If you or a loved one are paying for senior living or at-home senior care each month, it’s important to know whether Medicaid might cover some or all of your monthly expenses. Medicaid is a government program that provides health coverage to over 84 million Americans, including not only over 7 million senior and elderly Americans but also low-income adults, children, pregnant women, and people with disabilities. Medicaid is jointly funded by both the federal and state governments, and is administered by each state according to requirements established by the federal government. Most relevant to senior living residents and their families, is that Medicaid is often the primary payer for seniors’ long-term care including at assisted living and nursing home facilities.

Learning about Medicaid coverage for seniors has never been more important, particularly given that of the 1 in 3 seniors who will need nursing home care at some point, two-thirds of those will receive their care through Medicaid. If you or a senior loved one are living in, or thinking about moving to, a senior living community it’s important to learn if Medicaid may be able to help cover some or all of your monthly senior care bills. To learn more about what Medicaid covers for seniors, read our helpful guide below.

What does Medicaid cover for seniors?

Medicaid covers a variety of long term care services for seniors, including both seniors who live at senior living communities and seniors who live in their homes. Depending on the type of care you or your senior loved one receives, Medicaid may be available to pay some or all of your monthly senior care bills. 

Assisted living

One important distinction to note is that while Medicaid will generally cover the cost of long term care services that an individual receives in an assisted living community - things like personal care services, meal preparation, laundry, light housekeeping, case management, or transportation - Medicaid generally does not cover the cost of room and board. The extent of your care that Medicaid will cover will depend on not only your or your senior loved one’s state of residence, but also the level of care required as well as the specific state-level Medicaid program that you receive care through. 

In order to qualify for Medicaid to cover their assisted living a senior must meet financial and functional requirements that are set by each individual state. State financial requirements generally depend on factors like the kind of care that is required, the senior’s diagnosis, and their marital status. An additional wrinkle on the financial requirement for Medicaid to cover assisted living payments is that the Center for Medicare and Medicaid Services reviews applicants’ financial history to make sure that they have not given away funds to family or friends in the five years prior to applying for Medicaid, known as the Medicaid look-back period, at a below market rate in order to bring their assets below Medicaid’s threshold.

In addition to this financial test, an applicant must also show that they have a functional need for assisted living meaning that they require some level of nursing or daily care. In some states, functional need can be satisfied by showing that the applicant needs assistance with two or more Activities of Daily Living, such as dressing and undressing or getting up from the bed or toilet. In other states, a doctor is required to submit a statement that the senior’s care is medically necessary. 

Nursing home care

Unlike in assisted living communities, where Medicaid only covers the care a senior receives but does not cover their room and board, Medicaid will pay the full cost of nursing home care for qualified seniors. In order to qualify for Medicaid to cover nursing home care a senior applicant must show both financial and functional need (much like when applying for help paying for assisted living). Financial eligibility requirements are set by each state and look at an applicant’s income and total assets. Generally, these limits are different depending on whether the applicant is single or married, and if married, whether one or both spouses are applying.

Just like with financial requirements, functional requirements are also set by each state, and generally focus on whether an individual is capable of performing the Activities of Daily Living such as dressing, eating, and using the toilet. As with assisted living, the particular requirements necessary to show a functional need will vary with each state.

At-home senior care

Along with providing long-term care in senior living communities, Medicaid can also help cover the cost of at-home senior care through various state programs. For example, 31 states provide access to the Program of All-Inclusive Senior Care for the Elderly (also known by its acronym “PACE”), which helps pays for a variety of home care services designed to let seniors remain in their homes, including adult day care, dentistry, and prescription drugs. The PACE program is jointly funded by both Medicare and Medicaid, and provides enrollees an interdisciplinary team consisting of professional and paraprofessional staff (such as physicians, dieticians, nurses, and physical therapists) who create a care plan based on each enrollee’s specific needs.

How to find out if you’re qualified for Medicaid 

Because each state administers its own Medicaid program, Medicaid eligibility is different in each state. While it will vary based on what state you or your senior loved one lives in, Medicaid eligibility is generally based on household income, family size, age, any disabilities, as well as a variety of other related factors. If you want to determine whether you or your senior loved one is eligible for Medicaid, consult a local attorney who is familiar with elder law or Medicaid applications or learn more about your state’s eligibility requirements on the Medicaid website here. Along with having useful information on Medicaid eligibility requirements, the Medicaid website also has additional useful links where you can check the status of your Medicaid application or request a new Medicaid card. 

If you or a loved one are planning on using Medicaid to cover senior living expenses, but need help covering expenses before being approved and receiving Medicaid funds, then Sunbound may be able to help. To learn more about how Sunbound can help make senior living more affordable for you or your loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and is on a mission to make senior living affordable for everyone.