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Paying for Assisted Living

There’s a perception that you live in your home for as long as you can and then when your health deteriorates, you move into a nursing home. That may be true in some instances, but it does not have to be true as a general rule. Unfortunately, people make the assumption that they are headed from their home to the nursing home and there is nothing that can intervene.

There are other options available. Senior housing is one option. Bringing help into the home is another home. Qualifying for Home and Community Based Services is still another option. The focus of this article is on assisted living. Assisted living is a viable option for many, but it can be costly.

As a general rule, a nursing home, if it has one Medicaid resident, must accept any Medicaid qualified applicant. In other words, if it is a Medicaid qualified facility and has a Medicaid resident, that facility cannot turn an applicant down just because that applicant is on Medicaid.

That rule does not apply to assisted living facilities. Currently, there is no law in Kansas that requires assisted living facilities to accept Medicaid patients.

However, Kansas has a waiver program called Home and Community Based Services. Some facilities have agreed to set aside a few rooms for Medicaid residents. The Medicaid portion is provided through the Home and Community Based Services of Medicaid. That just pays for the service component. As an example, if someone has a nurses aide with them for a large number of hours, that would be covered. If the resident requires management of medications, Medicaid would cover that. If the person needed assistance transporting from their bed to a wheelchair or just getting up and down, Medicaid would pay for that. So too with bathing, aid going to the toilet and care of that nature. Those types of services will be covered by Medicaid and then the resident would be responsible for paying the room and board. Many times that room and board can be negotiated for less than the full price that a private paying person would be paying.

To qualify for Home and Community Based Services, you still must meet the Medicaid requirements. That means that you can only have $2000 in countable resources, $1500 cash value life insurance, your personal property, one vehicle, a funeral plan, a burial plot and your residence. Also remember, however, that if you are on Home and Community Based Services, you are still entitled to do a division of assets so that you can protect the well spouse who may not be living in the assisted living facility.

Another option to help pay for assisted living is the Veterans Administration’s Pension program. It will help cover assisted living care for veterans and spouses of veterans who have served at least 90 days on active duty and at least one day during war time. Persons seeking qualification, must meet a medical qualification test, but their conditions do not need to be related to military service. This particular pension benefit is called Aid and Attendance. It can pay a maximum benefit of $1949/month for married veterans, $1644/month for single veterans, and $1556/month for a surviving spouse. There are income and asset restrictions for the VA Pension Aid and Attendance program. However, the income is offset by the cost of the assisted living facility.

Less than one-third of people who are eligible for the VA benefit actually receive it, according to Cheryl Chapman Henderson, an attorney and veterans benefit consultant in College Park, Maryland. Many veteran applicants are told that they have too many assets to qualify for the program, when in fact, once you offset their assets and income with their expenses, they are well within the range of the VA program.

Contrary to what a lot of people believe, there is no age restriction on assisted living. My 96-year-old grandmother has been in an assisted living facility since May of 2006 and loves it. There, she participates in Bingo, church services, sing-alongs, group picnics, meals with her “pals” and other social activities.

If you or someone you know is having issues staying safe in their home, do not just assume that the nursing home is the only place. An assisted living facility cannot only be a bridge to the nursing home (such as my grandmother), it allows the person to stabilize and stay much more independent for as long as possible.

The rules for qualifying for Home and Community Based Services and the rules for qualifying for VA Pension Aid and Attendance are sometimes contrary to one another. There are some things that you can do when qualifying for VA benefits that will cause you to be disqualified for Medicaid later on. Be very, very careful and consult a qualified elder law attorney before you put any plan into place.


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