Medicare vs Medicaid, answered plainly

Does Medicare pay for supported homes?

Why Medicare is the wrong program for this — and which one pays.

Usually no. Medicare does not pay for a supported-home bed or long-term custodial care (daily-living support and room and board). It covers medical care, a limited skilled-nursing-facility stay after a qualifying hospital admission, home health, and hospice. Long-term supported living in a supported home is typically paid by Medicaid HCBS waivers, with the resident’s SSI covering room and board.

What Medicare does and doesn't cover

Medicare covers medical care — hospital stays, doctors, a skilled nursing facility stay of up to 100 days after a qualifying hospital admission, home health, and hospice. It does not cover long-term custodial care — the day-to-day support and room and board a supported home provides.

Source: Medicare.gov, Long-term care — medicare.gov.

What pays for a supported home instead

Long-term supported-home living is usually funded by a Medicaid Home & Community-Based Services (HCBS) waiver for the services, while the resident’s SSI pays room and board. See Does Medicaid pay for supported homes? and the waiver-by-state reference.

Source: Medicaid.gov, HCBS — medicaid.gov; SSA, SSI — ssa.gov.

If you have both Medicare and Medicaid

Many people are dually eligible — Medicare for medical care, Medicaid for long-term services and supports. If that’s the case, Medicaid is the program that can fund supported-home services. Your local ADRC (800-677-1116) offers free options counseling.

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Related

About Mai Heaven: this page is educational, not eligibility advice. We build small, permanent supported homes — also called group homes — for adults who are hard to place. Join the waiting list and we’ll reach out when a home opens near you. Need help now? Call or text 988, or dial 211.