For those who want to live at home or in assisted living, Medicaid may pay for care in those places if it can be obtained at a lower cost than long-term care. Private health insurance policies generally don't cover long-term care services, and Medicare coverage is very limited. If you already qualify for Medi-Cal, your Medicaid coverage includes nursing home care if you need it. There are groups of people who automatically qualify for Medi-Cal, such as SSI beneficiaries, participants in the CalWORKs program, refugees, and children in foster care.
Sarah Ordover, owner of Assisted Living Locators Los Angeles, is a respected senior housing counselor who can help families understand if this option would work for them. An assisted living contract will explain how they handle this situation, but in short, most residents can expect to be kicked out if they run out of money or switch to Medicaid to pay for care. When considering how you'll pay for assisted living, including the portion of room and board that Medicaid won't cover, remember to plan for expenses that are often overlooked, such as moving deposits, moving expenses, and rising costs over time due to high care needs. States are federally prohibited from using Medicaid funds to pay the cost of room and board for residents of an assisted living community.
In general, Medicaid pays for room and board only when they are offered in an institution that provides specialized care (such as a nursing home) and generally does not pay for room and board expenses in assisted living facilities. There are many different ways to be eligible for Medi-Cal, and there are specific eligibility rules for long-term care services. The doctor must also certify that caring for an older adult in an assisted living facility is medically necessary. If you qualify for the ALW program, you must use one of the state-approved assisted living centers to participate in the program.
Trying to find assisted living homes near you or a loved one that accept Medicaid as a form of payment is very common, but it's extremely difficult. Before you start the intensive search for assisted living homes that accept Medicaid, there are four things you should know: there is no centralized national database of assisted living homes that accept Medicaid; certified dementia care is available; moving deposits and expenses should be planned for; and states are prohibited from using Medicaid funds to pay the cost of room and board. It is recommended that you use Google Search and not an assisted living placement website to compile this list.
