Medicaids Benefits For Assisted Living Facility Residents
Assisted living facilities are a housing option for people who can still live independently but who need some assistance. Costs can range from $2,000 to more than $6,000 a month, depending on location. Medicare wont pay for this type of care, but Medicaid might. Almost all state Medicaid programs will cover at least some assisted living costs for eligible residents.
Unlike with nursing home stays, there is actually no requirement that Medicaid pay for assisted living, and no state Medicaid program can pay directly for a Medicaid recipients room and board in an assisted living facility. But with assisted living costs roughly half those of a semi-private nursing home room, state officials understand that they can save money by offering financial assistance to elderly individuals who are trying to stay out of nursing homes.
As of May 2016, 46 states and the District of Columbia provided some level of financial assistance to individuals in assisted living, according to the website Paying for Senior Care, which features a State by State Guide to Medicaid Coverage for Assisted Living Benefits that gives details on each states programs. According to the website, the Medicaid programs of Alabama, Kentucky, Louisiana and Pennsylvania are the only ones that provide no coverage of assisted living, although non-Medicaid assistance may be available.
For more about assisted living communities, .
Free Assisted Living Resources In Michigan
Michigan has several government agencies and various nonprofits that assist aging citizens who need help with their transition into assisted living, as well as for those who could use a helping hand before or after they have gotten settled in.
These organizations are especially helpful if you are looking into the different senior care and financing options available to you or the senior you love.
Michigan Area Agencies on Aging
The Area Agencies on Aging is a nationwide service that maintains some of its 600 offices in every major city in Michigan. This national nonprofit provides seniors and their families with information to help them find long-range senior care options and caregiver support resources, such as respite care and support groups. The agency also helps connect seniors with low- or no-cost money management programs, transportation options that go beyond public transit, and even meal services to supplement their diets.
See below for a list of the AAA offices in the state and their contact information.
Michigan Mi Choice Waiver Program
Medicaid will not directly cover the cost of assisted living in Michigan. However, they offer the MI Choice Waiver which covers personal care services to help with tasks such as taking a bath, shaving, getting dressed, and walking. Unlike Medicaid, the waiver only has a certain number of enrollment slots available, so when those are filled, you may be put on a waiting list.
The MI Choice Waiver does not cover room and board expenses. They do, however, offer community transition services for elderly who want to move from an institution to assisted living. The transition services help with security deposits, essential furnishings, and set-up fees or deposits for utility services.
Who Is Eligible?
Residents interested in applying for the MI Choice Waiver need to be financially eligible for Medicaid as well as meet the following qualifications:
- Age 65 or older
- Monthly income for a single resident must not exceed $1,012 , and assets must be $2,000 or less
- Monthly income for married residents must not exceed $1,372 , and assets must be $2,000 or less
- Meet nursing home level of care but prefer assisted living
If approved for the waiver, a registered nurse and social worker will do an in-home visit with the resident and his or her family and friends. At that time, a service plan based on what the resident wants will be created.
How to Apply
Can I Get Financial Assistance For Assisted Living Facilities
If you purchased a long-term care insurance policy, you may also qualify for benefits to cover assisted living facilities check your policy documents for more information.
Problems In Mi Choice
If you are a MI Choice participant and have a problem with your waiver agency or caregivers, you have a number of options available to you. Depending on the problem you have, some of the options discussed here may be more appropriate than others. You can also consider doing more than one of the things listed here at the same time.
1. Document the problem and any specific incidents. This will make a record of what happened and could be helpful if youre taking some of the other actions listed below.
2. If you are having a problem with the person who is providing your care, talk with that person to try to fix the problem informally. Your caregiver may be willing to work with you to fix the problem.
3. Talk with your supports coordinator to try to fix the problem. Part of your supports coordinators job is to make sure the MI Choice Waiver program is working for you and that you have an appropriate plan of service and are getting the services included in that plan.
4. If you are having a problem with the person providing your care and that person works for an agency, file a complaint or grievance with the agency, if it has a process for you to do so. You may be able to file a formal complaint with the agency . If there is a way for you to do this, the agency should investigate and respond to your complaint.
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Which States Cover Assisted Living
Currently, 44 states will fund a portion of the cost of Assisted Living through Medicaid, but not all will do so in the same way.
Keep in mind that this service may be referred to differently in various states, such as board and care homes, adult family care, alternative care facilities, dementia care homes, and congregate living.
The following states allow Medicaid to cover Assisted Living:
Although your state might be on this list, bear in mind that each has its own set of rules and restrictions. The greatest thing you can do is call your local AAA or Area Agency on Aging for further information.
Furthermore, you may always call your Medicaid representative and ask them directly about anything that concerns you.
Assisted Living Medicaid Policy
Michigans Medicaid only pays for skilled nursing care or therapy services when it comes to home care in an assisted living facility. However, the doctor must prescribe those services as part of the plan of care. Furthermore, the services must be needed on a temporary basis, which is to cure and rehabilitate.
If you or your elderly loved one needs ongoing services to help with activities of daily living, medication management, and/or other services and nursing care, the MI Choice Waiver is an option to look into.
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The State By State Guide To Medicaid For Assisted Living
Everyone wants to know: does Medicaid cover assisted living costs? And yet, everyone gets a different answer. Largely because whether or not Medicaid covers assisted living costs is dependent on which state you or youre loved one is a resident of.
The good news is that while Medicaid now provides some level of financial assistance for qualifying seniors assisted living in 44 states and D.C. Of course, what is classified as assisted living also varies by state, so youll need to do some research. To help you get the information youre looking for, we compiled the state-by-state master list of Medicaid benefits and availability for assisted living services. Find your state below for specific state-level Medicaid information.
What Is The Program Of All
The Program of All-Inclusive Care for the Elderly is a program for people over age 55 who need nursing facility level of care. The goals of this program are to enhance your quality of life and autonomy, maximize your dignity, enable you to live in the community for as long as possible, and preserve and support your family unit.
When you are a PACE participant, you have an interdisciplinary team that coordinates all of your services, including Medicare, Medicaid, and other services. Your team will assess your needs, develop a plan of care, and monitor how your services are being provided. Usually, PACE organizations provide social and medical services in an adult day health center and also provide necessary home and other services.
Services must include, but are not limited to:
Adult day care that offers nursing, physical, occupational and recreational therapies, meals, nutritional counseling, social work and personal care
All primary medical care provided by a PACE physician familiar with the history, needs and preferences of each beneficiary
All specialty medical care
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Does Medicare Advantage Pay For Assisted Living
Medicare Part C, more commonly known as Medicare Advantage, provides the same coverage you get with Original Medicare. The plans are sold by private insurance companies working under the guidance of the Centers for Medicare and Medicaid Services .
All Medicare Advantage plans must provide the same benefits you have with Original Medicare. However, they are not limited to this coverage and most Advantage plans provide additional benefits. The most common is prescription drug coverage, which is included with around 90 percent of Part C plans. Routine dental care, prescription glasses, and hearing aids are also common extra benefits when you join an Advantage plan.
Since the plans are provided by private health insurance companies, coverage and benefits vary according to the plan. Although long-term care is rarely covered by health insurance, check the plan’s details carefully for more information. You can also call the plan provider.
To compare Medicare Advantage plans, just enter your zip code into our Find a Plan tool.
Home Health Care And Assisted Living
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How Much Income And Assets A Spouse Can Keep
If you have a spouse who is going to continue to live independently, then Michigan will allow you to keep more income and assets to support that spouse. This is called spousal maintenance.
Your spouse will be allowed to keep some income each month. The amount will depend on how many dependents and expenses he or she has. In 2019, the minimum amount your spouse can keep is $2,057.50, and the maximum is $3,090. If your spouse needs more than the Department of Health & Human Services decides to allow, then you can go to court and ask a judge to order more.
You will also be allowed to keep more than $2,000 in resources if you have a spouse who will remain in the community. The Department of Human Services does a complicated calculation to determine how many assets your spouse can keep.
When you are admitted to a nursing home, you will complete a form called an “Assets Declaration,” and the staff will do ask you about all of your assets in an “Initial Asset Assessment” . Michigan assumes that half of your IAA should belong to your spouse, subject to a limit that changes annually. In 2019, the minimum “Protected Spouse Amount” is $25,284, and the maximum is $126,420. When you apply for Medicaid, your PSA is subtracted from your countable assets at the time of your application.
How Do Seniors Pay For Assisted Living Facilities
Most families cover assisted living costs using private funds, usually a combination of savings, Social Security benefits, pension payments and retirement accounts. When it comes to out-of-pocket room and board costs, long-term care can quickly become expensive. A licensed GoHealth insurance agent can help you understand your options.
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How Do I Find Out If Im Eligible For Medicaid
Eligibility criteria will vary by state. The general requirements are that individuals:
- Spend almost all of existing assets toward care
- Are low-income earners or have medical-related care expenses that exceed income
- Live in the state where they are receiving benefits
- Be a permanent resident or U.S. citizen
When A Nursing Home Is Medically Necessary
Medicaid will pay for a nursing home only when it is medically necessary. You must show that you require a “nursing home level of care,” meaning that you have a physical or mental condition that requires nursing supervision and assistance with activities of daily living .
Within the first two weeks after you are admitted to a nursing facility, Medicaid requires that you have a “Level of Care” determination. In Michigan, nursing facility staff do the LOC determination using an online state system.
To determine the level of care you need, nursing facility staff will ask you questions to determine how much assistance you need with your ADLs. The ADLs that Michigan uses to determine whether you meet the nursing home level of care are: bed mobility, transfers, eating, toileting, short-term memory, cognitive skills for decision-making, and making yourself understood. For each, the assessor will decide how much assistance you need and assign you a functional level. The levels are: Independent, Supervision, Limited Assistance, Extensive Assistance, Total Dependence or Activity Did Not Occur. For example, if you usually cannot get up from a chair without someone helping you, then the assessor may say that you need limited assistance with transfers.
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Unlicensed Assisted Living Facility
Because unlicensed assisted living facilities are not regulated by the state, there arent any specific rights guaranteed to residents in these facilities. You should look at your contract with the facility to see if it says what rights you have as a resident of that facility. You can also ask the staff or administration at the facility if they have a resident rights policy, and if so, if you can have a copy of it.
For some options you may have if any of your rights are being violated, see What Do I Do If I Have a Problem With My Long-Term Care Provider? below.
When you are a MI Choice participant, you have a number of important rights. Some of the rights you have are:
These rights and others are spelled out in the MI Choice Waiver Participant Handbook. You can download a copy of this Handbook here.
For some options you may have if any of your rights are being violated, see What Do I Do If I Have a Problem With My Long-Term Care Provider? below.
Paying For Assisted Living With Va Benefits
Low-income wartime veterans and their surviving spouses may qualify for either Aid and Attendance or Housebound benefits through the U.S. Department of Veterans Affairs .
Aid and Attendance eligibility starts with receiving a VA pension. In addition, you must meet at least one of the following qualifications:
- Require assistance with activities of daily living
- Are confined to bed rest due to illness
- Have a mental or physical disability that requires nursing home care
- Have limited eyesight even when wearing prescription lenses
Veterans may also qualify for Housebound benefits if they have a permanent disability that forces them to spend most of their time at home.
To apply, use the VA link above. Please note that you cannot receive both of these benefits.
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When Is It Time For Assisted Living
The transition to assisted living usually occurs when someone is no longer able to live independently and needs help with some or all of the activities of daily living . Slow decline in health, memory loss, or even an event like a fall can lead to the realization that living with assistance is a better option than living in a way that is unsafe or lonely. If youre unsure if youre loved one should be in assisted living, its a good idea to talk to them about how theyre managing their daily activities. Consulting a trusted medical professional and even assisted living communities can also be helpful in assessing if your loved one needs care and the level of care they require.
Finding Out About And Appealing Negative Actions
If DHHS evaluates you for Home Help and decides you dont qualify, they will send you an Adequate Negative Action Notice which must explain why you dont qualify.
If DHHS plans to reduce, suspend, or terminate your Home Help services, it generally has to give you an Advance Negative Action Notice at least 10 days before your services will be changed. The notice has to explain why your services are going to be changed.
If you get any kind of negative action notice, you have a right to a hearing before an Administrative Law Judge. DHHS should send you a Request for Hearing form along with the negative action notice that you can fill out to request a hearing. During your hearing, you can present evidence, testify yourself, or have others testify about why your services should not be reduced, suspended, or terminated.
If you are already receiving services and DHHS plans to reduce, suspend, or terminate them, and you request a hearing before the date that your services are supposed to change, DHS has to keep paying for your Home Help services until after the judge makes a decision in your case. However, if the judge decides that your services should be changed, you may have to pay for the services that were provided to you while the hearing was pending.
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