Does Missouri Medicaid Cover Assisted Living


Missouri Aged & Disabled Waiver

Does Medicaid Pay for Home Care or Assisted Living Care?

TheAged and Disabled Waiver offers in-home services to individuals aged 63 or over who have been assessed with certain impairments and unmet needs to the extent that they would require nursing home care in the absence of these services. The Department of Health and Senior Services, Division of Senior and Disability Services administers this program through an interagency agreement with the MO HealthNet Division.


Services include: homemaker, chore, respite, home delivered meals and adult day care.


  • Health: An applicant must Nursing Home Level of Care, however the determination process for the A& D waiver is different than for Medicaid nursing home long-term benefits.
  • Practical Considerations

    The Aged & Disabled waiver is available to seniors 63 and older, which is unusual for Medicaid waiver programs which usually have an age limit of 65. Further, the unique individual asset limit because of the status as a 209 state makes it harder for people to qualify because the income limit is lower than usual. Also, while the allowances and asset limits for the spouse are the same as Medicaid for nursing homes, the asset limit can be increased through the legal system, which is a unique feature to Missouris A& D Waiver.

    Alternative State Payments For Assisted Living Expenses

    States offer a broad range of alternative coverage for seniors that are not part of the typical Medicaid program. These payments are provided through alternative programs that allow for the waiver of some federal rules such as income eligibility. Most seniors who apply for these waivers must exhibit care needs equivalent to a senior who lives in a nursing home in order to qualify.

    Alternative payment programs also have a limited number of spots available, often significantly fewer than Medicaid. Because the waiting list is quite common and lengthy, many seniors will apply well in advance of their actual needs. Support programs differ from region to region and not all programs may be available to seniors statewide. Make sure to ask your enrollment officer about alternative programs available for their location when researching assisted living communities to join.

    There are also other non-traditional assistance programs that are available for specific groups of seniors. For example, veterans or the surviving spouse of a veteran have special programs available to help defray the cost of assisted living. Many religious groups and organizations also offer funding for long-term care or have assisted living facilities for seniors that operate on a not for profit model.

    Free Assisted Living Resources In Missouri

    Missouri Association of Area Agencies on Aging

    Missouri Association of Area Agencies on Aging, commonly shortened to MA4, serves seniors by implementing and endorsing programs that promote seniors physical, social and economic independence. Through MA4, seniors can receive important informational and educational resources and knowledge of local services, including meal delivery and transportation services, vaccine clinics and new legislation that may affect them.

    Region 1

    1735 South Fort Avenue, Springfield, MO 65807 862-0762

    Aging Matters

    1078 Wolverine Lane, Suite J, Cape Girardeau, MO 63701 335-3331

    106 West Young Street, PO Box 1078, Warrensburg, MO 64093 747-3107

    809 North 13th St. P.O. Box 265, Albany, MO 64402 726-3800

    815 North Osteopathy Street, Kirksville, MO 63501 665-4682

    1121 Business Loop 70 East, Suite 2A, Columbia, MO 65201 443-5823

    600 Broadway, Suite 200, Kansas City, MO 64105 474-4240

    14535 Manchester Road, Ballwin, MO 63011 207-0847

    1520 Market St. Room 4086, Saint Louis, MO 63103 612-5918

    531 East 15th Street, P.O. Box 3990 , Joplin, MO 64804 781-7562

    Through the states Veterans Service Program, accredited Veterans Service Officers provide support to seniors who served in the military and their family members. Seniors can consult their local office to find out if they qualify for income-based benefits and health care benefits that can help them cover the cost of assisted living.

    4040 Rangeline Street, Suite 105, Columbia, MO 65202573-814-6206

    Read Also: What Is The Difference Between Medicare & Medicaid

    How Do I Become A Paid Caregiver For A Family Member In Missouri

    So here are the 5 ways that you can get paid to take care of a family member.

  • 1) Consumer Directed Services in Missouri
  • 2) Caregiver Contracts Between Family Members.
  • 3) Medicaid Cash and Counseling Program, Missouri.
  • 4) Settlement of a Family Members Life Insurance Policy.
  • 5) IRS Tax Credits for Family Caregivers.
  • Medicaid Benefits For Alzheimers & Dementia By Location

    Does Medicaid Pay For Long

    At Home

    Rather than thinking only of Medicaids home health care benefits, one should think more broadly because Medicaid offers much more assistance in the home than just health care. First, well discuss the range of benefits, and then briefly how the Medicaid beneficiary would get access to these benefits. IMPORTANT each state offers slightly different long-term care benefits this article is written in generalized terms, not state specific terms.

    Medicaid recipients can access in-home support services either through their states regular Medicaid program or through a HCBS Medicaid Waiver.

    In Adult Day Care

    Adult day care is formal supervision during day-time hours, typically only on weekdays, in a structured, dedicated environment. Meals, activities, personal care assistance, and often medication management, are included. However, for persons with dementia, regular adult day care may not provide enough structure. Specialized adult day care centers, sometimes called Alzheimers Day Treatment Centers, may be necessary. Staff at these organizations receive specialized training for dementia-related behavior challenges and security is increased to preventing wandering. In nearly all states, Medicaid will pay for adult day care.

    Many states offer adult day care as a benefit of their regular Medicaid program, as well as a HCBS Waiver benefit.

    In Assisted Living / Memory Care

    In Adult Foster Care

    In Nursing Homes

    Read Also: Does Medicaid Cover Long Term Care Facilities

    Can I Get Financial Assistance For Assisted Living Facilities

    You may qualify for help from your state if you need long-term assisted living assistance contact your states Medicaid office or State Health Insurance Assistance Program for information.

    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.

    Does Medicare Pay For Assisted Living

    Medicare covers only short-term, non-custodial care, so you cant use Medicare to pay for long-term care like assisted living or a residential care home. However, Medicare may cover some of the costs of health care received while in an assisted living facility.

    Heres the short-term care that Medicare covers:

    • 100% of the first 20 days in a Medicare-approved skilled nursing facility after a three-night minimum inpatient hospitalization
    • 80% of days 21-100 in a Medicare-approved skilled nursing facility
    • Short-term rehabilitation care at a nursing home after a hospitalization
    • Rehabilitation services and in-home therapy in some cases

    Not all three-night hospital stays automatically qualify for inpatient rehabilitation, and youre not guaranteed a full 100 days even if you do qualify. Talk to a doctor, social worker, discharge planner, or case manager at the hospital to help determine if rehabilitation is the next best step for your loved one.

    If you have private health insurance, such as Blue Cross or Aetna, you will need to contact the insurer directly to determine the amount of skilled nursing coverage included in the policy. If youre having difficulties determining coverage, ask the social worker, discharge planner, or case manager at the hospital to assist you.

    Read Also: Can You Get Plan B For Free With Medicaid

    How Much Does Long

    The cost of assisted living and other types of long-term care vary widely according to the level of care services you need and where you live. National averages include:

    • Expect to pay around $3,700 per month for a one-bedroom unit in an assisted living community
    • A semi-private room in a nursing home costs around $6,900 per month
    • You’ll pay around $7,700 per month for a private room in a nursing home
    • A home health aid costs between $20 and $25 per hour
    • Adult day care costs around $70 per day

    Certain conditions usually lead to higher healthcare costs. For example, patients who require memory care due to Alzheimer’s disease or dementia usually have to pay more.

    Most people who require long-term care receive it in their own homes, with a loved one providing care. They may also have a home health aide or someone who provides respite care for the primary caregiver.

    Medicaid & Medicare Costs Coverage & Details

    Difference between Skilled Nursing and Assisted Living? Does Medicaid pay for Assisted Living?

    As of the last update, 46 states and the capital were listed as providing at least some level of payouts to those residing in an assisted living facility. Some states, specifically Louisiana, Kentucky, Alabama, and Pennsylvania do not provide Medicaid coverage for seniors who reside in assisted living homes. Though Medicaid is not offered, these states have other non-Medicaid programs that seniors may avail to help pay for their long-term care costs.

    Support types and levels vary greatly from state to state. However, states that are barred from offering direct Medicaid payments create other unique solutions for seniors. Some ways states assist seniors is by placing a firm limit on the number of fees a facility that is Medicaid certified may charge. Another is by offering seniors who are Medicaid-eligible supplemental assistance for their assisted living fees. Instead of these funds originating from Medicaid, they are taken out of general state funds to help pay for senior assisted living costs.

    Another way many states help senior Medicaid recipients reduce the expenses of assisted living is by covering the fees of supplemental services offered by these communities. Assisted living supplemental services may include personal care, medical assessments, coverage of nursing care, medication management, case management and medical exams.

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    How To Find An Assisted Living Residence

    Finding a nice facility for Assisted Living may be more challenging than you think. Because of the poor reimbursement rates, most homes will not take Medicaid. Furthermore, these facilities often have a restricted number of beds accessible for Medicaid patients.

    The best thing you can do is contact your local AAA or Area Agency on Aging, or your Medicaid help agent, and get a list of residences that take Medicaid.

    Who Is Eligible For Medicaid Assisted Living

    Now that weve covered the fundamentals, we can look at who is qualified for this program. In addition to locating a service that takes Medicaid, the individual must fulfill financial and functional standards to be eligible.

    • Financial criteria Financially, youd need a minimal salary and nearly no assets, in addition to devoting all of your present assets to care. States Medicaid plans to limit applicant income to 100% of the Federal Poverty Level or 100% of the Federal Benefit Rate.
    • Functional necessity There are a few factors that must be considered before accepting an application. For example, the individual must require nursing level care as specified by the state. If you or a loved one has difficulty dressing, eating, or moving and need assistance, you may be eligible.

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    Assisted Living Medicaid Policy

    Unlike many states, Missouri does not allow Medicaid waiver coverage to be used in long-term care facilities for people with greater medical needs. However, for eligible Medicaid recipients who need a greater level of care than their facility is able to provide, the state does reimburse for personal care services, and also for advanced personal care services to aid residents with medical maintenance tasks. For people in need of skilled nursing care who have an income that is less than the monthly charge of their facility, the state may offer a cash grant to cover the difference.

    Medicaid Assistance Programs For The Elderly

    Four Seasons Living Center, LLC

    Medicaid State Plan

    Medicaid is a program that offers health insurance to low-income residents throughout the U.S. While the federal government sets particular guidelines for the program, each state is able to manage the program as they see fit within the parameters set by the government. In Missouri, the Medicaid program is called MO HealthNet. As with the other states, the Missouri state Medicaid plan will cover the cost of nursing home care, as well as some home and community based services.

    The Missouri Care Options program, part of the state Medicaid plan, provides in-home and community care services to reduce the frequency of nursing home placement. This program is an entitlement, which means that anyone who is eligible is able to receive services. Benefits include personal care assistance, homemaker services, nursing services, adult day care, and respite care.

    The Missouri state Medicaid plan allows for self-direction of non-medical personal care assistance via the MO HealthNet Consumer Directed Services program. Friends and select family members can be hired to provide care as long as they are registered with MO HealthNet.

    Medicaid Waivers

    The Supplemental Nursing Care program offers financial assistance to help with the cost of care associated with living in a residential care facility, such as assisted living.

    Eligibility Requirements

    Eligibility requirements may vary slightly if applying for a Medicaid waiver.

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    Can A Person Preserve Some Assets When They Go Into A Nursing Home In Missouri

    Sponsored Answer Email

    One question we often receive from clients and other attorneys is how to protect at least some of a persons assets when the person must be admitted to a nursing home.

    Since Medicare does not cover long-term nursing home expenses, many families are concerned about how to pay for those expenses. The average cost for nursing home care in Missouri is over $5,000 a month. Paying for those costs out of pocket can exhaust a persons savings assets intended to leave to a family member can go to paying nursing home costs.

    There are ways to preserve at least some of a persons assets if he or she must go into a nursing home or may need nursing home care in the future. This area of law is often called Medicaid planning.

    Medicaid is a government program that will pay for nursing home expenses. Medicaid, however, is a needs-based program. To be eligible, a person must spend down his or her assets to a very low level. Medicaid planning typically involves transferring some assets to another person or to an irrevocable trust. Veterans can do similar planning to become eligible for VA benefits.

    There are two types of Medicaid planning: advance planning and crisis planning. Both are highly particular to a persons individual situation, family, assets and the state in which a person lives.

    Advance Medicaid Planning

    Crisis Medicaid Planning

    Paying For Assisted Living With Your Life Insurance

    Some life insurance policies can be used to pay for assisted living or other long-term care.

    • Accelerated death benefits: Also known as ADBs, this feature gives you a cash advance on your life insurance policy. Details vary depending on your policy. Typically, you must meet certain qualifications, such as having a terminal illness, requiring long-term care, or being confined to a nursing home.
    • Combination products: Some insurance companies let you combine life insurance and long-term care insurance into a single policy. This way, if you’re part of the two-thirds of people who never need long-term care insurance, there’s still a payout at the end.
    • Life settlements: You may be able to sell your life insurance policy if you meet your insurer’s requirements .
    • Viatical settlements: If you are terminally ill, you may choose to sell your life insurance policy to a third party and use the money to pay for long-term care. The third party that buys your policy becomes the beneficiary.

    We cannot stress enough how important it is to talk to a financial advisor before making any decisions on how you’ll pay for long-term care. Most of these options have tax repercussions. And, of course, may result in either no death benefit being paid out or significantly reducing the benefit.

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    How To Sign Up For Home Health Care In Missouri

    Step 1: Before you can sign up for CDS, you have to be eligible for Medicaid . If you are not currently on Medicaid in Missouri, call 855-835-3505 for information about how to enroll.

    To be eligible for MO HealthNet, you must meet certain income, age, and asset requirements listed below:

    â Own less than $4000 in assets if youâre married

    â Have a total income less than $1198 per month if youâre married .

    Note that some of your assets may not count toward your eligibility requirements. For example, the home that you live in permanently does not count as an asset if it is worth less than $585,000. And your vehicle and other personal items also donât count toward the total amount you own in assets.

    Step 2: After you have enrolled in MO HealthNet, you can apply for at-home services through the Missouri Division of Health and Senior Services. This process will involve a pre-screening along with a home assessment to determine level of care and any other requirements that must be met in order for you to receive high-quality care.

    â Bathing and personal hygiene

    â Toileting

    â Grooming

    â Assistance with moving from place-to-place inside the home

    â Laundry

    â Cleaning

    â Taking medications at the appropriate time

    â Cooking

    â Shopping

    â Essential transportation

    â You must be above 18 years of age

    â You must be a Missouri resident

    Assisted Living Service Plans

    Does Medicaid Pay For Long-Term Care Other Than In A Nursing Home?

    On moving into a long-term care facility, residents must meet with facility staff for an interview to establish the new residents needs and manage their expectations of what the facility can provide. At this time, a residential agreement will also be drafted which demonstrates that residents have been informed of their rights and of all costs for service.

    In assisted living facilities, part of the overall agreement must include provisions for any resident who is incapable of safely self-evacuating in cases of emergency. As part of the service agreement, these individuals or their representatives must be consulted to form an individualized evacuation plan.

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