With the help of Medicaid Ginny lived happily at her assisted living residence for 18 months. Then one day she received an official notice that her facility was withdrawing from the Medicaid program in favor of private-pay only. Ginny had 30 days to find another assisted living facility that would accept her Medicaid. Unfortunately, there were more people in her situation than there were other local subsidized openings. Ginny and many of the other Medicaid residents from her assisted living ended up with no option but to move into a nursing home.

Many states now offer Medicaid assistance for their seniors to receive assisted living care instead of forcing them to move to a nursing home. Under "home and community based waivers," this kind of care is offered as an alternative to more expensive nursing home care for those who could benefit. Sadly, there is a serious risk that seniors who take advantage of this benefit could lose their new assisted living home at any time, and with no recourse.

Nursing home patients receiving Medicaid are governed by federal regulations that protect their right to continue receiving care at a facility that wishes to withdraw from the Medicaid program. However, assisted living facilities are not governed by the federal regulations. They are free to terminate their Medicaid waiver contracts at any time and evict residents covered by Medicaid with 30 days' notice.

While assisted living facilities may be less expensive to operate than nursing homes, they are still costly to build and to run. When a new facility has only a few residents many find it very tempting to join the Medicaid program, as this is a viable way to quickly increase their occupancy. While Medicaid usually pays the facility much less than they would receive from a privately-paying resident, the prevailing thought is, "something is better than nothing."

When the available rooms have been filled, and new resident inquiries have increased, it quickly becomes obvious that income could be much greater, and the level of state regulatory "hassle factor" would be much lower if it weren't for Medicaid residents. At this point many assisted living facilities choose to opt out of the Medicaid program.

Compassionate owners simply allow the passage of time to reduce their number of Medicaid residents. Others give their Medicaid residents 30 days notice to relocate.

While nursing home residents receiving Medicaid are protected from eviction even if the nursing home opts out of the program, residents in assisted living facilities have no such protection. If they do not have the resources to become private residents, they have no protection against eviction.

There is Little You Can Do to Protect Your Senior on Medicaid in Assisted Living

We wish we could give you an easy "fix" for this potential minefield.

State federal courts have upheld the right of assisted living facilities to evict residents who cannot pay their private pay rates. As a consumer and advocate for a senior, your only protection is to be aware of the possibility that your elder's assisted living facility could withdraw from the Medicaid program.

If you are looking for an assisted living home for a senior already qualified for Medicaid, be sure to ask. You will undoubtedly be told that the residence has no intention of withdrawing from the Medicaid waiver program. Because the person you are talking to most likely works for a large corporation, he or she probably has no idea what the odds really are. Be sure to follow up with the, "but, what if?" question.

You can certainly ask if you can have a guarantee that your elder will not be asked to leave should the "unthinkable" happen by corporate decree. The chance of you receiving anything in writing are slim, but it's worth asking.

It doesn't appear likely that the federal government will expand the legislation covering nursing homes to assisted living facilities any time in the forseeable future. The various states do not appear to be interested in taking any steps to protect Medicaid residents in assisted living, either. Therefore, it is your job to remain vigilant so that you will at least be at the front of the line of people looking for alternatives if anything does happen.

If your senior receives an eviction notice because the facility is leaving Medicaid, do not waste time protesting. Get on the phone and start looking for both assisted living and nursing home alternatives immediately. What few are available at either level will disappear faster than you can imagine if many people are looking at once.