Can Medicare Part A be used to cover rent at assisted living center

[EricW236758]

Well, to make a long story as short as possible, I've been contacting assisted living centers in search of a place to live.  I'm getting quotes back for monthly rents which are almost exactly the same as what I'm getting on SSDI ($ 1,635 a month on SSDI).  However, one of the rental agents mentioned that Medicare might pay for part of my rent, but she didn't know where I would have to go in order to make that happen.

I'm 59 years-old, I am in fact disabled, and I've been on SSDI since 2012.  Is it really possible that Medicare might be able to pay for at least part of my rent in an assisted living center, or was the rental agent blowing smoke?  How would I get the ball rolling on something like this?

[GailL1]

No, Medicare, all of it,  pays only for medically needed therapy, treatments under order or direction of a physician. NOT for any Daily Living type care  Assisted Living is an alternative living place; not a medical facility like a nursing home.  Are you looking at an official assisted living place?  - where the rent covers your room and board, so to speak, though most have a medicine person that have extra training to give out meds - any level of daily living care over just the basic is added on top of the room and board charge.  As your level of daily living care increases, so does the monthly charge.  If you need something ordered by or through a doc where they come to you to provide the service,  those services are covered under Medicare as any other needed medical care.

Where I live, and I assume other places, we have places called Personal Care Homes.  These are smaller, community based type housing - disabled / elderly; somewhat like an assisted living facility.  They can do some daily living care but if it gets too extreme they might not be able to handle it because of the needs of the whole and limited staffing.  Medical care given in a persons home or living place, again is brought in for the service - and the service bills Medicare for payment just like any other needed medical necessity.

Medicaid (NOT Medicare)covers nursing home care for the low income - maybe that is what they were trying to say or you might have misunderstood since the names are similar - MEDICAID vs Medicare.  ??????  Medicaid also sometimes covers some daily living for the low income - 

No all facilities - Assisted Living / Personal Care Homes/ even Nursing homes accept Medicaid beneficiaries.  I am pretty sure that at $ 1635 per month on SSDI, you are over the low income limit for Medicaid in most, if not all, states.

Do you happen to be a Veteran?

[EricW236758]

Are you looking at an official assisted living place?

Yes, I've been looking at these types of facilities, and even the lower priced ones are just a bit out of my grasp. 

Do you happen to be a Veteran?

Nope, not a veteran.

Thanks, the rest of your answer sheds a lot of light on things. 

[GailL1 · Accepted solution]

@EricW236758 

Since you have been successful in getting on Medi-Cal - see if this may help you with the assisted living facility - sounds like from your description, you may need at least some daily living assistance- a watchful eye perhaps but you won't be cooking - BE CAREFUL.

California.gov - Dept of Home and Community Based Service - Long-Term Care Alternatives (Home and Co...

see the bottom of the page -

You need a Medi-Cal counselor that can hopefully explain the above as well as your Medi-Cal medical coverage.  They may have to have a doctor's order or description of what you need in the form of care - I don't know.  Under this program (HCBS), I believe  Medi-Cal can subsidize your living cost in a community type care home ( whatever the state calls it - assisted living or personal care home - alternative to Nursing Home) and leave you some (albeit, a little, probably)  of your SSDI benefits.  They can also bring in medical needs if you need it in the facility.

Some of those Personal Care Homes and maybe some assisted living facilities in my area are Medicaid subsidized under this program - Home and Community Based Services.

There are some services that help to find assisted living places - 'A Place for Mom' is one of the national ones - but you need something at the government level since they know which facilities take their subsidized payments, your health needs and what you are required to pay.  Work your place to live under your Medi-Cal - most likely the Home and Community Based Services.

Hope this help - 

[EricW236758]

...see if this may help you with the assisted living facility..

Unfortunately when I click on the link, and then scroll down to the bottom of the page, the only real info I see is a link titled "811 Project Rental Assistance (PRA)".   However, when I click on the "811 Project Rental Assistance (PRA)" link it takes me to a page which has been under construction since March of this year.  See below.

https://www.dhcs.ca.gov/services/ltc/Pages/811_PRA_Stakeholder_-Page.aspx

I tried searching Google for "Long-Term Care Alternatives (Home and Community-Based Service Options)" - but that just seems to take me down another rabbit hole which I don't understand.  

I'm really lost and overwhelmed with all of this right now. 

[GailL1]

Good grief - could they make it any more difficult.  I am sorry.  Frustrating for me too - EXTREMELY !!!

I did find a list of these facilities by CA county - the list link is at the bottom of this post - and the rest is just info on the program and how I got to the list.  Long, I know, but this is how I trace - it's still info -

Hope this helps more -

NOLO is a legal (encyclopedia-type) site for the common person and it does describe what I am talking about - so this is just for info but sometimes a little knowledge goes a long way especially when looking for a needle in a haystack [ 😉 ].

NOLO - When California's Medi-Cal Will Pay for a Nursing Home, Assisted Living, or Home Care 

from the link:

Medi-Cal for Assisted Living Facility Residents

Assisted living facilities (ALFs) offer a wide range of supportive services like housekeeping, medication management, meal preparation, and assistance with dressing and bathing, but they do not offer skilled nursing care. (In 2019, the average cost of an assisted living facility was $4,500 per month.)

In general, Medicaid pays for room and board only when they are offered in an institution that provides skilled care (like a nursing home), and it does not generally pay for room and board expenses in assisted living facilities. However, in California, to assist with the costs of assisted living facilities, the state has created a Medi-Cal program called the Assisted Living Waiver (ALW) that pays for ALFs in some counties.

( These MAY BE the counties - I don't know - these seem to be the ones that took nursing home residents in covid hot spots - but looks like these counties  are in the program)

California DHCS.gov - Assisted Living Waiver 

Back to the NOLO site:  it says -

Assisted Living Waiver

ALW is a Home and Community-Based Services (HCBS) waiver program that offers care coordination services and can pay for expenses associated with some assisted living facilities and also with some home health services. Most recipients of ALW services still have to pay most of their income to the assisted living facility for room and board charges.

To be eligible for ALW, you must be eligible for Medi-Cal (without the Share of Cost program) and require an intermediate level of care. You meet that level of care if, without the ALW services, you would need to live in a nursing home. However, because ALW is a Medicaid waiver program, it does not need to be equally available to everyone in the state who is eligible for it. At this time, California has opted to make the services available to some seniors and people with disabilities living in Sacramento, San Joaquin, Los Angeles, Sonoma, Fresno, San Bernardino, Contra Costa, Alameda, San Diego, Riverside, Kern, Orange, Santa Clara, and San Mateo counties.

If you qualify for ALW, you must use one of the assisted living facilities that have been approved by the state to participate in the program. The state licenses and regulates assisted living facilities that wish to receive Medi-Cal payments. Those approved facilities are called Residential Care Facilities for the Elderly (RCFE)RCFEs can have as few as six beds or as many as 100 beds.

Are you in one of those counties?  Then IF you are - there has to be some way for you to find out if you can enroll and if there are openings in this program -  Residential Care Facilities for the Elderly (RCFE)

I have found the actual manual of policies and procedures for this program

https://cdss.ca.gov/ord/entres/getinfo/pdf/rcfeman1.pdf 

It says it is under the STATE OF CALIFORNIA
HEALTH AND HUMAN SERVICES AGENCY - DEPARTMENT OF SOCIAL SERVICES -  COMMUNITY CARE LICENSING DIVISION

I found the place where the actual AS facilities actually apply, get reviewed for the program:

https://www.dhcs.ca.gov/services/ltc/Pages/Residential-Care-Facility-and-Adult-Residential-Facility-... 

but when I went to the link at the bottom of this page that says 

• Medi-Cal Member Enrollment Information  

The page says no longer available.  (Grrrrrrr ☹️) - but there are other links on the page Soooooo -

I found this list of the facilities (current as of 09/01/2021)

California Department of Health Care Services Assisted Living Waiver (ALW) Program Participating Fac... 

Now will you be eligible?  Do they have any openings????  Can you find out how to get in?  NOTE THE FOOTNOTES AT THE BOTTOM OF EACH PAGE as to the type of facility/ current openings/new facility - suppose to be current as of end of 08/2021.

But I hope this helps more.  GOOD LUCK

[EricW236758]

Thanks again, Gail. Sorry to be so dense.  I guess that my brain got a little weaker while I was living overseas all of those years. 

Also, the below segment from Nolo seems to be the key:

For Medi-Cal to pay for a nursing home stay, your treating physician must prescribe a nursing home for you because you either need the continual, round-the-clock availability of skilled nursing care or what's called "intermediate care." 

Well, that might be a path forward, but won't happen overnight, but at least it is a path.  Maybe. 

[EricW236758]

Thanks Gail, I will look into this before I start posting anymore questions in this forum.  (Sometimes I feel like I have to many pokers in the fire)  I've looked through the documentation I received from Medi-Cal, but it doesn't mention anything about a Medi-Cal counselor.  Would a Medi-Cal counselor be someone who works at Medi-Cal, or would it be some sort of third party advocate?  Sorry to be so dense, but this is really all very new to me. 

[GailL1]

As far as contacting a Medi-CAL counselor - see if this might work.  

California DHCS.gov - Medi-Cal Managed Care and Mental Health Office of the Ombudsman 

So you try to get an Ombudsman that can help you get in the Residential Care Facilities for the Elderly (RCFE) program.  It covers the disabled too.  If they can't actually do it - they should be able to put you in touch with a MediCal rep or a Social Worker than can help you.

Here is the list of facilities available by county, on that RCFE, If the county participates.  Note the footnote on each page as to type of facility that suites.  this is from my other post to you today in this same thread - at 09-20-2021 06:59 PM

California Department of Health Care Services Assisted Living Waiver (ALW) Program Participating Fac... 

list is suppose to be current as 09/01/2021