Does Medicaid cover assisted living?
Last verified:
Not the room and board, ever; the care services inside an assisted living facility can be covered through a state waiver, with waiting lists. Federal rule: room and board excluded; services at state option through waivers.
What federal law says
Federal law bars Medicaid from paying for room and board in home and community-based settings. 42 CFR 441.310 excludes federal payment for room and board under a 1915(c) waiver except for respite care in a facility and part of a live-in caregiver's costs. So the rent portion of an assisted living bill is always yours, or your state's supplemental program's, never Medicaid's.
What a state can cover is the care: personal care, medication management, nursing oversight and similar services delivered in an assisted living facility, through a 1915(c) waiver, 1915(i) or 1915(k) state plan option, or an 1115 demonstration. Most states do this for at least some facilities, but waivers have enrollment caps and waiting lists, and the facility has to be a Medicaid provider.
Some states pay an optional state supplement to SSI recipients living in assisted living to help with the room-and-board portion; it is state money, not Medicaid, and the amount varies widely.
Children under 21
Not applicable.
What to ask your state plan
- Ask the facility two questions: is it enrolled in the state's Medicaid waiver, and what is its private-pay room-and-board rate after the waiver covers services.
- Get on the waiver waiting list early; some states let you apply before you need the care.
- Find your state's agency, program name and phone on Medicaid by state.
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Common questions
Does Medicaid cover assisted living?
Not the room and board, ever; the care services inside an assisted living facility can be covered through a state waiver, with waiting lists.
Does Medicaid cover assisted living for children?
Not applicable.
How do I find out whether my state's Medicaid covers assisted living?
Three places. Your plan's member handbook or benefit summary, which lists the covered services and limits; the state Medicaid agency's provider manual for the service, which is public and states the medical-necessity criteria; and the member services line on your card, which can run a coverage check for a specific procedure code. Our state pages list each agency's phone and portal.
Sources
- 42 CFR 441.310 (limits on HCBS waiver payments: room and board)
- medicaid.gov: home and community-based services
- medicaid.gov: mandatory and optional Medicaid benefits
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