Does Medicaid Cover Assisted Living Costs?
Trying to understand if Medicaid covers assisted living? This article explains what’s included, what’s not, and how each state handles things differently. Get the facts you need to make an informed decision for your family.
Navigating how to pay for assisted living can feel overwhelming for older adults and their families. While personal savings and long-term care insurance are common funding sources, many people explore Medicaid as a possible way to help cover the costs. But does Medicaid pay for assisted living? The answer depends on where you live, what kind of support is needed, and whether the person qualifies for Medicaid in the first place.
This guide from Koelsch Communities explains how Medicaid may support assisted living residents, what services it doesn’t pay for, how to apply, and other funding options to consider. It also highlights how different states handle Medicaid coverage and outlines important facts to help families make informed decisions. Let’s get started!
What Is Medicaid and How Does It Work?
Overview of Medicaid for Long-Term Care
Medicaid is a state and federally funded health insurance program for people with low income, including many older adults. Unlike Medicare, which mainly covers medical needs and short-term rehabilitation, Medicaid can help pay for long-term care, including services offered in senior living communities.
Medicaid Eligibility Basics
To qualify for Medicaid to pay for long-term care, a person must meet income and asset requirements, which vary by state. In most states, the monthly income limit for a single senior to be eligible for Medicaid in 2025 is around $2,829, and assets must not exceed $2,000. Some states use a higher income limit for people needing long-term care. In addition to financial criteria, Medicaid also looks at whether the person needs help with activities of daily living such as bathing, eating, dressing, or moving from a bed to a chair.
Does Medicaid Cover Assisted Living?
Types of Assisted Living Costs Medicaid May Cover
Medicaid does not pay for rent or meals in assisted living facilities, but it can help cover personal care services. These services include:
- Help with bathing, grooming, dressing, and other daily tasks
- Medication management
- Health monitoring
- Case management and transportation
States offer these services through Home and Community-Based Services (HCBS) waivers or Medicaid State Plans. Coverage and availability depend on the state.
Medicaid Waivers and State Plans
- HCBS waivers let states provide long-term care services outside of nursing homes. Many states use these waivers to support residents in assisted living communities.
- State Plans may include Personal Care Services (PCS) for those who qualify medically and financially.
These programs often have waiting lists, and not all communities participate. If you plan to use Medicaid to help cover assisted living costs, you need to be sure to choose among assisted living facilities that accept Medicaid reimbursement.
What Assisted Living Services Are Not Covered by Medicaid?
Room and Board
Medicaid typically does not pay for rent, meals, or utilities in assisted living or skilled nursing facilities. Some states provide an Optional State Supplement (OSS) to help low-income seniors cover part of these costs. This supplement varies and is usually limited.
Private Services and Amenities
Medicaid only covers services that support health and daily living. It does not pay for:
- Private rooms or upgraded apartment features
- Salon visits or cable TV
- Social outings or entertainment packages
These extras must be paid for privately.
How Much Does Medicaid Pay for Assisted Living?
Reimbursement Structures and State Variations
Medicaid reimburses the community directly for approved services. It does not send money to the resident. The amount paid varies depending on:
- The state and its budget
- The type of Medicaid program used
- The level of care the resident needs
Some states pay a few hundred dollars per month, while others may pay several thousand.
State Program Examples
Here are a few examples of Medicaid programs that help pay for services in assisted living:
| State | Program | Services Covered |
| California | Assisted Living Waiver (ALW) | Personal care, medication oversight, meals |
| Florida | Long-Term Care Waiver | Personal care, medical oversight, therapies |
| Washington | COPES | Assistance with ADLs, wellness support |
| New Hampshire | Choices for Independence (CFI) | Help with daily tasks, case management |
What Type of Care Does Medicaid Usually Cover in Assisted Living?
Covered Services
Medicaid can help pay for services that allow older adults to remain in the community instead of moving into a nursing home. These services may include:
- Assistance with daily activities like bathing and dressing
- Medication reminders and health monitoring
- Transportation to medical appointments
- Meal preparation and laundry in some states
How States Decide What to Cover
Each state defines its services differently. Coverage depends on the individual’s needs and what services the Medicaid program includes.
How Is Most Assisted Living Care Paid For?
Private Pay as the Most Common Option
Most people in senior living pay using personal funds. This may include:
- Savings and retirement income
- Home equity
- Support from family members
Medicaid becomes an option only after other sources are used up.
Other Funding Sources
Besides Medicaid, families can also explore:
- VA Aid and Attendance Benefits
- Long-term care insurance policies
- Life insurance conversions or annuities
- Reverse mortgages
Common Misconceptions About Medicaid and Assisted Living
Medicaid Pays for Everything in Assisted Living
This is incorrect. Medicaid does not cover rent, meals, or optional services. It only covers medically necessary care.
Medicaid Means You Must Have No Assets
While income and asset limits exist, there are legal ways to become eligible without complete financial hardship. Medicaid planning strategies may include setting up a trust, converting assets, or applying under a spouse’s name.
Even if a resident qualifies for Medicaid, they may face waitlists for waiver programs. Many states place limits on the number of people who can receive services, and approval doesn’t always lead to immediate access. Planning early can make a major difference.
How to Apply for Medicaid to Help Pay for Assisted Living
Steps to Get Started
- Contact your state Medicaid office.
- Request a long-term care assessment.
- Submit proof of income, assets, and medical needs.
- Ask about HCBS waivers or state plan coverage for assisted living.
Tips for a Smoother Process
- Work with a Medicaid planner or elder law attorney.
- Keep clear records of all paperwork.
- Ask your preferred senior living community if they accept Medicaid.
- Use local Area Agencies on Aging for free help.
What Families Should Know Before Relying on Medicaid
Expect Waiting Lists
Many states cap the number of people who can receive HCBS waiver services. Some states have waiting lists that last for months or even years.
Not All Communities Accept Medicaid
Only some senior living communities accept Medicaid. Ask directly if they participate in your state’s program and whether they have any openings for Medicaid-supported residents.
Comparing Medicaid to Medicare for Assisted Living
What Medicare Covers
Many seniors have the mistaken impression that they can rely on Medicare to cover assisted living. It’s important to know that Medicare parts A & B do not cover assisted living rent or long-term support. However, it may help with short-term needs:
- Skilled nursing care after a hospital stay (up to 20 days covered fully)
- Physical or occupational therapy
- Doctor visits and preventive services
Comparison Table
| Service | Medicaid | Medicare |
| Assisted living rent or meals | ❌ Not covered | ❌ Not covered |
| Help with daily tasks (ADLs) | ✅ In many states via waivers | ❌ Not covered |
| Skilled nursing care (short-term) | ✅ If eligible | ✅ Up to 100 days post-hospital |
| Medication management & case oversight | ✅ Often included | ✅ For medical treatment |
Closing Thoughts
Medicaid can help pay for some services in assisted living communities, but not all. Each state has different rules, coverage levels, and application processes. Families should plan ahead, gather clear financial records, and understand that Medicaid support often takes time to access. Exploring other payment options in combination with applying for Medicaid may offer the best path forward.
About Koelsch Communities
Koelsch Communities offers a wide range of “Mom-approved” senior living options designed to create fulfilling and enjoyable experiences. With over 60 years of experience, we have built a reputation for providing top-quality care and exceptional living environments. Our communities are staffed by professionals dedicated to treating our Ladies and Gentlemen with respect and providing the special attention they need.
We pride ourselves on our high customer satisfaction, which reflects our commitment to excellence. Our experienced team ensures that every resident feels valued and cared for, promoting a thriving and supportive community atmosphere.
For more information about our senior living options and to discover how we can help you or your loved one enjoy the finest living experiences, please contact us today. We look forward to welcoming you to our community and helping you find the perfect senior living solution.
Disclaimer: This article is for informational purposes only and does not constitute medical, legal, or financial advice. It’s recommended to consult with a medical, legal, or financial professional for your specific circumstances.
