The cost of assisted living can stretch family budgets to the breaking point. The average cost of assisted living in Los Angeles is $5,800 per month and Alzheimer’s care or memory care is typically 25% more expensive.  But financial help is available. Medicare, Medicaid, and the US Department of Veteran Affairs offer assistance programs that can help pay for eldercare in certain circumstances.

MEDICARE

Medicare is national health insurance that all Americans are eligible to receive when they turn 65. Disabled people under 65 can also enroll in Medicare without paying premiums.

Medicare Only Covers Short-Term Care

Medicare can cover short-term rehab stays at a nursing facility, for example, after a hospitalization. It can also pay for rehabilitation and therapy at home for a limited period of time when prescribed by a doctor.

Medicare is not helpful to those looking for a solution to long-term care needs. Medicare is primarily a form of health insurance. This means Medicare does not pay for the following types of senior care:

• Assisted Living
• Long-term care at a nursing facility
• Residential Care Homes 
• Any long-term care

Visit the Medicare website for more information.

MEDICAID (Medi-Cal in California)

Medicaid is the foremost government assistance program paying for long-term care for people who can’t afford it on their own. It is administered cooperatively by the federal government and states. While the majority of its funding comes from the federal government, each state has some discretion in its individual rules, regulations, and certain eligibility requirements. 

Medicaid does not send payments directly to you, instead, it sends payments directly to your healthcare provider. In some cases, you may be required to pay a small part of the cost (co-payment) for some medical services.

Eligibility For Medicaid

• A senior must put almost all of his or her existing assets towards care.
• Be considered low income, or at least have medical or care expenses that are higher than income.

• If a married couple wants to qualify for Medicaid, the couple does not need to have exhausted all financial resources. The healthy spouse can usually keep the home he or she lives in but may still have to make significant sacrifices.

Medicaid Is The Social Safety Net For Ailing Elders

Medicaid is the safety net for Americans who need care that they cannot afford privately. Like Medicare, Medicaid acts as health insurance. But unlike Medicare, Medicaid can be used to pay for long-term nursing home care in all states. Many states also allow their residents to use Medicaid to pay for assisted living communities or other alternatives to nursing homes such as in-home care.

Some states even offer a program through Medicaid called PACE (Program of All-Inclusive Care for the Elderly) or ALW (Assisted Living Waiver Program) which covers some or all of the senior care and medical needs through one contracting agency, with the goal of allowing people who have traditionally gone to nursing homes to reside in a community or at home with support and assistance.

Medicaid (Medi-Cal) Assisted Living Waiver Program

For persons who have limited finances, Medicaid will pay for nursing home care. And if someone wishes to live at home or in assisted living, sometimes Medicaid will pay for care if the cost is lower than nursing home care. These are called Medicaid Waivers or Home and Community-Based Services (HCBS) Waivers. The Assisted Living Waiver program is available in Los Angeles. The California Department of Health and Human Services requires each participant to pay for room and board fee which is either $1,211.77 or $1,231.77, depending on income.  As of April 2022, the state set the monthly income limit at $1,564 for a single applicant and at $2,106 for a married couple who are both applying for benefits. These income limits will increase in April of 2023 and will reflect 138% of the 2023 Federal Poverty Level figures. 

To apply visit California Medicaid online.

To apply in person or find the nearest office call: 877-597-4777

It may be helpful to contact an elder law attorney who can help guide you through the complex process of completing a successful Medicaid application.

VETERANS AID

Veterans who are at least 65 years old and who served during war time (though not necessarily in actual combat) for at least 90 consecutive days may be eligible for financial assistance through the US Department of Veteran Affairs (VA) that can be used to help pay for care. Other dependents of the veteran may be eligible for assistance in some cases as well. Surviving spouses can apply if they have not divorced or remarried after the Veteran’s death.

Three Levels of  VA Pensions

There are three levels of VA benefits for wartime veterans and their dependents, which are based on the needs of the applicant.

Basic Pension

A Basic Pension is designed to function as cash assistance for low-income veterans and their dependents. Applicants may be healthy.

Housebound Benefit

Housebound assistance with day-to-day activities must be needed on a regular basis.

Aid & Attendance

Requires doctor’s certification that the claimant cannot leave the house without assistance or is in need of assistance with daily living activities. Assistance from the VA is “means-tested”, in other words, only people who are deemed genuinely in need will receive an award. It also means that the amount of the benefit is based on the applicant’s income, assets, and care needs. Applicants whose incomes are over maximum thresholds (excluding the home they live in and the car they drive), will usually be denied. However, decisions are primarily made on a case-by-case basis.

How To Apply For VA Benefits

Like Medicaid, VA benefits can be extraordinarily complex. For this reason, you might consider speaking with a volunteer Veteran Services Officer, many of whom can be found throughout the United States at local hubs for veterans like American Legion Halls or Veterans of Foreign Wars (VFW) lodges. Another option is to contact the various VA Benefit Attorneys and agencies who can streamline the process and whose services are often free of charge.

• Call (877) 222-VETS: Health Benefits Service Center
• Visit the Department of Veterans Affairs website

Need Help?

If you have additional questions regarding these programs, or how to pay for senior care, contact the Passaro Group at 310-428-8221. We have all of the latest information and are happy to help you navigate this complex and difficult process.