Medicaid covers room, board, and personal care in assisted living, but only in states that have chosen to fund it, and only for people who meet strict income and asset limits
Medicaid does not automatically pay for assisted living in every state. Some states cover it through their Medicaid program; others do not. Even in states that do cover assisted living, Medicaid typically pays only a portion of the cost — usually between $1,500 and $3,000 per month, depending on the state and the facility. The resident or family often covers the remainder out of pocket.
The amount Medicaid pays, which services it covers, and whether your state offers it at all depend entirely on your state's Medicaid plan. This is different from Medicare, which does not cover assisted living under any circumstances. If you are looking at assisted living and think Medicaid might help, the first step is to contact your state Medicaid office to learn whether your state funds it and what the payment rate is.
Key Takeaways
- Medicaid covers assisted living only in states that have chosen to offer it as part of their Medicaid program; your state may not cover it at all.
- Medicaid typically pays a fixed monthly rate toward room and board, ranging widely by state, and residents usually pay the difference out of pocket.
- You must meet your state's income and asset limits to receive Medicaid coverage, and these limits are often lower than for nursing home care.
- Medicaid generally covers personal care services like bathing and dressing but not medical services like nursing or medication management.
- Your state Medicaid office can tell you whether assisted living is covered, what the payment rate is, and which facilities accept Medicaid in your area.
Which states cover assisted living through Medicaid
As of now, most states offer some form of Medicaid coverage for assisted living, but the scope and generosity of that coverage vary dramatically. Some states cover it broadly; others limit it to specific populations or specific types of facilities. A handful of states do not cover it at all or cover it only through special waivers with long waiting lists.
The easiest way to find out whether your state covers assisted living is to call your state Medicaid office directly. You can also visit your state's Medicaid website, though the information is sometimes buried or unclear. If you cannot find a clear answer online, ask to speak with someone who handles long-term care coverage — they will know immediately whether assisted living is an option in your state and what the next step is.
How much Medicaid pays and what it covers
Medicaid payment rates for assisted living are set by each state and do not cover the full cost of care. A typical Medicaid payment might be $1,500 to $3,000 per month, but this varies widely. Some states pay less; a few pay more. The facility's actual cost is usually higher, so residents or families pay the gap out of pocket — this is called a resident contribution or patient pay.
Medicaid typically covers room and board (your bed and meals) and personal care services such as bathing, dressing, toileting, and grooming. It does not usually cover medical services like nursing care, wound care, or medication management — those are considered skilled nursing services, which belong in a nursing home, not assisted living. Some states do cover limited nursing or medication oversight in assisted living, but this is less common and varies by state.
The facility's contract with you will spell out what Medicaid covers and what you pay for. Before you move in, ask the facility for a written breakdown of Medicaid's payment, your monthly out-of-pocket cost, and what services are included in each. Do not rely on verbal promises.
Income and asset limits for Medicaid-funded assisted living
To receive Medicaid coverage for assisted living, you must meet your state's income and asset limits. These limits are often lower for assisted living than for nursing home care, and they vary by state. Generally, your monthly income must be below a certain threshold — often around $2,000 to $2,500 per month, though this changes by state — and your countable assets must be below a limit, often around $2,000 to $3,000.
Your home, one vehicle, and certain personal items are usually not counted as assets. Money in a revocable living trust may or may not be counted, depending on your state. If you have more assets than the limit allows, you may need to spend down your savings on care costs or other permitted expenses before Medicaid will cover you. This is a complex area, and the rules differ by state. A Medicaid planner or elder law attorney in your state can advise you on whether you meet the limits and what options you have if you do not.
How to find out what your state covers
Start by contacting your state Medicaid office. You can find the phone number on your state's Medicaid website, usually listed under "Contact Us" or "Long-Term Care." When you call, ask specifically whether your state covers assisted living, what the monthly payment rate is, and whether there is a waiting list. Also ask which facilities in your area accept Medicaid for assisted living — not all do, even in states where Medicaid covers it.
If you are already receiving Medicaid, you can also contact your Medicaid case manager or the social worker at your current care facility. They often know the local landscape and can point you toward facilities that accept Medicaid and have openings. If you are not yet on Medicaid, your state Medicaid office can tell you how to apply and what documents you will need to bring.
The difference between Medicaid and Medicare for assisted living
Medicare does not pay for assisted living under any circumstances. Medicare covers skilled nursing care in a nursing home (after a hospital stay) and some home health services, but assisted living is considered custodial care, which Medicare does not cover. If you are on Medicare and need assisted living, you will pay out of pocket or use Medicaid if you meet the income and asset limits.
Some people have both Medicare and Medicaid (called dual may be able to access). In that case, Medicare does not change the fact that Medicaid is your only option for assisted living coverage. However, if you need skilled nursing services in addition to assisted living, Medicare may cover the nursing part while Medicaid covers the personal care and room and board.
What happens if you run out of money while in assisted living
If you are paying out of pocket and your savings run out, you can apply for Medicaid at that point. Your state will assess your income and assets at the time of application. If you now meet the limits, you may become may be able to access, and Medicaid can begin covering its portion of your care going forward. However, Medicaid does not usually pay for past bills you have already incurred — the facility may pursue you or your family for those costs.
Before you move into assisted living, discuss this scenario with the facility. Ask what happens if you become unable to pay your share. Some facilities will work with you; others may ask you to leave. Getting this in writing before you move in protects you and the facility and prevents misunderstandings later.
Frequently Asked Questions
Does Medicaid cover assisted living in all states?
No. Most states cover assisted living through Medicaid, but some do not or cover it only under limited circumstances. You must contact your state Medicaid office to find out whether your state covers it and what the payment rate is.
Will Medicaid pay the full cost of assisted living?
No. Medicaid pays a fixed monthly amount set by your state, which is usually less than the facility's total cost. You or your family typically pay the difference out of pocket. The amount Medicaid pays varies by state but is often $1,500 to $3,000 per month.
Can I use Medicare to pay for assisted living?
No. Medicare does not cover assisted living. If you are on Medicare and need assisted living, you must pay out of pocket or use Medicaid if you meet your state's income and asset limits.
What if I have too many assets to may have access to for Medicaid right now?
You may be able to spend down your assets on care costs or other permitted expenses to meet your state's limits. An elder law attorney or Medicaid planner in your state can advise you on legal ways to do this and whether it makes sense for your situation.
Can a facility refuse to accept Medicaid residents?
Yes. Assisted living facilities can choose whether to accept Medicaid. Not all facilities do, even in states where Medicaid covers assisted living. When you are looking at facilities, ask directly whether they accept Medicaid and whether they have openings for Medicaid residents.