Medicaid is a joint federal and state program administered in Mississippi by the Division of Medicaid (DOM) that provides health coverage to low-income individuals. Assisted Living (AL) facilities offer housing, personal care, and support services for those who need help with daily activities but do not require intensive nursing home care. Mississippi Medicaid generally does not pay for the housing component of AL, but it can cover the care services provided within a state-approved facility through a specific waiver program.
Medicaid’s Coverage Limitations in Assisted Living Facilities
Federal Medicaid guidelines prohibit the program from funding room and board costs in residential settings, which significantly impacts assisted living coverage. This means expenses associated with housing, utilities, and meals are not covered, as Medicaid is primarily a healthcare payer, not a housing assistance program. The cost of the resident’s apartment, including rent and food, must be paid using the individual’s private funds, Social Security income, or other personal resources. Since assisted living is fundamentally a residential setting, the individual is responsible for the majority of the monthly cost of occupancy.
Utilizing Mississippi’s Assisted Living Waiver for Services
Although housing costs are excluded, the Mississippi Division of Medicaid funds care services through the Home and Community-Based Services (HCBS) Assisted Living (AL) Waiver. This waiver is a state option designed to prevent or delay institutionalization by paying for non-medical supports and personal care for eligible individuals residing in a licensed Personal Care Home-Assisted Living (PCH-AL) facility.
The AL Waiver covers services that help residents manage their day-to-day lives, including:
- Assistance with Activities of Daily Living (ADLs) like bathing, dressing, and mobility.
- Medication management, involving oversight and administration of prescriptions.
- Intermittent skilled nursing services.
- Homemaker services.
- An attendant call system.
This program is not an entitlement; it has a limited number of state-funded slots, and a waiting list may exist for enrollment. The facility must also be approved as a Medicaid provider for these services to be covered.
Financial and Medical Eligibility Criteria
To access the services funded by the Assisted Living Waiver, an applicant must meet strict financial and medical eligibility criteria. Financially, an individual must have limited income and assets to qualify for Medicaid long-term care programs in Mississippi. The asset limit for a single applicant is $2,000, excluding non-countable assets like a primary residence. Income is capped at 300% of the Federal Benefit Rate (FBR), currently around $2,829 per month for a single person. Applicants exceeding these limits must engage in approved financial planning strategies to “spend down” their resources, and the financial review includes a look-back period of up to five years to identify uncompensated transfers of assets.
The medical requirement is highly specific, mandating that the applicant must require a Nursing Facility Level of Care (NFLOC). This means a physician and a functional assessment must certify that the individual’s health condition and care needs are severe enough to warrant placement in a full-time nursing home. Although the individual chooses assisted living, they must meet the clinical criteria for this higher level of care to qualify for the waiver services.
Assisted Living vs. Nursing Home Coverage
The distinction between Medicaid coverage for assisted living and nursing home care is a key difference for those seeking long-term care options. Nursing home care is categorized as a mandatory benefit under federal Medicaid law, meaning every state must cover it for eligible individuals. This institutional coverage is comprehensive, paying for both medical care and the room and board costs, minus a small patient contribution.
In contrast, assisted living coverage through the AL Waiver is an optional benefit selected by Mississippi, not a mandatory one. This HCBS waiver exclusively pays for the services, creating a cost-sharing model where the resident pays for the residential portion. The nursing home setting is considered an institution, which allows Medicaid to cover the full cost of stay, while assisted living is classified as a community-based setting where the federal room and board exclusion applies. This difference in classification dictates what Medicaid can and cannot pay for.