For many seniors, the cost of moving into an assisted living community may seem out of reach. However, staying in their home may be challenging even with the help of a caregiver. To help older residents in this situation, many states have created publicly funded Medicaid programs to pay for assisted living services. Many of these programs have similar eligibility requirements, but they can vary significantly. Learning about the available options can help families find care for their loved one at an affordable cost.
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Medicaid is a public insurance program that provides health care to residents with limited income and resources. It’s funded by both the federal and state governments. While the federal government creates requirements, each U.S. state operates Medicaid with the flexibility to design and administer its own programs.
Waivers are a way for states to deliver new health care services that wouldn’t normally be covered by Medicaid.[01] A home and community-based services (HCBS) waiver is a type of Medicaid waiver intended to help seniors and people with disabilities avoid institutional care like a nursing home paid for by Medicaid.[02]Medicaid waivers might reimburse assisted living communities that provide services to eligible residents or pay an agency to provide in-home care, for example.
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The services that Medicaid will cover in assisted living vary by state and depend on the waiver program a senior gets approved for. Generally, the services that Medicaid waiver programs cover in assisted living include the following:
Medicaid alone won’t pay for a resident’s room and board in an assisted living community, although it will for a nursing home. However, some states have created programs to help eligible seniors cover these costs or limit the amount that a community can charge for room and board.
Some states don’t offer assistance with assisted living, but they may instead cover comparable services like in-home care or adult day health care.
The eligibility requirements for assisted living waivers vary from state to state. But many states have similar criteria:
Many states qualify seniors who have higher incomes of up to 300% of the SSI payment, which equaled $2,523 per month for an individual in 2022. Typically, there are also limits on the amount of resources a resident can retain to qualify.
If a senior qualifies for an assisted living waiver, they must then find a community that accepts Medicaid as payment. An estimated 48% of assisted living communities accept Medicaid.[03] Many states provide resources to help residents find assisted living communities that accept Medicaid. If you think your loved one might qualify for Medicaid long-term care, a local Area Agency on Aging could help educate you on your options.
These communities are reimbursed by Medicaid for the services they provide. Each state sets reimbursement rates for different types of services, and the amounts can change from year to year.
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Many states provide Medicaid assistance for services in an assisted living community. The exact rules and regulations for these waiver programs vary. Though not an exhaustive list, the following state-by-state guide provides a general idea of the assisting living waivers and other state programs families can use to pay for care.
Alabama has several Medicaid programs to help adults continue aging in place rather than entering a nursing home.[01] These include the Elderly and Disable Waiver Program, Technology Assisted Waiver for Adults, and the State of Alabama Independent Living (SAIL) Waiver. The state doesn’t offer a Medicaid waiver to cover the cost of assisted living in a residential community.
Alaskans Living Independently (ALI) is a Medicaid waiver program that supports Alaska residents who reside in assisted living.[01] It also covers adult day care, care coordination, respite care, meals, specialized medical equipment, specialized private-duty nursing, transportation services, and health- and safety-related modifications at home.
Eligibility requirements: The ALI waiver is available to Alaska residents age 65+ and people with physical disabilities between the ages of 21 and 64 who would otherwise require a nursing home level of care. An individual’s monthly income must not exceed 300% of the federal SSI payment, which equaled $2,523 in 2022.
The Arizona Long-Term Care System is a Medicaid program that can help residents pay for assisted living. Some of the services that the program may also cover include medical services, behavioral health, care in a nursing facility, and hospice.[04]
Eligibility requirements: To qualify for the Arizona Long-Term Care System, an applicant must be age 65+ or have a disability and require a nursing home level of care. Their income can’t exceed 300% of the SSI, which equaled $2,523 per month in 2022, and assets can’t be greater than $2,000.
In Arkansas, Living Choices is the state’s Medicaid waiver program for assisted living.[01] The program provides seniors with round-the-clock care and supervision in an assisted living community, while enabling them to live independently.
Eligibility requirements: The Living Choices waiver program is available to Arkansas residents between ages 21 and 64 who have a physical disability or seniors age 65+. Applicants must meet certain financial criteria, meet the nursing home criteria at the intermediate level, and need at least one of the available services.[05] The maximum monthly income is 300% of the federal SSI payment, which was $2,523 in 2022.
California’s Assisted Living Waiver (ALW) pays for personal care services in residential care facilities, adult residential care facilities, or public subsidized housing.[01] The program is available at assisted living communities in 15 counties: Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Francisco, San Joaquin, San Mateo, Santa Clara, and Sonoma.[06]
Eligibility requirements: The ALW is available to residents age 21+ with full Medi-Cal eligibility with zero share of costs and care needs equal to Medi-Cal residents living in nursing facilities.
The Elderly, Blind, and Disabled Waiver (EBD) in Colorado pays for services in an assisted living community.[01] These services include 24-hour oversight, medication administration, personal care, and homemaker services.
Eligibility requirements: The EBD waiver is available to Coloradoans age 65+ with functional impairment, residents who are blind, and those age 18-64 who are physically disabled or diagnosed with HIV or AIDS. They must require a level of care comparable to services provided in a nursing facility. Their monthly income must be less than 300% the SSI limit. Individuals must have countable resources less than $2,000, while couples must have countable resources under $3,000.[07]
Connecticut’s assisted living waiver is within the state’s Home Care Program for Elders (CHCPE).[08] The program provides nursing and personal care services to residents of assisted living communities. There are four service package tiers with an increasing amount of personal care and nursing hours, depending on the resident’s level of need.
Eligibility requirements: To be eligible for Connecticut’s assisted living waiver program, an applicant must be 65+ and meet functional and financial requirements. Participants of the program may need to pay a share of the cost or applied income payments. The waiver income limit is 300% of the SSI payment. This was $2,523 monthly for an individual in 2022. The asset limit is $1,600.[09]
Delaware provides help paying for assisted living through the Diamond State Health Plan Plus (DSHP-Plus), a managed care program for seniors and adults with physical disabilities. The program provides a range of services to eligible seniors, including nursing home care, assisted living, and other home-based support.[10]
Eligibility requirements: Delaware residents can qualify for the DSHP-Plus program if they meet medical and financial eligibility standards established by the Division of Medicaid and Medical Assistance. The monthly income limit for an individual is 250% of the SSI. That was equal to $2,102.50 in 2022.
Florida’s Long-Term Care Waiver provides assisted living to seniors and adults with physical disabilities. Besides assisted living services, the waiver pays for more than two dozen home and community-based services and nursing facilities services through the program.[11]
Eligibility requirements: The Long-Term Care Waiver is available to low-income Florida residents age 65+ in need of a nursing home level of care or adults age 18+ who are eligible for Medicaid due to a disability or nursing facility level of care. The monthly income limit is 300% of the SSI payment. In 2022, that equaled $2,523.
Georgia residents can receive assisted living services through the state’s Elderly and Disabled Waiver Program. The program can also provide adult day care, personal care, home-delivered meals, and respite care for family caregivers.[12]
Eligibility requirements: To qualify for Georgia’s assisted living waiver, applicants must be a state resident and age 65+ with physical limitations. Residents younger than 65 can qualify if they meet certain disability requirements. Physician approval for intermediate nursing home care is required. The monthly income limit is 300% of the federal SSI payment, which was $2,523 for an individual in 2022. The asset limit is $2,000.[13]
In Hawaii, the Medicaid program QUEST Integration provides assisted living services to eligible seniors. Some of the other long-term care benefits offered through the program include nursing facility care, adult day care, skilled nursing, and home-based personal care. Additionally, QUEST Integration provides primary and acute care services and behavioral health services.[14]
Eligibility requirements: For an applicant to be eligible for assisted living under the QUEST Integration program, a physician must determine that an applicant has met the required level of care. The applicant’s income cannot exceed the federal poverty level for Hawaii, which was $1,302.50 per month in 2022.
The Aged and Disabled Waiver provides assisted living to eligible residents in Idaho.[01] Some of the other services offered through the Medicaid program include adult day health care, homemaker services, home accessibility adaptations, skilled nursing, medical supplies, and respite care.
Eligibility requirements: The Aged and Disabled Waiver is available to Idaho residents age 65+ who meet a nursing home level of care or those ages 18-64 with disabilities. Their income must not exceed 300% of the federal SSI payment, or $2,523 a month for an individual in 2022.
The Supportive Living Program (SLP) provides assisted living services to eligible adults in Illinois.[01] Services available through the Medicaid waiver include medication oversight, health assessments by licensed nurses, assistance with activities of daily living, laundry, housekeeping, social programming, and meals.
Eligibility requirements: Illinois adults age 22+ with physical disabilities and seniors age 65+ who would otherwise require a nursing facility level of care are eligible for the waiver program. Their income cannot exceed the federal SSI payment, which was $841 monthly for an individual in 2022.
The Aged and Disabled Waiver helps seniors in Indiana afford assisted living.[01] The Medicaid waiver program also offers benefits such as adult day care, homemaker services, home or vehicle modifications, specialized medical supplies, transportation, and home-delivered meals.
Eligibility requirements: The program is available to Indiana residents with disabilities up to age 64 and seniors age 65+ who would otherwise require nursing home care. An individual applicant’s monthly income cannot exceed 300% of the federal SSI payment. That equaled $2,523 in 2022.
In Iowa, the Home- and Community-Based Services Elder Waiver helps seniors pay for assisted living.[01] Under this Medicaid waiver, eligible residents in assisted living can receive help with personal care and 24-hour on-site supervision to help provide safety and security.
Eligibility requirements: Iowa residents age 65+ can qualify for the Home- and Community-Based Services Elderly Waiver if their care needs would require admission to a medical institution. The maximum monthly income for an individual is 300% of the federal SSI payment, which would equal $2,523 in 2022.
Kansas seniors can be provided assisted living services through the Home and Community Based Services for the Elderly waiver.[01] The Medicaid waiver program is designed for low-income seniors who need help with personal care. This waiver also provides other types of services such as adult day care.
Eligibility requirements: The Home and Community Based Services for the Elderly waiver is available to Kansas residents age 65+ who would otherwise require a nursing home level of care. For financial eligibility, a resident’s income can’t be greater than 300% of the federal SSI payment, an amount that equaled $2,523 in 2022.
For most seniors in Kentucky, Medicaid doesn’t pay for assisted living. However, the state has several waivers designed to help provide personal care services.[01]
For instance, the Kentucky Home and Community Based Waiver offers adult day health care, in-home personal care, and home-delivered meals for eligible seniors age 65+ and adults age 18-64 with physical disabilities. The Supports for Community Living (SCL) waiver provides personal assistance to residents with intellectual or developmental disabilities.
Louisiana doesn’t have a Medicaid program that pays for assisted living. Instead, the Community Choices Waiver helps seniors and adults with physical disabilities access services such as adult day health care, home adaptations, assistive devices and medical supplies, in-home caregiving, and home-delivered meals.[01] It serves seniors age 65+ and adults age 21-64 who would otherwise require a nursing home level of care.
MaineCare, which is the name of the Medicaid program in Maine, can provide coverage for assisted living services. These services are provided through residential care facilities licensed by the state. Some of the services they provide include personal care, meals, medication management, and supervision.[15]
Eligibility requirements: To qualify for long-term benefits under MaineCare, applicants must meet the financial and functional requirements of the state plan. Maine assisted living residents can be covered if they’re eligible for SSI, if their countable income is equal to or less than the private pay rate for the facility, or if their countable income is above the private rate but they meet a deductible through medical expenses.[16] An individual applicant’s countable assets are limited to $2,000, but they’re allowed a bank account or investment accounts up to $8,000, too.[17]
In Maryland, the Community Options waiver covers assisted living for qualified seniors and adults with disabilities. The Medicaid waiver provides personal care, nurse monitoring, assistive technology, physician care, and other important services. It’s designed for residents who need help with activities of daily living.[18]
Eligibility requirements: To be eligible for the Community Options waiver, an applicant must be a Maryland resident who would otherwise need a nursing home level of care. An individual’s monthly income can’t exceed 300% of SSI, which equaled $2,523 per month in 2022. Their countable assets must not be greater than $2,000 or $2,500, depending on the category.
Massachusetts seniors can receive assisted living services through the Moving Forward Plan Residential Supports Waiver.[19] The Medicaid waiver enables seniors age 65+ or adults with disabilities who’ve resided in a nursing home or long-term care hospital for at least 90 days to return to their community. This could include moving into an assisted living community. Services could include homemaking, personal care, meals, chores, and other support.
Eligibility requirements: In addition to residing in a nursing home for at least 90 days, Massachusetts seniors must meet certain financial requirements for the Moving Forward Plan Residential Supports Waiver. An individual applicant’s monthly income can’t be more than 300% of SSI, an amount of $2,523 in 2022. Countable assets must not exceed $2,000.
The Michigan Choice Waiver Program provides assisted living and home-based services to seniors and adults with disabilities.[01] Seniors who choose a community residential setting can live in smaller group homes or larger-size homes for the aged. Some of the services included under the waiver are nursing, personal care, and transportation.
Eligibility requirements: To be eligible for the Michigan Choice Waiver Program, an applicant must be a senior age 65+ or an adult ages 18-64 with disabilities and require a nursing home level of care. They must require at least two services provided under the waiver, one of which must be the coordination of necessary services and supports. To be financially eligible, an individual applicant can’t have an income that exceeds 300% of the SSI, which was $2,523 in 2022.
Eligible seniors in Minnesota can receive assisted living services through the state’s Elderly Waiver.[01] The Medicaid waiver program also provides home care services for seniors who want to keep living in their own residence. Though the waiver doesn’t pay for room and board at assisted living communities, applicants may be eligible for assistance with these expenses through the Housing Supports program.
Eligibility requirements: To qualify for Minnesota’s Elderly Waiver, an applicant must be 65+ and require a nursing home level of care as determined through an assessment. Applicants whose income falls below the federal poverty level are eligible for the program. Additionally, they can become eligible by spending down their income with applicable expenses like paying for health insurance or qualifying services. The countable asset limit for most seniors is $3,000.[20]
Mississippi provides the Assisted Living Waiver to seniors who would otherwise require care in a nursing home.[01] Under this Medicaid waiver, eligible seniors and adults with disabilities can receive services such as personal care, medication administration, transportation, social programming, and intermittent skilled nursing.[21]
Eligibility requirements: The Assisted Living Waiver in Mississippi is available to state residents age 21+ who meet the eligibility requirements as determined through a screening process. The screening assesses the applicant’s medical conditions, cognitive or sensory deficits, behaviors, and need for assistance with activities of daily living. They must be financially eligible for Medicaid as an SSI recipient, or their monthly income must not exceed 300% of the SSI benefit, which equaled $2,523 in 2022.
In Missouri, the Supplemental Nursing Care program can help eligible residents pay for services in assisted living. The program from MO HealthNet (Missouri Medicaid) provides a varying amount of financial assistance depending on the participant’s level of need.[22]
Eligibility requirements: To qualify for the Supplemental Nursing Care program in Missouri, an applicant must be 21+ and demonstrate a medical need through an assessment. There must be a deficit when the applicant’s income is subtracted from the assisted living facility charge.
Montana seniors can get help paying for assisted living through the Big Sky Waiver Program, which helps residents who need a nursing home level of care. Some of the assisted living services provided under this Medicaid waiver include transportation, homemaker services, personal care, periodic nursing evaluations, and medication administration.
Eligibility requirements: To be eligible for the Big Sky Waiver Program, Montana residents must qualify for Medicaid and meet the minimum level of care requirements for being placed in a nursing facility. They must have a need that can only be met through the waiver program.[23]
For Nebraska seniors, the Aged and Disabled Waiver can help cover the cost of assisted living.[01] Some of the services available through this Medicaid waiver include assistance with activities of daily living, housekeeping, social activities, laundry, medication assistance, and transportation.
Eligibility requirements: The Aged and Disabled Waiver in Nebraska is available to anyone with a disability or seniors age 65+ who need a nursing home level of care. To be financially eligible, an individual’s income must not exceed 100% of the federal poverty level, which was $1,132 per month in 2022. Applicants who are medically needy can become eligible by spending down their income to the medically needy income level, which is $392 for an individual.
Nevada’s Home and Community Based Waiver for the Frail Elderly helps seniors pay for certain services in assisted living.[01] The Medicaid waiver program includes augmented personal care, which is care that goes beyond the mandatory services required for residential care facilities. There are four levels of augmented personal care, ranging from minimum assistance such as supervision over activities of daily living to critical behaviors that require the full attention of assisted living staff.
Eligibility requirements: Nevada seniors age 65+ who are at risk of being admitted to a nursing home can qualify for the state’s Home and Community Based Waiver for the Frail Elderly. Individual applicants with income up to 300% of SSI payments can qualify.
The Choices for Independence Program in New Hampshire helps seniors pay for services in assisted living.[01] Some of the residential care facility services that can be provided under the Medicaid waiver include personal care, 24-hour supervision, transportation, and dietary planning.
Eligibility requirements: New Hampshire residents age 65+ and adults between 18 and 64 who have disabilities may be eligible for the Choices for Independence Program if they would otherwise require care in a nursing facility. Individuals with income less than 300% of SSI, which was $2,523 per month in 2022, may be financially eligible. Medically needy applicants can also become eligible by spending down their income.
Assisted living is covered under New Jersey Medicaid’s NJ FamilyCare, a managed-care program designed to expand home- and community-based services in the state.[24] The program offers comprehensive services and supports to residents in assisted living.
Eligibility requirements: To be eligible for assisted living provided under NJ FamilyCare, an applicant must be at least 21 and meet the need for a nursing home level of care. This means they require assistance with at least three activities of daily living. Their income cannot exceed 300% of the SSI monthly payment, which was $2,523 in 2022. The asset limit is $2,000.
New Mexico seniors can receive help paying for assisted living through Centennial Care, the state’s Medicaid program. Specifically, the Community Benefit program offers assisted living services for residents who require a nursing home level of care.[25]
Eligibility requirements: New Mexico residents who are already enrolled in full coverage Medicaid and receive health care through a Medicaid-managed care organization may be eligible for the Community Benefit program. The maximum allowable income is $2,523 per month with an asset limit of $2,000.[26]
New York’s Assisted Living Program helps seniors in the state pay for assisted living. The Medicaid program provides personal care, housekeeping, supervision, nursing, therapies, and other services.
Eligibility requirements: To be eligible for the Assisted Living Program, applicants must be medically eligible for a nursing home but not require continual nursing care. The program is limited to 4,200 participants. An applicant cannot have an income greater than the federal benefit rate added to the state supplemental payment amount.[27] The asset limit was $15,900 in 2021.
The State-County Special Assistance Program helps North Carolina seniors pay for assisted living.[28] Referred to as adult care homes or family care homes, these licensed communities offer help with activities of daily living and 24-hour supervision. Seniors with Alzheimer’s disease or another type of dementia can live in special units within a community, and the program offers a different rate of assistance to these residents.
Eligibility requirements: North Carolina residents must be 65+ or disabled to qualify for the State-County Special Assistance Program. The state will analyze an applicant’s special assistance needs, income, and assets to determine eligibility.
In North Dakota, the Medicaid Waiver for Home and Community Based Services can help seniors pay for assisted living. Some of the services provided in residential care communities may include personal care, social programming, and 24-hour supervision.
Eligibility requirements: To qualify for North Dakota’s Medicaid Waiver for Home and Community Based Services, state residents must be 65+ or disabled and meet income and eligibility requirements for Medicaid. Applicants also must be capable of directing their own care and living in their own home or an apartment.
The Assisted Living Medicaid Waiver program in Ohio helps eligible residents cover the cost of assisted living.[29] Through this program, participants receive help paying for care services and use their own resources to pay for room and board. These services could include personal care, nursing, transportation, help with medications, social activities, and housekeeping.
Eligibility requirements: To be eligible for the Assisted Living Medicaid Waiver in Ohio, an individual must be 21+ and need assistance with activities of daily living. They also must meet the financial criteria for Medicaid eligibility and have the ability to pay the state’s monthly room and board rate. This rate is equal to the SSI payment minus $50. In 2022, that equaled $791 per month for an individual.
The Advantage Waiver Program covers assisted living in Oklahoma.[01] Under this Medicaid program, seniors and adults with disabilities can receive help paying for services in an assisted living community. Some of these services include help with personal care, housekeeping, laundry, periodic nursing evaluations, medication administration, social programming, and transportation to medical appointments.
Eligibility requirements: To be eligible for the Advantage Waiver Program, an Oklahoma resident must be 65+ or an adult with a disability and require a nursing home level of care. They cannot have a diagnosis of intellectual disabilities or cognitive impairment, and their needs must be met by the services provided under the waiver.
Oregon residents may be eligible for help paying for assisted living through the Oregon Health Plan, which is the state’s Medicaid program.[30] Assisted living facilities and residential care facilities in the state must offer 24-hour supervision, meals, personal care services, medication management, recreational activities, laundry, housekeeping, and transportation, among other services.
Eligibility requirements: Low-income individuals who demonstrate a need for long-term care services may be eligible for assisted living through Medicaid in Oregon. They also must qualify financially for Medicaid.
Pennsylvania’s Medicaid program doesn’t generally pay for care in assisted living communities, which are referred to as personal care boarding homes by the state.[31] Only about 4% of assisted living residents in the state rely on Medicaid for their long-term care needs.[03] However, the state adds a supplement to the federal SSI payment to eligible residents of personal care boarding homes. In 2022, this combined amount was $1,280.30 per month for an individual.[32]
Rhode Island’s Medicaid program can help seniors pay for assisted living and other long-term services and supports.[33] These could include both medical care and other services such as help with activities of daily living.
Eligibility requirements: To be eligible for Medicaid-funded assisted living in Rhode Island, an applicant must be 65+ and require a “high” level of care as determined by the state. If an individual’s monthly income exceeds $878, they may pay for a share of the cost of long-term care. Additionally, their assets must be less than $4,000.
South Carolina residents can receive help with assisted living services through the Community Choices Waiver.[01] This Medicaid waiver program may provide residential personal care, which could include help with activities of daily living, medication monitoring, laundry, housekeeping, and transportation.
Eligibility requirements: For eligibility in the Community Choices Waiver program, a South Carolina resident must be 65+ or an adult with a disability and require a nursing home level of care. An individual applicant’s income cannot exceed 300% of SSI, which was $2,523 per month in 2022.
The HOPE Waiver in South Dakota can help eligible seniors pay for assisted living.[34] Through the Medicaid waiver, residents may receive assistance with services such as personal care, chores, meal preparation, and 24-hour supervision.
Eligibility requirements: To be eligible for the HOPE Waiver, residents of South Dakota must be age 65+ or an adult with a disability and meet a nursing home level of care. An individual’s monthly income cannot exceed 300% of SSI, which was $2,523 per month for an individual in 2022. Their asset limit is $2,000.
TennCare, which is Tennessee’s state Medicaid program, offers the CHOICES program to help pay for assisted living.[35] The program will assist residents of assisted living communities with personal care, homemaker services, and taking medications.
Eligibility requirements: To qualify for the CHOICES program, a Tennessee resident must require a nursing home level of care. Additionally, their income can’t exceed 300% of SSI, which is $2,523 per month for an individual. Their assets can’t be greater than $2,000.
Texas residents can get help paying for assisted living through STAR+PLUS, the state’s Medicaid managed care program for adults with disabilities and seniors age 65+.[36] Assisted living services are offered through the STAR+PLUS Home and Community-Based Services Waiver.
Eligibility requirements: Texas residents may be eligible for assisted living services through STAR+PLUS if they’re approved for Medicaid. Applicants may also qualify if they’re age 21+, receiving SSI benefits, and qualified for Medicaid based on income; able to get STAR+PLUS Home and Community-Based Services; receiving Medicaid while in a nursing home; in the Medicaid for Breast and Cervical Cancer Program; or getting Medicaid through Social Security Exclusion programs.
The New Choices Waiver helps Utah seniors who’ve been living in a Medicaid-funded nursing home, assisted living community, or small health care facility.[37] Through this program, eligible residents can get assistance moving back home or into an assisted living community as long as their needs are safely met there.
Eligibility requirements: To be eligible for New Choices Waiver, an applicant must be age 18+ and satisfy Utah Medicaid financial requirements. Additionally, they must be receiving Utah Medicaid-reimbursed care in a nursing facility for at least 90 days, receiving reimbursed care in a medical institution for at least 30 days and discharge into a nursing facility for 60 days or more, receiving reimbursed services through a Utah home and community-based waiver and need nursing care, or residing in an assisted living community or small health care facility for at least 365 days.
Vermont’s Choices for Care program can help eligible residents pay for assisted living or a residential care home.[38] Services the Medicaid program may provide include personal care, meal preparation, medication management, nursing overview, activities, 24-hour supervision, laundry, and housekeeping.
Eligibility requirements: The Choices for Care program requires that Vermont residents be age 65+ or an adult with a disability and require a nursing home level of care. They must meet certain financial criteria for long-term care Medicaid in Vermont.
Virginia doesn’t have a state Medicaid program that will pay for assisted living. The state’s Adult Services Program does have an initiative to provide assisted living facility assessments.[39]
The Medicaid Personal Care program within Washington’s Medicaid State Plan helps seniors pay for assisted living.[40] Some of the services provided by the program include assistance with activities of daily living, medication management, meal preparation, and housework.
Eligibility requirements: To be eligible for the Medicaid Personal Care Program, a Washington resident must be age 65+ or considered disabled. They must need assistance with at least three activities of daily living, and their monthly income can’t exceed $841 for an individual.
The Elderly and Persons with Physical Disabilities (EPD) waiver covers assisted living for eligible residents in Washington, D.C. In addition to helping pay for assisted living, the program provides services to help people continue living in their home.[41]
Eligibility requirements: To be eligible for the EPD waiver in Washington, D.C., residents must be 65+ or ages 18-64 with a physical disability. They also must receive a prescription order form from a D.C. Medicaid provider, complete an assessment to establish a level of need, and have countable assets of less than $4,000 and countable income of 300% of the SSI payment. That amounted to $2,523 a month in 2022. Residents can also become financially eligible through a Medicaid spend down.
The Medicaid Personal Care Program in West Virginia is generally for residents who need assistance to continue living in their home.[42] It provides help with activities of daily living, light housekeeping, and health-related tasks. In certain instances, these services can be offered in an assisted living community if they don’t duplicate or replace services already offered by the facility and they’re approved. Only about 1% of West Virginia assisted living residents rely on Medicaid for long-term care.[03]
Eligibility requirements: A West Virginia resident must require assistance with at least three activities of daily living to be eligible for the Medicaid Personal Care Program. Additionally, they must meet the Medicaid program’s financial eligibility requirements.
In Wisconsin, Family Care is a Medicaid long-term care program that can help seniors pay for assisted living.[43] The program can assist eligible residents with personal care in adult family homes, community-based residential facilities, or residential care apartment complexes. Additionally, the Include, Respect, I Self-Direct (IRIS) program can similarly help adults find care in an assisted living community.[44]
Eligibility requirements: Wisconsin’s Family Care program is available to Medicaid-eligible adults with disabilities or seniors with functional needs as determined through a screening. They must have a long-term condition that will last longer than 90 days, which could include dementia or terminal conditions. The IRIS program is open to Wisconsin adults who meet the functional level of care. Their income can’t exceed 300% of SSI. Participants may need to pay for a share of costs if their income is greater.
The Community Choices Waiver in Wyoming can help seniors pay for assisted living. Through this Medicaid program, eligible residents can receive personal care and supportive services in a residential setting with 24-hour supervision.[45]
Eligibility requirements: Wyoming residents are eligible for the Community Choices Waiver program if they’re age 65+ or an adult with a disability and in need of a nursing home level of care. Their income can’t be greater than 300% of SSI, which was $2,523 per month for an individual in 2022.
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South Dakota Department of Human Services. Long term services and supports: Home and Community-Based Options and Person Centered Excellence (HOPE) Waiver.
Division of TennCare. What home care services are covered in CHOICES?
Texas Health and Human Services. STAR+PLUS.
Utah Department of Health. New Choices Waiver.
Disabilities, Aging and Independent Living Adult Services Division. Choices for Care Program.
Department for Aging and Rehabilitative Services Adult Protective Services. Adult services.
Washington State Health Care Authority. (2021, April 23). Medicaid personal care.
Department of Aging and Community Living. Elderly and Persons with Disabilities Waiver. DC.gov.
West Virginia Department of Health and Human Resources Bureau for Medical Services. (2017, December 19). Chapter 517 personal care services.
Wisconsin Department of Health Services. (2022, July 11). Family Care: benefits.
Wisconsin Department of Health Services. (2022, September 29). IRIS (Include, Respect, I Self-Direct).
Wyoming Medicaid Division of Healthcare Financing. (2020, October). Community Choices Waiver: Participant Handbook.
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