​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​Almost 1 in 5 assisted living 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.

A small minority of state Medicaid programs do not cover services in assisted living.  ​

 Featured Video

 Home and Community-Based Setting Rule (HCBS Rule)

​​In 2014, the Centers for Medicare and Medicaid Services (CMS) issued a final rule establishing requirements for the qualities of settings that are eligible for Medicaid HCBS waiver reimbursement.

On July 14, 2020, a State Medicaid Director letter was released by CMS, indicating that the transition period for compliance with home and community based settings criteria is extended until March 17, 2023.

HCBS Rule Overview
NCAL Policy Briefs