Will Medicaid Pay for Assisted Living?

May 9, 2023

People are living longer than ever. For many, there will come a time when they need some amount of help to live. There are home health services and nursing home care, which are both covered by Medicaid. However, many people need services in between in an assisted living facility that allows for some level of independence.

Long-term care of any kind is not inexpensive. The median cost for assisted living facilities in Ohio is currently $4,635 per month and is expected to be more than $6,000 by 2030. Will Medicaid help pay for any of that? The brief answer is that it depends on how well you plan.

That is where KJK comes in. We help individuals and families in Columbia and throughout Central Ohio with Medicaid planning as part of their estate planning process. It is never too early to start.

Will Medicaid Pay for Assisted Living in Ohio?

The first two things you need to understand are what Medicaid and assisted living are. Medicaid is a program jointly funded by the federal and individual state governments. Medicaid is a public health insurance program designed to cover certain medical costs for people with limited incomes and assets.

Assisted living facilities are residential care facilities that provide some services that would not be available in, for example, a senior housing community, but do not rise to the level of care provided by a nursing home or other skilled nursing facility. The terminology can be confusing, and while Medicaid definitely pays for hospital and nursing home care, it does not pay for the routine room and board costs of assisted living.

Assisted living facilities are private pay, and they are not required to accept Medicaid waivers under Ohio’s Assisted Living Waiver Program. In fact, many facilities do not accept waivers or only accept them from established residents. It is wise to research facilities to find out whether they participate if you are counting on Medicaid to help.

Although Medicaid will not pay for the underlying monthly room and board cost to live in an assisted living facility, it will pay for some of the services you may need while you are there. These facilities are designed to provide services a la carte as residents require them.

Who Qualifies for Medicaid Waivers in Ohio?

Since Medicaid helps those with limited income and assets, qualifying for Medicaid coverage of assisted living is the first hurdle. What you own and earn must be at or below income and asset guidelines. A single applicant’s monthly income limit is approximately $2,500 and higher if the applicant for the waiver is married and the spouse still resides at home.

The applicant’s asset limit is $2,000. Again, if the applicant is married and the spouse remains at home, there are higher allowances for assets that support the independent spouse. If both spouses are applying for assisted living, the household income and asset limits are lowered.

Spending down assets and income to qualify for a Medicaid waiver is prohibited. Medicaid has what is called a “look-back period” of five years. In other words, the program will look at your income and assets over the past five years when determining eligibility. If you eliminated assets by selling them off or giving them away, Medicaid will not only not approve your application, but keep you from approval for longer as well.

As you can imagine, the limits for Medicaid waiver eligibility and the costs of assisted living not covered by the waiver seem disparate and complex. This is the reason why you should work with an estate planning attorney to explore ways you can put assets into trusts that might preserve an inheritance for your children or provide for a spouse who continues to live at home without disqualifying you from Medicaid eligibility.

What Costs Will Medicaid Cover for Assisted Living in Ohio?

For those in nursing home care whose health has improved enough to move to assisted living, Medicaid will cover some of the costs of the transition.

Other costs the Medicaid Assisted Living Waiver will cover include daily meals, personal care, housekeeping, laundry services, health monitoring, some recreational and social activities, and transportation other than for medical care. The waiver will cover the expense of around-the-clock monitoring to respond to medical conditions, as well as for skilled nursing services if they are needed.

Although the monthly cost of room and board to live at the facility must be paid out of your own pocket, these other costs can add up quickly. Having Medicaid cover them will help ease the financial burden of assisted living.

Personal & Professional Legal Guidance

You will probably experience significant stress if you stop to think about the potential cost of care when you can no longer take care of yourself. That is largely attributable to the fact that so much about your future needs is unknown. It will help if you can move some of those unknowns to the “known” column.

Let me help you find ways you can take care of yourself and your loved ones through thoughtful estate planning. If the time comes that you need assisted living, your plan will be ready as well.

Get in touch today with Gregory Williams (GLW@kjk.com; 614.427.5746) to schedule a consultation and discuss your case.