary
- Social and recreational activities
- Prepared meals
- Housekeeping and laundry
- Nursing home transition case
Medi-Cal Social Worker
A short time ago we discussed meeting with an assisted living community admissions staff member to discuss paying the costs of residing in this type of facility. This included talking with staff about strategies to pay the costs associated with residing in a California assisted living program.
If you qualify for Medi-Cal, you will be assigned a social worker to assist you in navigating benefits and othe related issues. A Medi-Cal social worker can assist you accessing funds necessary to assist in paying some of the costs associated with residing in a California assisted living community.
In the end, being able to pay some of the costs associated with assisted living through a Medi-Cal waiver can be helpful. This permits you to spend less money from other resources to pay assisted living costs.