On the whole, no ALs are not covered by Medicaid. Medicare is a health insurance and does not cover Longterm care.
You may want to call your Social Service office and talk to a Medicaid caseworker to see if there are any scenarios where an AL may be covered. In my State, Medicaid may cover ur AL after at least 2 years of paying privately. That depends if the AL excepts Medicaid and how many recipients they already have.
Medicaid will pay for Longterm care if the person fits the criteria. The person must be 24/7 care. Assets no more than the cap allowed, in my state 2k. There is a cap for monthly income (Social Security and pension), my state a little over $2300. Some states allow Miller Trusts if the person goes over the income limit.
I had no problem seeing a Medicaid caseworker to help me with Moms application. I was given a list of information I had to supply. Her house was not considered an asset but was for sale. I did everything by email except for the 5 years of bank statements needed. TG Mom had saved hers so no problem there. She was able to pay two months privately so that gave me time to get everything together for Medicaid. I think because I was involved with process things went pretty smoothly. My State only gives 90days, to apply, spend down, produce info needed and find placement.
It is totally dependent on if your States Medicaid program has chosen to seek a waiver from the dedicated funding that your State gets to provided for skilled nursing care services in a long term care facility aka LTC SNF/NH from the federal government (& which state govt does a % match based on demographics & why census is mucho importante).
Most states do NOT seek an AL waiver at all.
States that do will likely have small list of AL actually participating as the reimbursement is low and the reporting requirements etc to the State are heavy. Plus it is funded on a 3-5 yr cycle so if $ gets stopped that AL is stuck with impoverished residents who cannot private pay. Most AL can easily fill their rooms with private pay so no need to even think abt being “Medicaid”.
My moms IL was in a tiered facility that ran from IL to AL to NH and a hospice wing. It did participate in the TX AL waiver program at the time, but it was a handful of beds from the AL and realistically they were residents already in AL who had gotten way more frail and were waiting for an open bed in the NH sector. They became “duals” aka on MediCARE and Medicaid once in one of these AL beds and went into a shared room. On the facilities part this was a smart move as it kept occupancy full plus easy transition of care and records. The irritating 😠 part personally was that we were lead to believe that mom would seamlessly go from IL to AL to NH and go on Medicaid when her $ ran out…. that didn’t happen. A learning experience!
What states tend to do instead of AL waivers is to seek a waiver to provide for community based program for those that otherwise might could need a placement in a LTC SNF/NH but would rather continue to live in their home or live with a family member. If your community has a PACE center, it’s mainly funded from a “waiver” from Medicaid $. For PACE, their Medicaid waiver $ spreads out over a larger # and viewed as better use of funding than 1-1 AL payments. States do it for 5-7 yr funding cycles. We have one nearby - the Benson Center - and it’s a great use of the waiver. Look to see if there’s a PACE program in your areas, it might be a good gap program till your elder is clearly showing they need to be in a NH.
ALF not covered by medicare and I THINK not by medicaid. This is something for you to ASK at the ALFs in your area that interest you. Give the admins a call. It was clear in all of our intake papers at my brother's ALF that it was self pay. Written in black and white.
4 Answers
Helpful Newest
First Oldest
First
You may want to call your Social Service office and talk to a Medicaid caseworker to see if there are any scenarios where an AL may be covered. In my State, Medicaid may cover ur AL after at least 2 years of paying privately. That depends if the AL excepts Medicaid and how many recipients they already have.
Medicaid will pay for Longterm care if the person fits the criteria. The person must be 24/7 care. Assets no more than the cap allowed, in my state 2k. There is a cap for monthly income (Social Security and pension), my state a little over $2300. Some states allow Miller Trusts if the person goes over the income limit.
I had no problem seeing a Medicaid caseworker to help me with Moms application. I was given a list of information I had to supply. Her house was not considered an asset but was for sale. I did everything by email except for the 5 years of bank statements needed. TG Mom had saved hers so no problem there. She was able to pay two months privately so that gave me time to get everything together for Medicaid. I think because I was involved with process things went pretty smoothly. My State only gives 90days, to apply, spend down, produce info needed and find placement.
Most states do NOT seek an AL waiver at all.
States that do will likely have small list of AL actually participating as the reimbursement is low and the reporting requirements etc to the State are heavy. Plus it is funded on a 3-5 yr cycle so if $ gets stopped that AL is stuck with impoverished residents who cannot private pay. Most AL can easily fill their rooms with private pay so no need to even think abt being “Medicaid”.
My moms IL was in a tiered facility that ran from IL to AL to NH and a hospice wing. It did participate in the TX AL waiver program at the time, but it was a handful of beds from the AL and realistically they were residents already in AL who had gotten way more frail and were waiting for an open bed in the NH sector. They became “duals” aka on MediCARE and Medicaid once in one of these AL beds and went into a shared room. On the facilities part this was a smart move as it kept occupancy full plus easy transition of care and records. The irritating 😠 part personally was that we were lead to believe that mom would seamlessly go from IL to AL to NH and go on Medicaid when her $ ran out…. that didn’t happen. A learning experience!
What states tend to do instead of AL waivers is to seek a waiver to provide for community based program for those that otherwise might could need a placement in a LTC SNF/NH but would rather continue to live in their home or live with a family member. If your community has a PACE center, it’s mainly funded from a “waiver” from Medicaid $. For PACE, their Medicaid waiver $ spreads out over a larger # and viewed as better use of funding than 1-1 AL payments. States do it for 5-7 yr funding cycles. We have one nearby - the Benson Center - and it’s a great use of the waiver. Look to see if there’s a PACE program in your areas, it might be a good gap program till your elder is clearly showing they need to be in a NH.
ADVERTISEMENT