Will Medicare or Medicaid Pay for Assisted Living?

Quick Answer

Medicare does not pay for assisted living. Medicaid may cover it, but only in states that offer the right waivers and only after you meet strict financial and functional criteria.

Medicare and Assisted Living

Original Medicare (Parts A and B) is structured around skilled medical care, not room and board. It will cover a short stay in a skilled nursing facility after a qualifying hospital admission, but it stops once you no longer need daily skilled care. It does not pay for the personal care and housing that assisted living provides, even if you need help with medications or mobility.

When Medicaid Can Help

Medicaid is the primary public payer for long-term care in the United States, and it can sometimes pay for assisted living through state-specific programs:

• Section 1915(c) Home and Community-Based Services (HCBS) waivers: These let states cover assisted living as an alternative to nursing homes, but they have limited slots and income caps.
• State plan personal care services: Some states include assisted living under their regular Medicaid plan for eligible beneficiaries.
• Aged, Blind, and Disabled (ABD) Medicaid: If you qualify financially, some states allow Medicaid funds to be applied toward room and board in an assisted living facility.

Financial Eligibility

Medicaid is needs-based. To qualify, your income and assets must fall below your state's limits. Most states require you to spend down excess assets on care before Medicaid begins paying. Asset rules vary, and certain assets like a primary home may be exempt depending on state policy and whether a spouse remains at home.

What You Should Do Now

Because rules differ by state, contact your state Medicaid office or a local Area Agency on Aging to ask whether your state covers assisted living through a waiver or state plan, what the income and asset limits are, and whether there is a waiting list. A social worker at the facility you are considering can also help you apply.