Assisted Living Facilities

Consumer's Guide 

Paying for Assisted Living Care 
Medicaid does not pay for assisted living care the way it pays for care in nursing centers. Almost all of assisted living care is paid out of the private resources and/or income of the resident. 

PRIVATE PAY. Assisted living is expensive care although usually less expensive than nursing center care. The basic daily rate will depend upon the extent of services offered and the location of the facility. Frequently facilities will require the prospective resident to state their various resources and sources of income. This is an intrusive request but there are no regulations prohibiting the facility from requesting this information. However, facilities are not allowed to discriminate. 

LONG TERM CARE INSURANCE. Many long term care insurance policies offer coverage for assisted living care as well as nursing center care. This has not always been true but as assisted living has grown insurance companies had to expand their policies. However, these policies do not promise to cover the actual cost of care. Policies promise to pay a certain amount per day or per month regardless what the actual charge for the facility is. Also, policies generally offer coverage for limited periods of time, for example 2 years or 5 years. You decide the length of coverage. In essence long term care insurance policies offer you a pool of money that can be drawn down upon over a period of time to pay for either assisted living care or nursing center care. The criteria for when coverage begins for tax qualified plans is based upon limitations on ADLs or if the person has developed a severe cognitive impairment. 

THE AUXILIARY GRANT PROGRAM. As stated above, Virginia has one program that provides payment to assisted living facilities for qualified applicants. For those who have low incomes equal to the federal SSI (Supplemental Security Income) level, a state can augment this level of income to help pay for the cost of assisted living care. Virginia does augment the SSI benefit under its auxiliary grant program.
 
To be eligible for the grant you must have very limited income and resources along with a documented need for assisted living. If found eligible there are several layers of payment that can be made by the state to the facility depending upon the level of need. The highest payment is for intensive assisted living in which the patient would ordinarily be eligible for nursing center care except that the assisted living facility is able to provide the level of care required by this individual. 

However, whatever level of assistance the resident qualifies for it, the auxiliary grant is much lower than the actual cost of care that the facility charges private pay residents and thus it is very difficult to find a facility that will accept a resident under the auxiliary grant program. Realistically, the auxiliary grant program is very limited in Virginia. 


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