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My mother is in an assisted living facility. Her life savings

My mother is in an...
My mother is in an assisted living facility. Her life savings is running out in the next few months. Her assisted living facility costs exceed her income from my father's pension, social security and VA. (My father is deceased.)

A friend said the deficit can be covered by Medicaid. Is this true? Are there any other resources? Currently, not knowing of other resources, her children will have to pay the difference or move her to another, lesser facility as we may not have the resources to cover the deficit.
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2/27/2013
John Legal
John Legal, Attorney
Category: Legal
Satisfied Customers: 4,631
Experience: Over 15 years legal experience.
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Welcome! Thank you for your question.

Have you checked into the following additional benefits through Medicaid in Massachusetts?

Medicaid/Mass-Health Programs

Group Adult Foster Care

Administered by The Executive Office of Elder Affairs, Group Adult Foster Care (GAFC) is a Medicaid program that reimburses providers for providing administrative and clinical oversight and daily assistance with personal care services to financially and clinically eligible elderly and disabled individuals who are at risk of institutionalization.

In order to qualify, participants in GAFC must:

  • Be aged 22 and older;
  • Meet financial criteria;
  • Reside in a certified assisted living residence (only for SSIG eligibility);
  • Be serviced by a certified GAFC provider;
  • Have physician authorization of a medical diagnosis that deems GAFC an appropriate program for their needs;
  • Require daily assistance with at least one Activity of Daily Living (ADL), which is related to a medical diagnosis; and
  • Receive clinical approval from an Aging Services Access Point (ASAP)

Elder Affairs reimburses the provider for the provision of personal care services and the administration of the program. Effective April 1, 2008, the per diem reimbursement rate is $40.33. Approximately $1,150 per participant per month is reimbursed to the provider for services, while the resident remains responsible for the rent. See Supplemental Security Income Living Arrangement G (SSIG) for a detailed explanation of assistance with rent.

For more information about GAFC, visit massresources.org.

Senior Care Option (SCO)

A combined MassHealth and Medicare program that includes health care and social services, to help low-income seniors stay healthy and able to live in their own homes. A team of health professionals develops a plan of total individualized care for each member. Services are provided by a network of medical and other professionals, including a primary care doctor, nurses, specialists, and a geriatric support coordinator, who are part of a senior care organization. For more information about SCO, visit massresources.org.

Program of All-inclusive Care for the Elderly (PACE)

The PACE model of care is a national insurance program funded jointly by Medicare and Medicaid. PACE provides and coordinates all needed preventive, primary, acute and long term care services so that older individuals can continue living in the community. The PACE model is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.

Although all PACE participants must be certified to need nursing home care to enroll in PACE, only about seven percent of PACE participants reside in a nursing home nationally. If a PACE enrollee does need nursing home care, the PACE program pays for it and continues to coordinate his or her care.

For more information, visit massresources.org.

- See more at: http://www.massalfa.org/find-a-residence/payment-options#sthash.jeeNASQr.dpuf

Medicaid/Mass-Health Programs

Group Adult Foster Care

Administered by The Executive Office of Elder Affairs, Group Adult Foster Care (GAFC) is a Medicaid program that reimburses providers for providing administrative and clinical oversight and daily assistance with personal care services to financially and clinically eligible elderly and disabled individuals who are at risk of institutionalization.

In order to qualify, participants in GAFC must:

  • Be aged 22 and older;
  • Meet financial criteria;
  • Reside in a certified assisted living residence (only for SSIG eligibility);
  • Be serviced by a certified GAFC provider;
  • Have physician authorization of a medical diagnosis that deems GAFC an appropriate program for their needs;
  • Require daily assistance with at least one Activity of Daily Living (ADL), which is related to a medical diagnosis; and
  • Receive clinical approval from an Aging Services Access Point (ASAP)
Elder Affairs reimburses the provider for the provision of personal care services and the administration of the program. Effective April 1, 2008, the per diem reimbursement rate is $40.33. Approximately $1,150 per participant per month is reimbursed to the provider for services, while the resident remains responsible for the rent. See Supplemental Security Income Living Arrangement G (SSIG) for a detailed explanation of assistance with rent.

For more information about GAFC, visit massresources.org.


Senior Care Option (SCO)

A combined MassHealth and Medicare program that includes health care and social services, to help low-income seniors stay healthy and able to live in their own homes. A team of health professionals develops a plan of total individualized care for each member. Services are provided by a network of medical and other professionals, including a primary care doctor, nurses, specialists, and a geriatric support coordinator, who are part of a senior care organization. For more information about SCO, visit massresources.org.

Program of All-inclusive Care for the Elderly (PACE)

The PACE model of care is a national insurance program funded jointly by Medicare and Medicaid. PACE provides and coordinates all needed preventive, primary, acute and long term care services so that older individuals can continue living in the community. The PACE model is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.

Although all PACE participants must be certified to need nursing home care to enroll in PACE, only about seven percent of PACE participants reside in a nursing home nationally. If a PACE enrollee does need nursing home care, the PACE program pays for it and continues to coordinate his or her care.

For more information, visit massresources.org.

- See more at: http://www.massalfa.org/find-a-residence/payment-options#sthash.jeeNASQr.dpuf

Medicaid/Mass-Health Programs

Group Adult Foster Care

Administered by The Executive Office of Elder Affairs, Group Adult Foster Care (GAFC) is a Medicaid program that reimburses providers for providing administrative and clinical oversight and daily assistance with personal care services to financially and clinically eligible elderly and disabled individuals who are at risk of institutionalization.

In order to qualify, participants in GAFC must:

  • Be aged 22 and older;
  • Meet financial criteria;
  • Reside in a certified assisted living residence (only for SSIG eligibility);
  • Be serviced by a certified GAFC provider;
  • Have physician authorization of a medical diagnosis that deems GAFC an appropriate program for their needs;
  • Require daily assistance with at least one Activity of Daily Living (ADL), which is related to a medical diagnosis; and
  • Receive clinical approval from an Aging Services Access Point (ASAP)

Elder Affairs reimburses the provider for the provision of personal care services and the administration of the program. Effective April 1, 2008, the per diem reimbursement rate is $40.33. Approximately $1,150 per participant per month is reimbursed to the provider for services, while the resident remains responsible for the rent. See Supplemental Security Income Living Arrangement G (SSIG) for a detailed explanation of assistance with rent.

For more information about GAFC, visit massresources.org.

Senior Care Option (SCO)

A combined MassHealth and Medicare program that includes health care and social services, to help low-income seniors stay healthy and able to live in their own homes. A team of health professionals develops a plan of total individualized care for each member. Services are provided by a network of medical and other professionals, including a primary care doctor, nurses, specialists, and a geriatric support coordinator, who are part of a senior care organization. For more information about SCO, visit massresources.org.

Program of All-inclusive Care for the Elderly (PACE)

The PACE model of care is a national insurance program funded jointly by Medicare and Medicaid. PACE provides and coordinates all needed preventive, primary, acute and long term care services so that older individuals can continue living in the community. The PACE model is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.

Although all PACE participants must be certified to need nursing home care to enroll in PACE, only about seven percent of PACE participants reside in a nursing home nationally. If a PACE enrollee does need nursing home care, the PACE program pays for it and continues to coordinate his or her care.

For more information, visit massresources.org.

- See more at: http://www.massalfa.org/find-a-residence/payment-options#sthash.jeeNASQr.dpuf

Group Adult Foster Care

Administered by The Executive Office of Elder Affairs, Group Adult Foster Care (GAFC) is a Medicaid program that reimburses providers for providing administrative and clinical oversight and daily assistance with personal care services to financially and clinically eligible elderly and disabled individuals who are at risk of institutionalization.

In order to qualify, participants in GAFC must:

  • Be aged 22 and older;
  • Meet financial criteria;
  • Reside in a certified assisted living residence (only for SSIG eligibility);
  • Be serviced by a certified GAFC provider;
  • Have physician authorization of a medical diagnosis that deems GAFC an appropriate program for their needs;
  • Require daily assistance with at least one Activity of Daily Living (ADL), which is related to a medical diagnosis; and
  • Receive clinical approval from an Aging Services Access Point (ASAP)

Elder Affairs reimburses the provider for the provision of personal care services and the administration of the program. Effective April 1, 2008, the per diem reimbursement rate is $40.33. Approximately $1,150 per participant per month is reimbursed to the provider for services, while the resident remains responsible for the rent. See Supplemental Security Income Living Arrangement G (SSIG) for a detailed explanation of assistance with rent.

For more information about GAFC, visit massresources.org.

Senior Care Option (SCO)

A combined MassHealth and Medicare program that includes health care and social services, to help low-income seniors stay healthy and able to live in their own homes. A team of health professionals develops a plan of total individualized care for each member. Services are provided by a network of medical and other professionals, including a primary care doctor, nurses, specialists, and a geriatric support coordinator, who are part of a senior care organization. For more information about SCO, visit massresources.org.

Program of All-inclusive Care for the Elderly (PACE)

The PACE model of care is a national insurance program funded jointly by Medicare and Medicaid. PACE provides and coordinates all needed preventive, primary, acute and long term care services so that older individuals can continue living in the community. The PACE model is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.

Although all PACE participants must be certified to need nursing home care to enroll in PACE, only about seven percent of PACE participants reside in a nursing home nationally. If a PACE enrollee does need nursing home care, the PACE program pays for it and continues to coordinate his or her care.

- See more at: http://www.massalfa.org/find-a-residence/payment-options#sthash.jeeNASQr.dpuf

Group Adult Foster Care

Administered by The Executive Office of Elder Affairs, Group Adult Foster Care (GAFC) is a Medicaid program that reimburses providers for providing administrative and clinical oversight and daily assistance with personal care services to financially and clinically eligible elderly and disabled individuals who are at risk of institutionalization.

In order to qualify, participants in GAFC must:

  • Be aged 22 and older;
  • Meet financial criteria;
  • Reside in a certified assisted living residence (only for SSIG eligibility);
  • Be serviced by a certified GAFC provider;
  • Have physician authorization of a medical diagnosis that deems GAFC an appropriate program for their needs;
  • Require daily assistance with at least one Activity of Daily Living (ADL), which is related to a medical diagnosis; and
  • Receive clinical approval from an Aging Services Access Point (ASAP)

Elder Affairs reimburses the provider for the provision of personal care services and the administration of the program. Effective April 1, 2008, the per diem reimbursement rate is $40.33. Approximately $1,150 per participant per month is reimbursed to the provider for services, while the resident remains responsible for the rent. See Supplemental Security Income Living Arrangement G (SSIG) for a detailed explanation of assistance with rent.

For more information about GAFC, visit massresources.org.

Senior Care Option (SCO)

A combined MassHealth and Medicare program that includes health care and social services, to help low-income seniors stay healthy and able to live in their own homes. A team of health professionals develops a plan of total individualized care for each member. Services are provided by a network of medical and other professionals, including a primary care doctor, nurses, specialists, and a geriatric support coordinator, who are part of a senior care organization. For more information about SCO, visit massresources.org.

Program of All-inclusive Care for the Elderly (PACE)

The PACE model of care is a national insurance program funded jointly by Medicare and Medicaid. PACE provides and coordinates all needed preventive, primary, acute and long term care services so that older individuals can continue living in the community. The PACE model is centered around the belief that it is better for the well-being of seniors with chronic care needs and their families to be served in the community whenever possible.

Although all PACE participants must be certified to need nursing home care to enroll in PACE, only about seven percent of PACE participants reside in a nursing home nationally. If a PACE enrollee does need nursing home care, the PACE program pays for it and continues to coordinate his or her care.

- See more at: http://www.massalfa.org/find-a-residence/payment-options#sthash.jeeNASQr.dpuf
John Legal
John Legal, Attorney
Category: Legal
Satisfied Customers: 4,631
Experience: Over 15 years legal experience.
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Customer reply replied 4 years ago

You listed a bunch of sites for me to research that I know about already. No real answer.

How can I provide you better assistance? There is no GUARANTEED benefit to cover the cost of assisted living. If the evaluation of your mother determines that she needs nursing home care instead of assisted living then Medicaid in Mass. will cover the cost of her nursing home care for sure. However, Assisted Living care is a catch 22 hole in Mass. and in most states. There are some pieces of Medicaid like the ones I listed above that will possibly pick up some of the cost of care. However, there is NOT one that will assure that she is covered.

I would highly suggest that instead of further research that you go to your local Health and Human Services office to sit down and get them to help you with the options. They are very good at assisting folks that already financially qualify.
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