The short answer is: sometimes, but Medicaid does not work the same way in Maryland, Washington, DC, and Virginia. Coverage depends on the specific program, financial eligibility, functional or medical eligibility, provider participation, and the services being requested.
First, understand what Medicaid may pay for
Medicaid may pay for certain long-term services and supports for eligible individuals. In programs that include assisted living services, Medicaid generally pays for approved care and support services rather than the full monthly assisted living bill. Room and board are generally not covered by a Medicaid home- and community-based services waiver.
Maryland
Maryland's Community Options Waiver provides home- and community-based services for eligible adults who require a nursing-facility level of care and meet the program's other requirements. Approved services may be delivered through participating providers, including qualifying assisted living providers. Not every assisted living community participates, and waiver approval does not mean every charge is covered.
Families should confirm both the person's program eligibility and the community's current Medicaid participation before relying on waiver assistance.
Washington, DC
The District's Elderly and Persons with Physical Disabilities, or EPD, Waiver provides community-based services for qualified older adults and adults with physical disabilities who meet financial and level-of-care requirements. Assisted living services may be available through enrolled providers. The waiver does not cover room and board.
Provider participation, the applicant's assessed needs, and current program rules must all be verified before choosing a community.
Virginia
Virginia is different. The Commonwealth Coordinated Care Plus, or CCC Plus, Waiver generally does not cover waiver services for someone living in a licensed assisted living facility that serves five or more residents. Therefore, families should not assume that the CCC Plus Waiver will pay the assisted living community's care charges.
Virginia's Auxiliary Grant program is a separate state-supported income supplement that may help certain eligible adults living in an approved assisted living facility or adult foster care home. Eligibility, participating settings, and payment rules must be confirmed through the local department of social services.
Important questions to ask
- Which specific Medicaid or state assistance program is being considered?
- Does the applicant meet the program's financial and functional eligibility rules?
- Is the assisted living community enrolled in and currently accepting that program?
- Which care services are covered, and which charges remain the resident's responsibility?
- Is there an enrollment, assessment, or provider-availability delay?
- What happens if the resident's care needs or financial situation changes?
Where to verify current information
Because rules and eligibility limits can change, verify current information directly with the appropriate agency:
- Maryland Department of Health — Community Options Waiver: health.maryland.gov/mmcp/ltss/Pages/community-options-waiver.aspx
- DC Department of Health Care Finance — Long-Term Services and Supports: dhcf.dc.gov/service/long-term-care-services
- Virginia Medicaid — CCC Plus Waiver: dmas.virginia.gov/for-members/benefits-and-services/waivers/ccc-plus-waiver/
- Virginia Department for Aging and Rehabilitative Services — Auxiliary Grant: dars.virginia.gov/
This article provides general educational information and is not legal, financial, or eligibility advice. Program eligibility is determined case by case. Confirm current rules with the applicable Medicaid agency, local department of social services, benefits counselor, or elder law attorney before making a financial commitment.
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Contact UsWritten by EverCare Senior Solutions.
