Touching Lives With Hands LLC

Overview of Medicaid in Assisted Living

What is Medicaid?

Medicaid is a government program that provides health coverage for low-income individuals, including seniors who need assisted living. Some states offer Medicaid waiver programs to help cover the cost of assisted living services.

Who Qualifies?

• Must meet income and asset limits (varies by state)

• Must require assistance with daily living activities (bathing, dressing, medication management, etc.)

• Some states require applicants to live in a Medicaid-approved facility

How to Apply

1. Check eligibility on your state’s Medicaid website or through a Medicaid planner.

2. Gather financial documents (income statements, bank records, assets).

3. Submit an application online, by mail, or through a local Medicaid office.

Assisted Living and Medicaid:

In Maryland, Assisted Living Facilities are licensed to provide three levels of care, corresponding to the residents’ needs:

• Level 1: Low care needs
• Level 2: Moderate care needs
• Level 3: High care needs

It’s important to note that Medical Assistance (Medicaid) does not cover level 1 care. Medicaid may cover services for individuals with moderate care needs, which is Level 2. It may also cover high care needs, known as Level 3. This is possible through programs like the Home and Community-Based Services (HCBS) waiver.

To qualify, for Medicaid assistance in an assisted living setting, individuals must meet specific income and medical criteria. The HCBS waiver allows eligible individuals at risk of nursing home placement to receive necessary services in their homes. They can also receive these services in assisted living facilities that accept Medicaid.

Eligibility Criteria:

In Maryland, Medicaid can help with assisted living costs. This is possible through specific programs for individuals who meet certain eligibility criteria. Here’s an overview of these programs and their requirements:

1. Community Options Waiver:

• Age Requirement: Applicants must be at least 18 years old.
• Medical Necessity: Applicants must require a nursing facility level of care. They must need assistance with activities of daily living such as bathing, dressing, or mobility.
• Financial Criteria:
  • Income Limit: As of 2025, the income limit for a single applicant is $2,742 per month.
  • Asset Limit: Applicants must have countable assets not exceeding $2,000.

This waiver provides services like assisted living, medical day care, personal assistance, and home-delivered meals to eligible individuals. 

2. Senior Assisted Living Group Home Subsidy Program:

• Age Requirement: Applicants must be at least 62 years old.
• Medical Necessity: Applicants should require assistance with activities of daily living but not require full-time nursing care.
• Financial Criteria:
  • Income Limit: Varies by county; applicants must have limited income as defined by local program guidelines.
  • Asset Limit: Typically, assets must not exceed $11,000 for an individual or $14,000 for a couple.

This program offers subsidies to help cover the cost of assisted living in approved facilities. It is designed for seniors who might not qualify for other Medicaid programs. 

Application Process:

• Community Options Waiver: Interested individuals should contact their local Department of Social Services. They can also reach out to the Maryland Department of Health to apply. Due to limited slots, there may be a waiting list.
• Senior Assisted Living Group Home Subsidy Program: Applications are typically handled through local Area Agencies on Aging. Eligibility and availability can vary by county.

• Step-by-Step Application:

1. Gather necessary documentation.

2. Contact your local Medicaid office.

3. Submit the application.

4. Follow up with a care assessment.

Important Considerations:

• Eligibility criteria can change. It’s essential to consult with the appropriate state or local agencies for the most current information.
• Given that program slots may be limited, early application is advisable.

Maryland residents can better navigate the options available to assist with the costs of assisted living. They achieve this by understanding these programs and their requirements.

Cost Comparison:

Comparison of Assisted Living Costs in Maryland: With vs. Without Medicaid Assistance

Cost Factors	Without Medicaid (Private Pay)	With Medicaid (Community Options Waiver or Subsidy Program)
Monthly Assisted Living Cost	$4,500 – $7,000+	Reduced cost based on Medicaid coverage
Personal Care Assistance	$20 – $30 per hour	Included in Medicaid coverage
Room & Board	Full cost paid by resident	Medicaid covers part (resident pays a portion)
Medication Management	Additional fee ($200 – $500/month)	Included in Medicaid plan
Medical Services (Doctor/Nurse Visits)	Out-of-pocket or private insurance	Covered for eligible residents
Home-Delivered Meals	$8 – $15 per meal	May be covered under Medicaid
Transportation (Medical Appointments)	$50 – $100 per trip	Covered under Medicaid

Key Takeaways:

Eligibility for Medicaid waivers is required to receive financial assistance for assisted living.

Without Medicaid, residents must pay full private pay rates for assisted living and care services.

With Medicaid, costs are significantly reduced, covering medical, personal care, and some room/board expenses.

Next Steps & Resources

• What to Do Next:

• Check Your Medicaid Eligibility:

• Additional Resources:

For additional resources to government websites and contact information for local agencies click link below.