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What Does Medicaid Pay For Assisted Living Private Room?

Medicaid has limitations on what it will pay and will not pay. Assisted living facilities are not covered by Medicaid in most states.

Medicaid primarily pays for medical needs that include physician care, hospital care, nursing home care, and prescribed medicines. There are certain limitations that apply to Medicaid in all fifty states.

Does Medicaid Pay for Assisted Living in a Private Room?

The general answer is no. Medicaid will pay for long term care in a nursing facility that is structurally set up similar to a hospital. However, in none of the fifty states does Medicaid pay for private rooms in assisted living facilities. In forty-two states there are no provisions for religious non-medical long term care facilities. Only nine states and territories include physician care and per diem care for the facility.

The Medicaid benefits for institutional care are primarily limited to mental health issues or rehabilitation programs. The number of days covered is limited by state.

Will Medicaid Pay for Assisted Living Within My Own Residence?

Long term care outside a nursing home facility is generally not available. Medicaid beneficiaries will find a deficit between nursing home came and home care. However, under the PACE program set up in 1997, enrollees may use Medicaid benefits to pay the costs of transportation, therapy, meals in some cases and acute nursing care within their own homes or residences.

For the Medicaid beneficiary who wishes to maintain a somewhat independent lifestyle, the PACE program available in many areas of the country will serve their needs. PACE is as close to private assisted living as Medicaid will come. Availablity of the PACE program may not be found in all parts of the country. However, for those area with the PACE program, Medicaid will pay benefits for the enrollee allowing the beneficiary to live as independently as possible.



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