Medicaid and Assisted Living Facilities

So you or a loved one is living in an assisted living facility (“ALF”) or thinking about moving to one. You’ve heard or been told that you can get Medicaid benefits to help pay for the monthly ALF cost. Sounds great, right? Well, it can be. However, obtaining Medicaid coverage in an ALF isn’t necessarily a quick and easy process. There are some things you should know about Medicaid and how it works relevant to assisted living facilities.

Medicaid helps with medical costs for some people with limited income and resources. Medicaid offers benefits not normally covered by Medicare, like nursing home care. Basically, if you are in a nursing home and meet Medicaid’s medical and financial criteria, you are entitled to Medicaid coverage. It’s referred to as ICP Medicaid (Institutional Care Program Medicaid).

If you are in an ALF or even at home, there is still Medicaid coverage available but it is not an automatic benefit. It is not ICP Medicaid that is applicable. States, Florida included, have “Waiver” Medicaid Programs in addition to the main ICP Medicaid. These programs deal with non-nursing home services and each state gets to determine how many people the programs cover and how much they get funded.   Florida has the “Statewide Medicaid Managed Care Long Term Care Program” (that’s a mouthful) of which part (the Waiver program) covers non-nursing home situations. This is the Medicaid coverage that you can get while at an ALF or even at home. However, just because you may meet the financial and medical criteria for Medicaid coverage doesn’t mean you can automatically get coverage. You first get on a Wait List. There is a procedure for that. Priority on the Wait List is based on your acuity and your need for assistance with “Activities of Daily Living” (eating, bathing, dressing, transfer, and ambulating). This is not a first come, first served Wait List. You could be on the Wait List for months or years.

Once on the Wait List, you wait until a slot becomes available. When that happens, you will be notified by the appropriate state agency to see if you still want Medicaid coverage. If yes, then you proceed to apply for Medicaid and will need to show that you meet the medical and financial criteria for the Program. This is a complicated process and it is strongly recommended that you have an Elder Law attorney to assist you throughout it.