Jun 13, 2023

Navigating Medicaid benefits: a guide for assisted living care

Manny Cominsky

Understanding Medicaid benefits is crucial for seniors and their families seeking assisted living care. Medicaid is a government-funded program which provides essential financial assistance for medical expenses to those with low incomes and limited resources. This comprehensive guide aims to demystify the complexities of Medicaid benefits specifically for assisted living care. Whether you're a senior in need of financial flexibility for assisted living or a caregiver seeking assistance for a loved one, this guide will provide valuable insights to help you make informed decisions and access the vital care you or your senior loved one requires. To learn more about applying for Medicaid benefits to help with the cost of assisted living care, read our helpful guide below or reach out to the Sunbound team for more information

What types of medical expenses are covered by Medicaid?

Medicaid covers a wide range of medical services for seniors, including doctor visits, hospital stays, prescription drugs, laboratory tests, and medical equipment. Additionally, Medicaid may cover long-term care services such as nursing homes, home health care, and care that is provided in assisted living facilities for eligible seniors. It is important to note however that generally Medicaid does not cover the cost of room and board in an assisted living community, and only covers the care-based component of an senior’s stay.

Medicaid also covers some types of preventive care, including immunizations, cancer screenings, and wellness visits. However, because Medicaid coverage varies from state to state it is advisable to check with your local Medicaid office to find out the specific services covered in your area.

What is the eligibility criteria for Medicaid?

Eligibility criteria for Medicaid varies by state, and so make sure to check out our state-specific guides on Medicaid eligibility (for example our guides to Arizona and Florida). But generally, seniors who meet the following requirements are eligible:

Income limit: The senior's income must be at or below the federal poverty level (FPL) or the state-specific income limit.

Asset limit: Medicaid has strict asset limits, which means the senior's assets must be below a certain limit. This includes cash, bank accounts, property, and investments, but generally excludes things like the seniors primary home or vehicle.

Age: Seniors who are 65 years or older may be eligible for Medicaid.

Disability: Seniors who have a disability that meets the Social Security Administration's definition of disability may be eligible for Medicaid.

Residency: The senior must be a resident of the state where they are applying for Medicaid.

Keep in mind that a senior applicant will need to provide documentation and go through an application process to determine their eligibility. It's recommended to consult with a Medicaid specialist or a financial advisor to understand the eligibility criteria and application process. The Sunbound team is also always happy to help assist with any Medicaid questions you or your senior loved one may have.

Are there any limits on how much I can receive in Medicaid benefits?

Yes, there are limits to how much Medicaid benefits a senior can receive. While this limit will vary from state to state, the amount of Medicaid benefits a senior can receive is determined by several factors, including their income, assets, and medical needs. So while Medicaid benefits will generally cover a range of services like hospital care, doctor visits, prescription drugs, nursing home care, and home health care, there are generally limits to the amount of benefits a senior can receive for each type of service.

For example, there may be limits on the number of days a senior can stay in a hospital or nursing home, or the amount of prescription drugs a senior can receive each month. Additionally, there may be restrictions on the type of medical services that Medicaid will cover. Always keep in mind that Medicaid is not a one-size-fits-all program, and the amount of benefits a senior can receive will depend on their individual circumstances. 

What services are covered by Medicaid?

The services covered by Medicaid vary from state to state, but there are some common services that most states cover. These services include doctor visits, hospital stays, prescription drugs, lab tests, x-rays, and preventive care such as immunizations and cancer screening. Medicaid also covers some long-term care services such as nursing home care and home health care. Additionally, some states may cover dental, vision, and hearing services. It is important to check with your state's Medicaid program to see what services are covered.

How long does it take to receive Medicaid benefits?

The timeframe for receiving Medicaid benefits can vary based on a few factors. The approval process can take up to 45 days after submitting an application, but it can take longer if additional documentation is required or if your state Medicaid agency has any additional questions on your application. Once approved, benefits can start immediately or retroactively to the date of the application. However, some states may have a waiting period before benefits begin. It's important to note that Medicaid benefits may also be subject to annual renewal and ongoing eligibility requirements. It's best to consult with a Medicaid specialist or financial advisor for more specific information regarding your situation.

How do I apply for Medicaid?

As you’ll probably be able to figure out by this point, each state has its own process of applying for Medicaid benefits and so it is important to check with a local Medicaid or financial advisor, or your state’s Medicaid agency, before applying to make sure that you know all the required steps. That being said, generally, the Medicaid application process will go according to the following steps:

Check your eligibility: Before applying, you need to check if you are eligible for Medicaid. You can visit your state’s Medicaid website or contact your local Department of Social Services to find out if you meet the requirements.

Gather necessary documents: Once you have determined that you are eligible, gather all the necessary documents such as proof of assets and income, citizenship status, and medical records.

Fill out the application: You can generally apply for Medicaid by mail, online or in person at your local state Medicaid agency’s office. The application will require you to provide personal information and financial details, so make sure you have all the information ready.

Submit the application: Once you have completed the application, submit it to the local state Medicaid agency for review. They will review your application and let you know if you are approved for Medicaid.

Follow up: If you have not heard back from your state Medicaid agency within a reasonable time, follow up with them to ensure that your application is being processed. Your state will often give you a timeframe within which to expect the next steps in your application once you have submitted it. 

Applying for Medicaid may seem overwhelming, but it can provide you with the financial flexibility you need to afford assisted living and other forms of senior care, so make sure to explore all the options that are available under your state’s Medicaid program.

To learn more about how Sunbound can help make senior living more affordable for you or your loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and is on a mission to make senior living affordable for everyone.

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