Medicaid & Assisted Living: State by State Benefits & Eligibility

Medicaid’s Benefit for Assisted Living

Medicaid assistance for assisted living changes by state. This is because Medicaid is partly funded by the federal government and partly by the states. The federal government sets guidelines on how each state must spend their Medicaid dollars. But the states are permitted considerable latitude within those guidelines. This allows states to set their own policies on how they assist persons residing in assisted living residences.

Adding to this complexity is the fact that there are many types of Medicaid programs that pay for services in assisted living. Most commonly, states use 1915c Medicaid HCBS Waivers (Home and Community Based Services). Other types of waivers employed are 1115 Demonstration Waivers and 1915b Managed Care Waivers. Finally, regular Medicaid (sometimes called State Plan Medicaid) is also used in some states for assisted living services.

From the family’s perspective, there are pros and cons to each of these Medicaid options. Waivers usually allow participants to have higher income eligibility limits than regular / State Plan Medicaid. In 2024, most waivers allow monthly income limits of $2,829, while Medicaid State Plans may limit income to $1,435 / month. Note that these are very general numbers, and they vary by state, marital status and other factors. It is recommended families review their state specific information in the table below. Waivers are almost always enrollment capped. They have a limited number of “slots” available, and waiting lists are common. Regular / State Plan Medicaid is an entitlement, so these programs cannot limit enrollment. Finally, in most states, Waivers require the participant have “nursing home level of care needs.” Regular Medicaid can be less restrictive with the care requirements of program participants.

Forty-six states and the District of Columbia now provide some level of financial assistance to individuals in assisted living. However, the term “assisted living” is not used consistently across these states, nor are their definitions or benefits the same. Other terms that are used include: residential care, adult foster care, personal care homes, and supported living, to name a few. Some states pay only for personal care services received in assisted living. Others include nursing services. Coverage for medication administration, chore and homemaker services, and even recreational activities, varies by state. No state is permitted to pay for room and board costs in assisted living. But states have other means of controlling these costs. They can:

• Cap the amount the residences can charge.
• Offer Medicaid eligible individuals supplemental Social Security assistance to cover assisted living room and board (from general state funds).
• Pay for meal preparation and serving but not actual food costs.

It is important to recognize that Medicaid may not be the best source of funding for assisted living for every family. As Medicaid payment rates for assisted living (in Medicaid language it’s called “reimbursement rates”) are not high, not every assisted living community accepts Medicaid. Also, given the limited range of services for which Medicaid provides assistance and the enrollment caps and waiting lists for Medicaid waivers, many families might benefit by finding affordable assisted living outside of the Medicaid system.

State by State Guide to Medicaid Coverage for Assisted Living Benefits

Other Financial Assistance Options

Medicaid is not the only financial assistance option for assisted living.  Many states offer alternative programs. Federal, nonprofit and private assistance options are available. Use our Resource Locator Tool to find other programs and options for which you or your loved one is eligible. Get answers to questions about your circumstances and receive a customized list of options in your geographic area.  Start here.

Alternatively, read our article about paying for assisted living with non-Medicaid sources of assistance.

Finding Affordable Care

For persons not eligible for Medicaid or wait-listed for their state’s Medicaid waiver that offers assisted living benefits, finding quality, affordable care is critical. As care costs can vary by as much as 50% in the same city, state or town, it is helpful to contact multiple care residences. Our organization provides a free service to help families find the most affordable care that meets their needs.  Find affordable care now.

Assisted Living Family Loans

There are short- and long-term loans available designed specifically to help families afford the cost of assisted living. These loans are designed to bridge a funding gap. For example, while waiting for a home to sell or to be approved for a veteran’s pension. One of these loans will allow many family members to share the cost of assisted living for their loved ones. More information on eligibility, fees and the application process is available here.