Does Medicaid Cover Assisted Living?

Whether you can receive Medicaid coverage for assisted living services depends on where you live. Each state administers its own Medicaid program with the federal government setting regulations that specify the minimum services that must be provided to Medicaid recipients. States are not required to provide more services than mandated by the federal government, but have the discretion to do so. With regard to assisted living, the federal government does not mandate this coverage and most states do not provide it; however, a number of states are involved in programs that provide assisted-living coverage to varying degrees.

Assisted-living Services

When an elderly person needs help with any one of life's daily activities, such as meal preparation, dressing or bathing, but is not in need of skilled nursing or medical care, he can be in need of assisted-living services. In such situations, moving to a nursing home is unnecessary -- and expensive -- yet living independently at home is not an option. Assisted-living services fill the gap between independent living and nursing-home care. By receiving such services, an elderly person can live in his home until such time as medical conditions may warrant nursing-home care.

State Medicaid Coverage for Assisted Living

Only five states -- New York, Massachusetts, Oregon, Wisconsin and Hawaii -- provide any Medicaid benefits for assisted living. New York has the most extensive program, called Home Care Services Program, giving Medicaid recipients who are disabled or elderly the ability to stay safely in their own home. The other four states provide assisted-living benefits to its Medicaid recipients, but only when living in an assisted-living or group-home facility, not their own home.

Medicaid Waiver Program

Because of the need for assisted-living services and the high cost of using a nursing home as the only alternative, the federal government and many state Medicaid programs are using "Medicaid waivers" to address the issue. By using a Medicaid waiver, a state Medicaid program can set aside certain Medicaid requirements, such as having to offer all services to all Medicaid recipients. This allows the states to provide benefits to a limited group of persons on a trial basis to determine whether the services can be provided in a cost-effective manner. The state can also use the waiver program to determine the scope and the need for certain types of services, such as assisted-living services.

Waiver Program States

Many states engage in Medicaid waiver programs and the website maintained by the Centers for Medicare & Medicaid Services provides a list of all Medicaid programs in each state. If a state has a Medicaid waiver program for assisted-living services, it will be specified on CMS list. State Medicaid programs also maintain websites providing information regarding what benefits are available and the eligibility requirements for programs, including programs providing assisted-living services.