FINANCE
The majority of assisted living residents use some form of private pay (e.g., long term care insurance, personal finances) to cover the cost of their assisted living services.
Cost of Care
The national median rates for assisted living services are
$4,500 monthly and
$54,000 annually. View cost estimates by state.
Annual Median Cost of Long Term Care in the Nation
|
Home Health Care |
|
| --Homemaker Services |
$59,488
|
| --Home Health Aide |
$61,776
|
|
Adult Day Health Care |
$20,280
|
|
Assisted Living Community |
$54,000 |
|
Nursing Home Care |
|
| --Semi-Private Room |
$94,896
|
| --Private Room |
$108,408 |
Medicaid
Low-income individuals may be able to utilize Medicaid to help cover the cost of services, depending on their state's Medicaid program. Almost
1 in 5 residents relies on Medicaid to pay for daily services (18%).
State Medicaid programs can cover home and community-based services (HCBS) such as personal care and supportive services provided in assisted living communities. Medicaid does not pay for room and board costs.
States can use several different Medicaid authorities to cover such services in assisted living:
- Medicaid state plan authorities,
-
§ 1915(c) HCBS waiver,
-
concurrent § 1915(b) managed care waiver, or
-
§1115 research or demonstration programs.
Note, a small minority of state Medicaid programs do not cover services in assisted living.
Over time, spending on Medicaid long-term services and supports (LTSS) has shifted from traditional settings of care towards HCBS settings.
-
57% ($94 billion) of Medicaid long term care services and supports spending was on HCBS in FY 2016
-
HCBS spending increased 10% from FY 2015 to FY 2016
-
Of the total Medicaid HCBS spending, 51.1% was through 1915(c) waiver programs.
Medicare
Medicare does not cover long term care services and supports, and therefore, assisted living services. However, the majority of assisted living residents are Medicare beneficiaries. Thus, assisted living providers are interested in many issues related to the delivery of Medicare services, such as:
- hospital readmissions
- off-label use of antipsychotic medications
- access to Medicare Part B therapy
- Medicare beneficiaries three-day stay requirement for skilled nursing care
- Bundled Payment Initiatives
- Medicare Advantage