Does Missouri Medicaid Pay For Assisted Living

Does Medicare Pay For Assisted Living In Missouri

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 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.

Assisted Living Service Plans

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.

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.

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What Is Assisted Living

Assisted living is a type of long-term care that provides personal care and services to people who need help with activities of daily living, such as dressing, bathing, eating, and using the restroom. Assisted living facilities typically provide housing, meals, activities, and supervision or assistance with medications.

Will Medicaid And Medicare Pay For Memory Care In Assisted Living Facilities

Any care that is medically necessary for a person who suffers from dementia or Alzheimers disease is covered by Medicare. However, Medicaid / Medicare will not cover the cost of living in a memory care facility, custodial care, or a memory patient’s personal care. What is covered is any stay in a hospital, hospice care and skilled nursing with a limit of 100 days consecutively. Medicare will also cover the cost of preventative care for a person who suffers from a memory condition. This can include medical equipment, doctors appointments, physical therapy, and diagnostic testing. Overall, though, Medicare will not cover the cost of a room in an assisted living facility, but a senior can use Medicare to pay for memory-related treatments and services received while staying in an assisted living community.

Medicaid will pay for memory care in any facility that has a contract to offer Medicaid services. Some of these may include specialized assisted living homes, or they may be separate wings inside of a nursing care facility. For any independent long-term care home, assisted living community, or memory care facility, Medicaid will cover the services listed in the assisted living section we have listed earlier in the article.

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Long Term Care 1915 Waiver Training Requirements

Long term care waiver providers are required by Administrative Code to ensure all staff meet training requirements as defined by the Division of Medicaid. The provider type specific memorandums linked below define the current training requirements for all direct care staff.

In an effort to streamline and standardize procedures across waiver platforms, along with reducing the burden on Medicaid providers, the Division of Medicaid would like to confirm the removal of the forty hour training requirement for Assisted Living Waiver direct care staff. The list of the required training topics to be covered in training can be located on the Medicaid website at Training Requirements for AL Waiver Direct Staff. The Division of Medicaid is in the process of updating the Administrative Code to reflect removal of the forty hour requirement.

Medicaid has partnered with the Person Centered Planning Institute and is excited to offer training on Person Centered Planning/Person Centered Thinking. If they have not already done so, PCPI will be reaching out to your agency with a schedule of courses offered and dates they are available. All AL case managers have attended this training and PCPI does an outstanding job presenting the material. You are strongly encouraged to avail yourself of this outstanding resource.

Thank you for all you do to serve our Medicaid population.

More Ways To Finance Assisted Living

Some additional ways to finance assisted living costs include:

• Veterans Benefits: Veterans can take advantage of several different pension programs to help cover the cost of assisted living. For more information, see the article on benefits.va.gov.

• Life Insurance Policies: Even if a spouse or loved one hasnt died, certain types of life insurance policies can be used to pay for assisted living. More information is available at longtermcare.acl.gov

• Long-Term Care Insurance: Long-term care insurance is a type of insurance policy that pays for long-term care when it becomes necessary, including the cost of assisted living. For more information on the benefits and drawbacks of this financing method, visit longtermcare.acl.gov.

• Reverse Mortgages: Reverse mortgages allow seniors to access the equity from a home that they own, and these funds can be used to pay for assisted living. The U.S. Department of Housing and Urban Development offers a federally insured reverse mortgage program.

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Medicaid’s 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 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.

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City, State

As of 2019, 44 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, Maine, Pennsylvania, and Virginia are the only ones that provide no coverage of assisted living, although non-Medicaid assistance may be available.

For more about assisted living communities, .

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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Alternatives To Assisted Living That May Be Covered By Medicaid

Finding the best care arrangement for a loved one can be a stressful process. While an assisted living community can offer care services and peace of mind, there may also be other options. Your state ultimately determines the type of services that are covered by Medicaid, but some of the following alternatives to assisted living may be available to you:

Does Medicaid Pay For Assisted Living

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Data from Genworth suggests that seven out of ten individuals will require long-term care at some point in their life. As of 2022, the national median cost of assisted living is $4,365 per month, but costs can exceed $100,000 per year depending on the type of care. Even more striking, is that these costs are estimated to increase about 3-6% each year for the foreseeable future.

Even with adequate retirement savings, individuals may find it difficult to pay for assisted living costs and seek solutions from the government. To help you understand your options, well explain the role of Medicaid when paying for assisted living. Plus, get other helpful information on covering these costs.

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Who Can Get Medicaid Assistance For Assisted Living

While the federal government requires Medicaid to cover low-income adults over 65, as well as those who are blind or have a disability, states themselves get to decide what criteria to use to determine someones eligibility.

Requirements are typically based on someones resources, but states have different thresholds for how much a person can have in savings or assets before enrolling in Medicaid. In some cases, states will adjust those thresholds to account for dependents or spouses who dont require assisted living. Even so, seniors generally have to deplete almost all of their savings before being eligible to receive assisted living benefits through their states Medicaid program.

Visit Benefits.gov or your states Medicaid website for more information on eligibility requirements and how to enroll.

Missouri Aged & Disabled Waiver

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

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

Eligibility

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.

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Who Is Eligible For The Assisted Living Waiver

Eligibility for Assisted Living is limited to individuals age 21 years old and older, who meet clinical eligibility requirements determined through screening the following areas:

• activities of daily living,
• instrumental activities of daily living,
• sensory deficits,
• medical conditions, and
• medical services.

Beneficiaries of this waiver must be Medicaid eligible either as a Supplemental Security Income recipient or meet the income level up to 300% of the SSI federal benefit rate.

Medicaid & Medicare Costs Coverage & Details

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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What Assisted Living Services Does Medicaid Cover

Not all states offer financial assistance for assisted living, and those that do rarely cover the full costs associated with it. States pick and choose what services they will cover for enrollees. That said, there are a few common services that Medicaid will typically pay for, at least in part. These include:

• Case management

• Registered nurses or health aides

While fees for room and board arent covered through Medicaid directly, some programs might cover the cost of food preparation and dining services, though not the food itself. In some states, like Ohio, Medicaid might also pay for recreational activities and housekeeping, as well as help families transition from rehabilitation facilities to assisted living facilities. Those who are eligible to receive Medicaid benefits might still need to pay a co-pay or some subset of the costs, even for services covered under the states program, says Tyler White, an elder law attorney at JacksonWhite Attorneys at Law in Mesa, Arizona.

As a rule of thumb, single Medicaid members are entitled to keep a personal needs allowance of about $115.00, White says.

The rest of their income goes toward covering their share of assisted living costs.

Missouris Aging & Disability Resource Centers

Aging & Disability Resource Centers are senior support organizations selected by the state government of Missouri. These centers are often housed in the same offices as the Area Agencies on Aging, serving as a single point of contact with the long-term services and supports system for older adults across the state.

For more information, consult the table in this guide to find your local Area Agency on Aging, or go online to consult Missouris Administration of Community Living.

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Does Medicare Cover Assisted Living In Missouri

The short answer is that no, Medicare does not cover the cost of assisted living in Missouri. Assisted living facilities are considered to be a residential setting and not a clinical setting, . While Medicare doesnt cover the cost of care received in an assisted living community, it does still cover things like approved medications, doctor visits, medical equipment, etc., just like it would if you lived at home.

For more information about when Medicare can be used to pay for senior living in a nursing home, and for Medicare-related resources, see our guide to Nursing Homes in Missouri.

Are There Other Financial Assistance Options For Assisted Living In Missouri

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Can You Use Medicare To Pay For Memory Care In Missouri

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be “social settings,” so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

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.

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