Finding Assisted Living That Accepts Medicaid

Even in states where Medicaid pays for assisted living services, finding a facility that accepts Medicaid, has an opening and is a good fit can take real effort. Many assisted living communities serve only private-pay residents, and those that accept Medicaid often have a limited number of spots. This guide walks through a practical, step-by-step search, the questions to ask, and the warning signs to watch for.

Figures change periodically. Double-check current amounts before relying on them.

The short version

First confirm that your state’s Medicaid program covers assisted living services and which program does it.
Get a list of participating facilities from the state Medicaid agency, the waiver program, the managed care plan or the Area Agency on Aging.
Call each facility and ask specific questions about Medicaid spots, room-and-board charges and private-pay requirements.
Visit, compare and get every promise in writing.
Start early, because waiting lists for both waiver slots and facility openings are common.

Step 1: Confirm your state’s program

Before looking for facilities, find out:

whether the state covers assisted living services through Medicaid;
the name of the program (often a waiver or a managed care plan);
whether there is a waiting list for the program itself;
the level of care and financial rules.

Each state guide gives an overview, and the state Medicaid agency or the local aging and disability resource center can confirm details. See Assisted living rules by state.

Step 2: Get a list of participating facilities

Ways to find facilities that accept Medicaid:

State Medicaid agency or waiver program. Many publish lists of enrolled assisted living providers.
Managed care plans. In states using managed long-term services and supports, the plan’s provider directory lists contracted facilities.
Area Agency on Aging or aging and disability resource center.
Waiver case managers, who know which facilities have openings.
State licensing agency, which lists licensed facilities and inspection reports.
Long-term care ombudsman, who can share general knowledge about facilities.
Hospital discharge planners and social workers.

Be careful with free online “placement services.” Some are paid by facilities and may steer families toward private-pay communities. They can still be useful, but ask how they are paid and verify Medicaid participation directly with each facility.

Step 3: Call and ask specific questions

When calling a facility, ask:

Do you accept Medicaid waiver residents (or residents through our state’s program)?
How many Medicaid spots do you have, and are any open now?
Is there a waiting list? How long?
Do you require a period of private payment before a resident can switch to Medicaid? How long?
What do you charge Medicaid residents for room and board? Is it capped by the state?
Can a private-pay resident stay in the same apartment after switching to Medicaid?
Do you accept residents whose Medicaid is pending?
Do you provide memory care for Medicaid residents?
What happens if care needs increase?

Take notes and record the name of the person you spoke with.

Step 4: Visit and compare

Visit the facilities that meet the basic needs. During a visit, look at:

Cleanliness and safety.
Staff interactions with residents: friendly, respectful, unhurried?
Resident engagement: activities, social spaces, outdoor access.
Food quality and dining options.
Apartment size and privacy, including what Medicaid residents receive.
Care staff availability at night and on weekends.
Medication management procedures.
Inspection reports from the state licensing agency.

Ask to speak with residents and families if possible.

Step 5: Review the agreement

Assisted living residency agreements are governed by state law. Read carefully for:

monthly charges, what is included and how increases are handled;
move-out and discharge policies (see Assisted living evictions);
what happens when the resident switches to Medicaid;
deposits and refunds;
arbitration clauses;
responsibility for payment (sign as the resident’s agent, not as a personal guarantor).

The private-pay-first approach

Some facilities accept Medicaid only for residents who first pay privately for a period, sometimes one or two years. This can work for families with enough savings, because the resident can move in, settle and switch to Medicaid once eligible. Before agreeing:

get the facility’s promise to accept Medicaid later in writing;
confirm that the state’s program will have a slot when the time comes (or that the resident is already on the waiting list);
plan the spend-down so the switch happens smoothly.

Federal settings requirements

Participating facilities must meet the federal home and community-based settings rule, which aims to make Medicaid-funded settings home-like and integrated in the community. Residents should have a lease or similar protection, privacy in their unit with lockable doors, choice of roommate, control of their schedule and activities, access to food at any time, the right to have visitors at any time, and physical accessibility. Facilities that seem very restrictive may not meet these standards.

When no Medicaid facility is available

If there are no openings or the waiver has a long waiting list, options include:

staying at home with Medicaid personal care or other services while waiting;
adult foster care or smaller residential settings, if covered;
PACE, where available (see PACE programs);
a nursing home, if care needs require it, possibly with a later move through Money Follows the Person.

A simple example

Jack’s mother needs assisted living. Their state covers assisted living services through a waiver with a short waiting list. Jack puts his mother’s name on the waiver waiting list and gets the list of enrolled facilities from the state. He calls eight. Three accept Medicaid; one has an opening now; two require a year of private pay. His mother has enough savings for about 14 months of private pay, so he chooses a facility that requires 12 months, gets its written promise to accept the waiver later, and works with a planner to time her Medicaid application.

Getting help

The Area Agency on Aging and waiver case managers know local facilities. A Certified Medicaid Planner can plan the timing of the switch from private pay, handle the application and help with income issues such as a Miller trust.

Frequently asked questions

Can a facility drop out of Medicaid? Facilities can stop accepting new Medicaid residents. State rules and the residency agreement govern what happens to current residents.

Do Medicaid residents get smaller rooms? Some facilities offer specific units to Medicaid residents. Ask what is available.

Is there a list of all Medicaid assisted living facilities nationwide? No single national list exists. Each state or plan keeps its own.

Key terms

Participating (enrolled) facility: an assisted living community enrolled as a Medicaid provider.
Medicaid spot: a unit or bed the facility makes available to Medicaid residents.
Private-pay period: a time the facility requires a resident to pay privately before accepting Medicaid.
Placement service: a referral company that matches families with facilities, often paid by facilities.

A simple tracking table

Facility	Accepts Medicaid?	Openings?	Private-pay period	Room-and-board charge	Notes

Keeping a table like this during calls makes it easier to compare options and follow up. Note the date of each call and who you spoke with.

Common mistakes

Relying only on a placement service’s list.
Not asking whether a resident can keep the same unit after switching to Medicaid.
Taking verbal promises instead of written ones.
Waiting until savings are almost gone to start the search.
Not checking state inspection reports.

A second example: a rural search

Ellen’s father lives in a rural county with only two assisted living communities, neither of which accepts Medicaid. Ellen widens the search to the nearest towns and finds a small residential care home that participates in the state’s waiver, about 30 minutes from her father’s church. She visits twice, meets the owner and two residents’ families, and checks the state inspection report. The home has one Medicaid spot opening next month. Ellen’s father is already on the waiver, so his case manager arranges the transfer of services. Ellen also asks the home how it handles hospital stays and what happens if her father’s needs grow, so there are no surprises later.

When the search takes longer

If the search drags on, keep the person safe at home with whatever services are available, keep in touch with facilities on your list every few weeks, and ask the waiver case manager to alert you when openings come up. Facilities sometimes have openings that are never advertised.

Questions to ask on a visit

How many staff are on duty during the day and at night?
Who gives medications, and how are errors prevented?
How are care needs reassessed, and how often?
What happens if a resident falls or needs to go to the hospital?
Can residents bring their own furniture?
How are concerns and complaints handled?

Write down the answers and compare them across facilities before deciding.

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.