Are You Eligible For Assisted Living Care?
Will Medicaid Really Help Pay for Assisted Living Costs?
In most states, yes—Medicaid can cover certain long-term services and supports in assisted living, including memory care for those with Alzheimer’s or related dementias. However, Medicaid does not pay for the room and board portion of assisted living costs. Instead, it funds care services such as personal assistance, homemaker help, and sometimes skilled nursing. Many states also have systems to make housing costs more affordable for Medicaid participants.
Why Is Assisted Living So Costly?
According to Genworth’s 2024 Cost of Care Survey, the national average for assisted living is about $5,900 per month—over $70,000 a year. Memory care averages about $7,899 per month ($94,788 yearly), per 2023 NIC data. For many families, Medicaid is the only practical way to manage these expenses.
What Exactly Is Assisted Living—and How Is It Different from a Nursing Home?
Assisted living offers help with daily living activities for seniors or adults with disabilities who do not need the round-the-clock medical care of a nursing home. Living arrangements range from private apartments to shared rooms, often with communal dining and activities. Services typically include personal care, housekeeping, meals, supervision, and social programs. Memory care units add dementia-specific staff training, secure layouts, and programs to support cognitive function.
What Do States Call “Assisted Living”?
Terminology varies. For example: California calls it a Residential Care Facility for the Elderly, Colorado an Alternative Care Facility, Illinois a Supportive Living Facility, Michigan a Home for the Aged, and Texas a Personal Care Facility.
Which Medicaid Programs Can Pay for Assisted Living Services?
Option 1: Regular State Medicaid (State Plan)
This is an entitlement—if you meet eligibility rules, you receive services without being waitlisted. While Medicaid must cover nursing home care, personal care services in assisted living are optional for states. Some states offer them through their regular Medicaid program or through State Plan Options like:
- 1915(k) Community First Choice – Offers attendant care in home or community settings, including assisted living.
- 1915(i) Home and Community Based Services – Provides supportive services for independent living without requiring nursing home level of care.
Enrollment in State Plan services can’t be capped, and services are available statewide.
Option 2: HCBS Medicaid Waivers
Most states rely on 1915(c) Home and Community Based Services Waivers to fund assisted living care. These waivers aim to help people remain at home or in community settings rather than move into nursing homes. Services may include personal care, medication management, transportation, home modifications, respite care, and more. But—enrollment slots are limited, and waitlists can stretch months or years.
Some states combine 1915(b) waivers with 1915(c) waivers to require managed care delivery. Others use 1115 Demonstration Waivers to pilot programs that may also fund assisted living.
What Kinds of Services Can Medicaid Fund in Assisted Living?
Coverage varies by state and program, but common Medicaid-funded services include:
- 24/7 staff availability
- Help with bathing, dressing, eating, mobility, and toileting
- Housekeeping, laundry, grocery shopping, and meal preparation
- Medication reminders and administration
- Non-medical transportation
- Nursing services and case management
- Personal emergency response systems
Memory care adds specialized dementia care, safety features to prevent wandering, and cognitive-stimulating activities like art, music, or memory games.
How Much Will Medicaid Actually Pay?
The number of caregiver hours and services Medicaid funds depends on state rules, program type, and assessed care needs. Those with higher support needs often receive more hours. While services may be fully covered, room and board is always paid by the resident.
What Are the Financial Eligibility Rules for Medicaid-Funded Assisted Living?
Applicants must live in the state where they apply and either reside in or agree to move into a Medicaid-certified assisted living facility. Typical limits for 2025:
- State Plan Medicaid – Income often capped at 100% of the Federal Poverty Level ($1,304.17/month) or 100% of the Federal Benefit Rate ($967/month).
- HCBS Waivers – Higher income cap, usually 300% of the Federal Benefit Rate ($2,901/month).
- Assets – Generally limited to $2,000 for both State Plan and HCBS Waiver applicants.
Being over the limit doesn’t always mean disqualification—tools like Miller Trusts or spend-down strategies may help, but improper transfers can trigger penalties under the 60-month look-back rule.
What Functional Needs Must Be Proven?
HCBS Waivers usually require proof of needing a Nursing Home Level of Care, often demonstrated by help needed with multiple daily living tasks or risk of institutionalization without support. State Plan options may require a lower level of care. For memory care coverage, a dementia diagnosis plus a need for specialized care is generally required.
Do All States and Facilities Offer Medicaid-Funded Assisted Living?
No. Some states—like Alabama, Kentucky, and Louisiana—do not offer Medicaid-covered assisted living services at all. Others limit which facilities or units qualify. Even within Medicaid-certified residences, “Medicaid beds” may be capped, meaning availability is not guaranteed.
How Can You Find Medicaid-Friendly Facilities?
There’s no single national database. Local Area Agencies on Aging usually keep lists of Medicaid-accepting residences and may know which ones currently have open Medicaid beds. Some facilities also allow outside caregivers paid by Medicaid, even if the facility itself doesn’t bill Medicaid directly.
Assisted Living at a Glance: Eligibility & Services (2025)
| Eligibility Snapshot | Common Services Covered |
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Important: State rules vary and change periodically. Always verify your state’s current limits and program availability.
What Should Families Do Next?
- Take a Medicaid pre-screen to estimate eligibility.
- Speak with a Certified Medicaid Planner to explore payment strategies.
- Contact facilities directly to ask if they 1) accept Medicaid, 2) have open Medicaid beds, or 3) allow outside caregivers funded by Medicaid.
