Monthly bills at an assisted living facilities are made up of two parts. One part is the monthly rent for the apartment (room and board) and the other part is for the additional care services the facility provides. For example, a monthly bill totaling $3,000 may break down to $1,000 for rent and $2,000 for care services.

Medicaid will only assist with the services portion of the bill. Medicaid pays the benefits through Home and Community Based Services (HCBS) which is different than benefits they pay when a resident is in a skilled care facility or nursing home.

When a Medicaid application is filed asking for HCBS benefits in an assisted living facility, the Medicaid caseworker requests that a case manager from one of the licensed care provider companies go out and do an assessment on the applicant to determine the level of care the resident applicant requires. The level of care must meet the required level of care Medicaid says is necessary for that person to be medically qualified for HCBS benefits.

When determining the level of care the case manager is also determining the care services that Medicaid will help allow for.They could determine that the person needs services that would cost $1,000 per month or they could determine they need services costing $2,000 per month. It just depends on their evaluation of the person's care needs.

Next the Medicaid caseworker will look at the applicant's asset and income figures to see if they are financially eligible for HCBS benefits. The first part is to see if they are below the $2,000resource limit. If they are below that limit then they look at the income.

The caseworker first determines the applicant's total income. They will give an automatic deduction of $727.00 which the applicant can use towards the room and board portion of the rent. They also deduct the cost of any health insurance premiums and a $65 personal needs allowance. The final income figure would be the monthly amount the applicant would pay towards the care services portion of the assisted living bill. This is called the "patient liability".

If the patient liability is more than the costs for services Medicaid covers then the person is not eligible. If the patient liability is less than the care costs then the person is eligible. The person pays the patient liability and Medicaid pays the rest.

Another thing to be aware of is that when someone is on HCBS Medicaid in an assisted living facility, Medicaid only allots $727 for the person to use to pay the room and board portion of the monthly bill.In reality that portion could be more than $727. In some cases the facility will be willing to accept the resident's monthly income less a small deduction as payment in full. If the facility is unwilling to do this then it is up to the family to make arrangements to have the bill paid in full.

For more information:

The Kansas and Missouri Nursing Home and Assisted Living Guide

How to be a Better Caregiver to Elderly Loved Ones

The Consumer's Guide to Hospice Care