Who Pays for Assisted Living Room and Board?
Medicaid & Assisted Living – Quick Facts
Yes—many state Medicaid programs now cover certain services in assisted living, but never room and board costs.
Residents are responsible, but some states cap provider charges or offer state cash supplements.
A small monthly income Medicaid residents can keep for personal use—amount varies by state.
In some states, yes—family members may supplement costs without impacting eligibility.
What assisted living services can Medicaid cover?
While Medicaid will not pay for housing, meals, or utilities in assisted living, it can fund services such as personal care, help with daily activities, homemaker support, transportation, and even memory care for residents with dementia. Coverage specifics depend on state rules.
How do states make room and board more affordable?
States use different strategies to help residents pay for room and board, including:
- Charge Caps: Limiting how much providers can bill Medicaid residents, often linked to the SSI Federal Benefit Rate minus the Personal Needs Allowance.
- Optional State Supplementation (OSS): State-funded payments added to SSI to raise income to a level that covers living costs.
- Family Supplementation: Allowing relatives or friends to directly pay the facility for uncovered costs.
What is the Personal Needs Allowance (PNA)?
The PNA is the small portion of a resident’s income they can keep each month for personal expenses like clothing or toiletries. All other income typically goes toward room and board and, in some cases, toward a share of care costs.
How do SSI caps work for room and board?
In about a dozen states, the maximum room and board fee equals the SSI benefit minus the PNA. For 2025, the SSI Federal Benefit Rate is $967/month. Examples:
- Ohio: PNA $50 → Cap $917
- Texas: PNA $85 → Cap $882
- Illinois: PNA $120 → Cap $847
- Georgia: PNA $214 → Cap $753
Do all states use SSI-based caps?
No—some states set their own limits. For instance, Colorado caps alternative care facility rates at $797/month, while Oregon’s limit is $752/month. Tennessee’s cap is higher at $2,320.80/month but allows residents to keep a larger PNA.
How does Optional State Supplementation help?
OSS programs provide extra monthly payments to SSI recipients (and sometimes near-SSI-eligible individuals) to help cover living costs. Some states set caps based on SSI + OSS minus the PNA. Examples for 2025:
- Michigan: OSS $179.30 → Cap $1,102.30
- California: OSS $632.07 → Cap $1,420.07
- North Carolina: Basic rate $1,359; Enhanced memory care rate $1,743
- Florida: OSS $345 → Cap $1,152
- New York: SSP $694 → Cap $1,406
Can families contribute to room and board costs?
Some states, including Colorado, Tennessee, and New Jersey, allow family members or others to directly pay the facility for room and board or upgrades. Direct payments to the resident are discouraged, as they may count as income and affect Medicaid eligibility.
Do different states call assisted living by different names?
Yes—terms vary widely. Facilities may be called adult care homes, supportive living facilities, homes for the aged, managed residential communities, residential care facilities for the elderly, or other state-specific names.
