Will Medicaid Cover Assisted Living Care?

Providing an elderly person meets certain financial qualifications, Medicaid will help them cover long-term medical care. Most of the time, families use this for nursing home care – but it is also possible, in certain situations, for Medicaid to cover assisted living care as well. Assisted living facilities (ALFs) provide a high level of care, but those who choose them do not necessarily need the high level of medical help that nursing homes provide.

Regulations Can Be Complex

Assisted living facilities are normally private entities, accepting private pay residents. Medicare does not generally cover assisted living care (also called custodial care), deeming it “not … medically necessary or a health insurance issue.” Medicaid, by comparison, will cover assisted living facilities, at least in New York, under its Assisted Living Program (ALP) – but only in very specific circumstances that can be very difficult for the average person to meet.

New York’s regulations state that in order to qualify for ALF care, a person must require placement in a nursing home “due to the lack of a home or suitable environment,” as well as financially qualifying for such care. (Medicaid has strict income and asset limits that a person must be under before their care can be covered by the program). However, the person in question must not need continual care or otherwise be “bedfast” or a danger to other ALP residents.

Potentially Difficult For Families

In addition to the complexities of Medicaid law in New York, it is important to be aware that the ALP program is also limited to 4,200 residents, making availability quite low. 85 percent are Medicaid recipients, meaning that those who have not otherwise required Medicaid services are behind the proverbial eight-ball when trying to seek acceptance to the program.

If your loved one is truly in need of Medicaid-covered care, this lack of options may mean a difficult choice – namely, to accept placement in a nursing home, though it may not strictly be required. Many elderly people do not react well to such a choice, equating it to an unnecessary loss of personal freedoms, and it may require considerable tact to work out a solution that is best for your family.

Contact A Mahopac Elder Law Attorney

Assisted living is not seen as optimal care for many, and as such, state programs to help it be covered are few and far between. If this is the best solution for your elderly loved one, consulting a knowledgeable Westchester County elder law attorney from Meyer & Spencer, PC may help you get the answers you need. Call our office today to speak to an attorney.

Sources:

forbes.com/health/medicare/does-medicare-cover-assisted-living/

health.ny.gov/health_care/medicaid/program/longterm/alps.htm