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How Much Does Medicaid Pay for Assisted Living in Canada?

Assisted living is one of the housing options available to Canadians with basic needs. These people could be living with disabilities, or people who need help with daily living. However, regardless of the category you fall under, making proper preparation on how to sort your bill will aid your stay.

Generally, you can either pay out-of-pocket or get a part of your bill sorted by the government via Medicaid. In addition, Medicaid usually pays for assisted living depending on the amount of care you are eligible for. So, how much does Medicaid pay for assisted living in Canada?

What is Medicaid in Canada?

Medicaid is a federal-provincial partnership initiative aimed towards helping low-income earners and asset-poor individuals pay for healthcare, including long-term care. However, there are different guidelines you must follow when trying to access funds from Medicaid.

Guidelines for Medicaid vary per your province in Canada. Medicaid covers a range of costs of assisted living in Canada including memory/Alzheimer care.

However, you must meet the eligibility requirements to qualify for this assistance. Note that the requirements and benefits you can access will depend on your province of residence.

Nonetheless, Canadian federal law requires that provinces provide certain services to Medicaid recipients. The province per federal law must pay for nursing facilities and home health care services for qualifying Medicaid recipients.

Coverage Determining Factors

Some factors will determine the amount Medicaid will pay for assisted living. Below are some of the factors:

  • The level of care
  • Province of residence
  • The province Medicaid program

However, the fully determine how much Medicaid will pay for assisted living, you will need to carry out a need assessment. A need assessment usually calculates the number of hours Medicaid will cover. For instance, people with a more significant need for assistance can get a huge amount of money for caregiver hours per month.

Medicaid Coverage

Medicaid assistance approval is based on financial(income and assets) and functional needs. However, provinces can decide to use Medicaid funding to provide additional long-term care services such as home health care for non-qualified individuals.

These can be people who do not qualify for a nursing home, assisted living facilities, adult foster homes, and in-home services such as help with housekeeping and medication management. 

In addition, Medicaid may cover the cost of skilled nursing and emergency response systems. However, Medicaid will not cover the cost of room and board as it most times account for half of the cost of assisted living.

General Medicaid Coverage

And as stated above, the coverage by Medicaid depends on provincial programs. However, some general services under assisted living are paid for by Medicaid. Below are some of the coverage:

  • Inpatient hospital services
  • Physician services
  • Federally qualified health centre services
  • Home health services
  • Transportation to medical care
  • Early and Periodic Screening, Diagnostic and Treatment services: EPSDT
  • Outpatient hospital services
  • Nursing facility services
  • Rural health clinic services
  • Laboratory and X-ray services

Conclusion

Medicaid assistance coverage depends on your province of residence. However, each province has right within the federal government guideline that gives room for modifications. In addition, these modifications allow the province to set policies on how they assist persons residing in assisted living communities.

Since the aid per person depends on provincial law, it is advisable to review your province’s specific Medicaid details. Also, it is important to note that most assisted living communities do not accept Medicaid, hence we may want to ask for community policies before signing up.

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