Medicaid, a joint federal and state health insurance program for low-income individuals, can help cover some costs associated with long-term care and assisted living.
But who qualifies, and how much does Medicaid cover? We’ll examine the ins and outs of Medicaid options so you can budget accordingly in case your future holds a stay at an assisted living community.
[Read: Medicaid Coverage for Nursing Home Care.]
Does Medicaid Pay for Assisted Living?
Medicaid may pay for some aspects of assisted living but not all. For instance, the National Council on Aging (NCOA) reports that Medicaid does not cover room and board, two big components of assisted living communities
that are major contributors to the price tag. (The median monthly cost of an assisted living facility is $5,900, according to Genworth and CareScout.)
However, many states have Medicaid waiver programs that can assist with other costs associated with assisted living. Called Home and Community-Based Services (HCBS) waivers or 1915(c) Medicaid waivers, these programs help cover some of the services and supports that older adults and some people with disabilities need. These beneficiaries typically prefer to get long-term care services and support in their home or community rather than in an institutional setting, such as a nursing home. The idea is that providing care in the person’s house or in an assisted living facility is often less expensive than providing the same care in a nursing home.
Medicaid.gov provides a list of all state waiver programs with more information about which programs are available in each state and what’s covered.
NCOA notes that nearly 1 in 6 assisted living residents depends on Medicaid to pay for daily care services.
[READ: How to Pay for a Nursing Home With No Money.]
Assisted Living Costs Covered by Medicaid
Medicaid, namely HCBS waivers, may cover some or all of the following expenses for those who are unable to pay:
— Activities of daily living, such as toileting and personal hygiene
— Nursing care
— Medical supplies and equipment
— Medication management
— Medical assessments and exams, such as preventive care, checkups and diagnostic tests
— Case management services (coordination with medical providers)
— Respite care for a primary caregiver
— Mental health services
— Access to senior centers or adult day care services
— Transportation services, particularly to and from medical appointments
While these waivers can provide a real lifeline for many older adults in assisted living situations, NCOA notes that these waiver programs have limited enrollment. That means some people who meet all the requirements will find themselves on a waiting list until a slot becomes available.
[Read: Low-Income Assisted Living Options]
Assisted Living Costs Not Covered by Medicaid
As noted above, while Medicaid covers most of your nursing and medical care needs while you’re living in an assisted living community, it doesn’t pay directly for room and board.
Check with your state agency that handles Medicaid benefits to determine your eligibility for any supplemental assistance programs, what exactly is covered and how to get enrolled. The Medicaid.gov website lists lots of resources that can direct you to the right place in your state to ask for help paying for assisted living expenses.
Do All Assisted Living Facilities Accept Medicaid?
Not all assisted living facilities accept Medicaid. The facilities that do accept Medicaid may also cap the number of beds they make available to residents who rely on Medicaid.
However, facilities that don’t accept Medicaid may still permit service providers who do to come into the facility to assist Medicaid-funded residents. It can be complicated, so be sure to ask at any facility you’re considering moving into about their policies in case you end up relying on Medicaid.
Your local Area Agency on Aging can also help you figure out which communities near you accept Medicaid and how to find the right place for your needs.
How to Qualify for Medicaid
According to the Centers for Medicare & Medicaid Services, to qualify for Medicaid, you must meet several criteria:
— Your income must be below your state’s Medicaid income limit, or your medical-related care expenses must exceed your income.
— Your “countable assets” (cash, stocks, bonds, investments, bank accounts and real estate holdings that are not your primary residence) must fall within a certain range.
— You must be a citizen of the U.S. or a permanent resident.
— You must reside in the same state where you’re seeking benefits.
— You must have a qualifying medical need.
Navigating Medicaid eligibility can be confusing, notes Kate Granigan, CEO of LifeCare Advocates in Newton, Massachusetts, and president of the board of directors with the Aging Life Care Association. But working with an elder law attorney who specializes in Medicaid can help ensure you meet the strict criteria and avoid “unknowingly disqualifying yourself by making financial gifts” or stumbling into other pitfalls that could affect your qualification status.
She also notes that senior living facilities that accept Medicaid often have someone on staff who can help you navigate the process of applying.
Start planning early for senior care expenses
Medicaid may not become an option until you’ve spent down your assets to meet the qualifying financial threshold, so it’s best to plan ahead to finance care using other resources, such as long-term care insurance policies, for as long as possible, says Stephanie Pogue, a St. Louis-based certified Medicare insurance planner and the CEO of St. Louis Insurance Group.
Such policies can help pay for nursing home and assisted living communities, “but the policy must be in place for a period of time prior to using the services, and you must be healthy enough to qualify for it initially,” Pogue notes.
If you don’t have such a policy, you may be in for a bumpy ride until you have used up your reserves enough to qualify for Medicaid.
“People must pay out of pocket until their assets are depleted and the state’s Medicaid program steps in,” Pogue notes.
How to Qualify for Medicaid Payments for Assisted Living
To qualify for a Medicaid HCBS waiver for assisted living, you must meet certain financial and functional requirements laid out by the state in which you reside. These can vary by state, but in most, the financial requirements indicate that the applicant can’t have income in excess of 300% of the Federal Benefit Rate.
The 2025 Federal Benefit Rate is $967 for a single individual and $1,450 for a married couple. So, if you’re taking in more than $2,901 per month as an individual or $4,350 as a married couple, Medicaid won’t be able to help you.
The Federal Benefit Rate is adjusted annually based on the Social Security Cost of Living Adjustment (COLA) rate. Some years, the increase is 0%, as occurred in 2016, but in others it may be significantly higher — in 2023, the COLA was 8.7%.
Also worth noting: If you qualify for Social Security Insurance benefits, you’ll also qualify for Medicaid benefits in some states, the American Council on Aging reports.
How to Apply for Medicaid
Using Medicaid benefits to cover some of the costs of assisted living will require you to apply for and receive an HCBS waiver — and that’s not guaranteed because each state has caps on enrollment in the program.
The application process for these waivers also varies by state. In addition, you’ll have to apply for Medicaid if you aren’t already enrolled.
You can contact your state Medicaid agency for advice on how to apply. As mentioned, the Medicaid.gov website is also a great resource for understanding your options and how to access this benefit. You can also find lots more information on the Medicaid application information site.
Other Ways to Cover Assisted Living Costs
Many people may also assume that Medicare will cover senior care expenses, but this can be an expensive miscalculation, says Diane J. Omdahl, Wisconsin-based president and co-founder of the Medicare consulting firm 65 Incorporated.
“It’s worth noting that Medicare, often mistaken for covering long-term care, actually does not provide such coverage,” she explains. “In fact, 56% of middle-income baby boomers believe that Medicare will pay for their ongoing long-term care.”
Instead, Omdahl recommends looking to other programs and products for help in paying for senior living expenses.
“There are several options available to help older adults cover the costs of assisted living, especially if they require assistance with daily activities,” she says.
These options include:
— Traditional long-term care insurance
— Deferred long-term care annuities
— Combination insurance products
— Health savings accounts
— Reverse mortgages
— Charitable remainder trusts
— Medicaid
Start Today by Exploring Top-Rated Assisted Living Facilities With U.S. News
Paying for senior care needs can get expensive, and for many seniors who haven’t been able to set aside enough funds for assisted living, Medicaid could help offset some of the costs.
You can start your search for the best assisted living community for your needs, whether you’ll be relying on Medicaid or not, with U.S. News’ Best Assisted Living Communities 2025 rating, which includes more than 3,800 communities across the country. These facilities have been listed based on more than 450,000 survey responses from residents and family who’ve benefited from the services and support these communities provide.
New this year, each community was considered for accolades covering areas such as activities and enrichment, care, home-like feel, food and dining, and management and staff. U.S. News selected these categories of service because they are important differentiators for many consumers. Accolade-earning communities’ usnews.com profiles highlight that they are, for example, “High Performing in Food & Dining.”
Start your search today to get a jump on future needs and access the best care near you.
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Does Medicaid Pay for Assisted Living? What You Need to Know originally appeared on usnews.com
Update 04/30/25: This story was previously published at an earlier date and has been updated with new information.
