Does Medicare or Medicaid Pay for Assisted Living Facilities?
Understanding the Cost of Assisted Living
Assisted living can be a crucial step for your adult child with IDD, offering vital support and community. However, we know families often worry about the significant costs involved. Understanding funding options like Medicaid and Medicare can feel overwhelming, but you don’t have to figure it out alone.
We’re here to walk with you, offering clarity, guidance, and support every step of the way. With over a decade of experience serving families across North Carolina, we’ll help you navigate the financial side of care with confidence and peace of mind.
What is Assisted Living?
Assisted living offers a residential environment where an individual can receive support with daily tasks such as bathing, dressing, meal preparation, and medication management. It provides a structured yet comfortable setting that promotes independence while ensuring safety and assistance are readily available. These facilities are designed for individuals who need more support than independent living provides but do not require the intensive medical care of a nursing home.
At Covenant, our approach to residential support, including Supported Living and Residential Programs, is tailored to meet individual needs. We focus on creating a supportive environment where your adult child can thrive, with assistance that adapts as their needs evolve. Our goal is to empower them to live as freely and fully as possible within a community setting.
Does Medicare Cover Assisted Living?
Medicare does not cover the cost for assisted living facilities. It primarily covers medical care, such as hospital stays, doctor visits, and some short-term rehabilitation. Long-term care, which includes daily living support in residential settings, is generally not covered by Medicare. This means services like personal care and meals in an assisted living facility fall outside its scope.
Medicare is a federal health insurance program primarily designed for people aged 65 or older, and certain younger people with disabilities, and it focuses on medical care rather than custodial care.
Does Medicaid Cover Assisted Living?
Medicaid covers aspects of assisted living, though this largely depends on the specific programs available in your state. Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. When it comes to assisted living, many states offer Home and Community-Based Services (HCBS) waivers that allow individuals to receive care in their homes or community settings, including assisted living, rather than in institutions.
In North Carolina, the NC Innovations Waiver is a Medicaid program designed to support individuals with IDD outside of institutional settings. This waiver aims to provide the necessary services to help your adult child live as independently as possible within their community. Through this waiver, eligible individuals may qualify for a range of services that can contribute to the cost of assisted living or provide essential support within a residential program.
These services can include Supported Living (Levels I–III), which offers varying degrees of assistance to help your adult child manage daily life and live independently. Additionally, the waiver can cover tailored care management, ensuring a coordinated approach to their care, as well as respite care, supported employment, and various day programs that foster purpose and community engagement. These services help create a comprehensive support system, making assisted living a more accessible option for your adult child.
Eligibility for Medicaid and the Innovations Waiver
Medicaid eligibility depends on income and resource limits, which vary by state and program. For individuals with IDD, specific pathways exist to qualify, often through programs designed to support their unique needs. It is important to review the most current eligibility guidelines of the NC Waiver to determine if your adult child meets these criteria.
While it offers extensive support, the application process can take time. These waivers often have limited slots, and waiting lists are common. We understand that this can feel daunting, but starting the application process as early as possible is vital.
Early application ensures your adult child is placed on waiting lists, positioning them for future support. We are here to help you understand these requirements and assist you in taking the necessary first steps toward accessing these valuable services for your adult child.
How Covenant Can Help
We understand that navigating the complexities of funding and services for your adult child can feel overwhelming. At Covenant, we walk with families every step of the way, from understanding intricate funding options like Medicaid and the Innovations Waiver to accessing the services your adult child needs. We are your partner in building a future where your adult child can thrive.
We offer personalized planning and advocacy to help you navigate the often-confusing Medicaid system. Our team is deeply familiar with North Carolina-specific programs, including the NC Innovations Waiver and 1915(i) services. We can help you understand how these can fund essential support like personal care assistance, skill-building, and supported employment.
Whether it is developing an Individual Support Plan (ISP) that includes employment goals or connecting you with day programs like Dream Center, our aim is to simplify the process for you. We are committed to whole-person support, which means we look beyond just services to ensure your adult child can live their purpose.
Conclusion
Navigating assisted living and its funding can feel like vast, uncharted territory, especially when seeking the best for your adult child. The process is complex, but with the right partner, it is entirely navigable.
Our mission is to fuel brighter futures through education, advocacy, and partnership. Reach out to us for guidance and personalized care planning. We can help you understand eligibility requirements, explore funding options like the NC Innovations Waiver, and connect your adult child with the services that will empower them to live a life of purpose. Remember, we do not just provide services—we walk with you through every challenge and decision, helping your adult child reach their unique potential.
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