Will Medicaid Cover Your Assisted Living or Adult Family Home Care?

Will Your Assisted Living Accept Medicaid?

By Mark Robinson, Elder Care Advisor at Elder Services NW

Elder Care and Medicaid

A recent Seattle Times article about a 99 year old woman being evicted from her Assisted Living community for enrolling in the Medicaid program really struck a chord with me. Unfortunately, her situation is not unique. The only thing I found unusual about the story was the fact that the resident was fighting back and had delayed the eviction. Medicaid (the state program for low income seniors) pays for assisted living care, adult family home care, in-home care, and nursing home placement. The issue is access. Since the state reimburses providers much less than they can earn from private pay clients, many are reluctant to accept Medicaid residents at all.

In the case above, a resident had paid privately at an assisted living community for a number of years and had been promised that when her funds ran out she could convert to Medicaid and remain at the community. Turns out, when the time came, the community said they were at their limit of Medicaid residents and told her to either continue paying privately or find a new assisted living community. Talk about a bad outcome. Here is someone who trusted the community and had been reassured all along that this was her home and not to worry. Finding a new home and starting over is tough enough for anyone at any age. For a senior who has already given up her home, accepted her new situation, and settled in and made new friends to be asked to do it all over again can be devastating. Imaging having to move and start over again at 99!

The Whatcom and Skagit County Assisted Living Scene.

Several assisted living communities and adult family homes in the Bellingham area do not accept any Medicaid residents. Although this limits choices, at least families know the rules upfront and can plan accordingly. Most assisted living and adult family home owners allow resident who have paid privately for a specified period to convert to Medicaid and remain in their facility when funds dry up. There are risks in this though. In fact, two assisted living facilities in Whatcom county recently decided to no longer accept new Medicaid residents, or to allow their current residents to convert to Medicaid when they had spent all their resources. That means, when the money is gone it’s time to find a new place to live. Yikes! So many times I have talked to seniors who expected the Medicaid program to cover their Assisted Living or Adult Family Home costs when they could no longer do so privately. The reality is that a senior depending on Medicaid will have few choices and may even end up in a nursing home sooner because other options are closed to them.

What does all this mean? First of all, read and understand the residency agreement for an assisted living community or adult family home before you sign it. If the part about Medicaid payment is unclear, ask questions or better yet insist on a written agreement that Medicaid will be accepted when the time comes. Second, start planning today for care costs. Long Term Care Insurance policies usually cover assisted living or adult family home costs. Cindy Sherwin at LTC Solutions is a great local resource for policy options. Third, consider working with a qualified elder care advisor. They can ensure that you find the best care setting for yourself or your loved one and that you ask the right questions when evaluating options.

I hope this information is helpful. Taking care of seniors who have given given so much to our lives and our communities is a passion of mine.