Does Medicare Cover Assisted Living in Massachusetts?

The short answer is no, Medicare does not cover the costs of assisted living. However, there are other insurance and benefit programs, such as long-term care insurance and the help and assistance benefit for veterans, that can help. In addition, some states have Medicaid programs, such as the Massachusetts Adult Group Foster Program (GAFC), which can provide financial assistance to those who qualify. Most Massachusetts residents who live in assisted living facilities pay their own expenses.

If you have limited income and few assets, you may be eligible for programs that can help cover some of the costs of assisted living. MassHealth, the Massachusetts Medicaid program offered by the State of Massachusetts, does not fund assisted living. Most assisted living residents in the state pay privately. However, MassHealth has certain programs that fund a portion of assisted living services for MassHealth members who have limited resources. The average monthly cost of long-term care options that provide a higher level of care, such as memory care and skilled nursing, is more expensive than assisted living.

The American Health Care Association (ACHA) and the National Center for Assisted Living (NCAL) provide consumers with useful information about assisted living and how to pay for it. To qualify for PACE (Programs of All-Inclusive Care for the Elderly), you must be 55 years or older, live in an area served by a PACE ESP (Elder Services Program), meet the standard of care of a nursing home, and be able to live safely in the community with PACE ESP services. The Executive Office of Aging Affairs has described a training and continuing education program that should be conducted in an assisted living residence to inform and guide its staff. To qualify for the State Supplemental Program, individuals must be eligible to receive federal Supplemental Security Income payments, be part of the group of adult foster homes, and live in a state-certified assisted living facility. The following directory contains information on 256 assisted living centers in the state of Massachusetts.

The GAFC does not pay for accommodation expenses (i.e., room and board) in an assisted living facility, only personal care expenses. Assisted living facilities are generally less expensive and less medically intensive than nursing homes. Not all assisted living centers are certified by group adult care programs, nor do all assisted living centers accept MassHealth payments. Medicaid is a joint federal and state medical assistance program based on financial need, administered by the Division of Medical Assistance in Massachusetts. The adult group care program reimburses GAFC-certified assisted living facilities for personal care services provided to MassHealth residents.

It's important to research those aspects, as well as the amenities each center offers, when looking for an assisted living facility for you or your loved one. Care provided in an assisted living facility is not considered specialized like that provided in a nursing home or skilled nursing facility (SNF). Beneficiaries of the adult group care program who are eligible for the federal and state supplemental income security program typically use the SSI-G to pay for assisted living expenses. The adult group foster home and Supplemental Security Income offered by the state of Massachusetts only fund personal care services for adults who reside in an assisted living facility certified by the Department of Aging Affairs. MassHealth (the Medicaid program in Massachusetts) will pay for some home health care services through several programs and, in some cases, part of the cost of assisted living facilities.