IMMEDIATE ACTION REQUIRED: YOUR MEDICAID ENROLLMENT IS AT RISK
According to Medicaid, your enrollment record is due for revalidation. If you don’t respond immediately, you risk losing your billing privileges.
You only have 90 days to enroll in Medicaid or risk losing your contract.
ACT NOW!
IMPORTANT: Even if you don’t treat Medicaid patients, you are still required to enroll in Medicaid!
PROTECT YOUR PRACTICE – STAY AHEAD!
Avoid disruptions, prevent contract termination, and secure your revenue. WCH ensures a seamless revalidation process.
TIME IS RUNNING OUT! Contact WCH today to secure your Medicaid enrollment.
What Providers Need to Know About Medicaid and Assisted Living Coverage
Assisted living facilities provide a supportive environment for older adults and individuals with disabilities who require help with daily activities but do not need the intensive medical care provided in nursing homes. These facilities offer private or shared accommodations, meal services, supervision, social activities, and personal care assistance. While Medicare does not cover assisted living costs, Medicaid may cover specific home- and community-based services (HCBS), making assisted living more accessible for individuals with limited financial resources.
Medicaid and Assisted Living: The Basics
Medicaid is a joint federal and state program that provides healthcare coverage for low-income individuals. While Medicaid fully covers nursing home care—including both room and board as well as medical services—its coverage for assisted living is more limited. Federal regulations prohibit Medicaid from paying for room and board in assisted living facilities, but it can fund various HCBS that help residents receive the care they need in an assisted living setting.
Each state sets its own Medicaid policies, determining whether and to what extent it will cover home care services in assisted living. These services are typically offered through Medicaid waivers or state plan options, with coverage varying widely across states.
What Home Care Services Does Medicaid Cover in Assisted Living Facilities?
Medicaid can cover a range of home and community-based services for eligible assisted living residents. These include:
Personal Care Services: Assistance with activities of daily living (ADLs) such as bathing, dressing, eating, and mobility.
Case Management: Coordination of healthcare and other essential services to ensure residents receive appropriate care.
Nursing Services: Limited nursing care, including medication management and monitoring of chronic conditions.
Assistive Equipment and Home Modifications: Coverage for assistive devices, emergency response systems, and necessary modifications to improve accessibility and safety.
Non-Medical Transportation: Transportation services for medical appointments, social activities, and other necessary travel.
Day Services and Social Support: Structured activities, therapy, and social interaction programs to enhance well-being.
Home-Delivered Meals: In some cases, Medicaid may cover meal preparation and delivery services for individuals who require assistance with nutrition.
How Do States Offer Medicaid Coverage for Assisted Living?
Medicaid provides coverage for HCBS in assisted living through two primary mechanisms:
Medicaid Waivers (Section 1915(c) and 1115 Waivers): These waivers allow states to provide HCBS to specific populations, such as seniors or individuals with disabilities, as an alternative to institutional care. Waivers often have limited enrollment slots, meaning not all eligible individuals can access these services immediately.
Medicaid State Plan Benefits: Some states include HCBS as part of their standard Medicaid benefits, making them available to all eligible Medicaid beneficiaries without enrollment caps.
As of 2025, 41 states provide Medicaid coverage for home care services in assisted living facilities through at least one of these mechanisms, though the scope and availability of services vary widely.
Protections for Medicaid Beneficiaries in Assisted Living
Medicaid enrollees in assisted living facilities face financial and regulatory challenges, but some protections help ensure access to care:
Eviction Protections: Assisted living facilities that accept Medicaid funding must follow state and local landlord-tenant laws, which often require formal notice and legal proceedings before eviction can occur.
Room and Board Assistance: While Medicaid cannot cover room and board, 44 states provide financial assistance through Supplemental Security Income (SSI) or other state-funded programs to help residents afford housing costs.
Facility Participation Requirements: Only 10 states mandate that assisted living facilities accept new Medicaid-eligible residents, while 25 states have eviction protections beyond federal requirements, helping ensure continuity of care.
Challenges and Future Considerations
Despite Medicaid’s role in covering home care services in assisted living, several challenges persist:
Limited Availability: Many assisted living facilities do not accept Medicaid due to lower reimbursement rates, making it difficult for Medicaid recipients to secure placement.
State Variability: Coverage and eligibility criteria differ widely among states, creating disparities in access to care.
Potential Policy Changes: Legislative or regulatory shifts at the federal and state levels could impact Medicaid funding and the availability of services in assisted living.
What This Means for Healthcare Providers
For providers, understanding Medicaid’s role in assisted living is essential for guiding patients and families toward the best care options. Ensuring that Medicaid-eligible patients complete their enrollment and revalidation on time is critical to preventing coverage gaps and disruptions in care.
Key Takeaways for Providers:
Encourage Medicaid-eligible patients to stay updated on their revalidation deadlines to avoid coverage loss.
Inform families that while Medicaid does not cover room and board, it can fund essential care services in assisted living.
Be aware of state-specific policies to help patients navigate their options effectively.
Partner with billing and credentialing experts, like WCH, to streamline the Medicaid enrollment and revalidation process.
As policymakers explore ways to improve Medicaid’s role in long-term care, individuals and families should stay informed about available options and advocate for comprehensive, equitable access to assisted living services. Understanding Medicaid’s coverage limitations and state-specific policies can help seniors and their families make informed decisions about long-term care.
Secure Your Medicaid Enrollment Today!
Don’t let enrollment delays put your revenue at risk! Contact WCH now to ensure a smooth revalidation process and uninterrupted billing privileges. Act before the deadline!
