Can You Really Get $122,000 Per Room with Medicaid in Assisted Living?
Jul 24, 2025
Yes—you read that right.
$122,000 per room per month using Medicaid. Sounds wild, right?
In this post, I’m going to walk you through exactly how this works. We’ll break down what Medicaid really is, how the money flows, and what you need to do to tap into these kinds of numbers (ethically and legally).
Check out this video too:
๐ง First, What is Medicaid?
Before we get into the money, let’s clear up some confusion.
โ Medicare vs. Medicaid
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Medicare is a federal program—think of it as traditional healthcare for older adults. It covers inpatient, outpatient, and meds (Parts A, B, D).
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Medicaid is state-administered and based on income and assets, not just age.
Many residents in assisted living qualify for both, and Medicaid often supplements Medicare or private insurance.
In assisted living, Medicaid is your secret weapon—but you’ve got to play by the rules.
๐ต How You Actually Get Paid with Medicaid
When someone qualifies for Medicaid, you can be paid three ways:
1. Daily Medicaid Rate
This is a state-set daily payment.
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You can’t choose your rate—the state tells you.
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You bill Medicaid daily for each resident.
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Sometimes the rate increases based on level of care.
2. R.U.F. Payment (Rent, Utilities, Food)
This comes from the resident’s Social Security income:
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You’re allowed to collect about 90% of it.
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It helps cover basic living costs like food and housing.
3. Spend-Down or Share of Cost
If a resident has a small trust, pension, or investment income, they may be required to spend it down to qualify for Medicaid.
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That money goes directly to you.
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This is called their “share of cost.”
๐ These three income streams make Medicaid powerful—even stronger than private pay in some cases.
โ How to Accept Medicaid in Your Facility
There are two main steps:
1. Get Licensed
You must be a licensed assisted living facility in your state. Unlicensed = no Medicaid. Period.
2. Apply for Medicaid Certification
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Each state has a different agency for Medicaid (separate from the licensing department).
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You’ll need to fill out an application, often similar to your facility license process.
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Expect little coordination between departments—you’ll be the one doing the follow-up.
๐ In Brandon’s case:
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Colorado took 4 months.
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Idaho took just 3–4 weeks after learning from earlier mistakes.
If you want help navigating this, check out the Success System
๐ก How We Reached $122K Per Room
Now let’s break it down with a real example.
The Setup:
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This is a multi-resident room (shared by 2 residents).
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These rooms are large—160+ sq ft, not cramped.
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In Idaho, with the state’s Medicaid rates, this room generated over $122,000 per month.
Sounds crazy, right? But it’s real. Here's how:
The Math:
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Let’s say the daily Medicaid rate is $250/resident.
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$250/day × 30 days = $7,500/month
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Multiply that by 2 residents = $15,000/month
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Add their Social Security RUF payments (≈ $1,000 each) = $17,000/month
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Add spend-down/share of cost payments (varies) = $20,000–$22,000/month is realistic.
Now apply that same model across 6 shared rooms in a home…
Boom. You’re looking at $100,000+ per month—from Medicaid.
โ ๏ธ Important Note on Multi-Resident Rooms
This only works if:
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You’re okay with shared rooms.
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The rooms are properly sized and compliant with state regulations (e.g. 80 sq ft per resident).
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Your state allows this setup for Medicaid residents.
If you’re not open to this, the strategy won’t work for you.
But if you are open to it, this could change everything.
๐ Your Next Steps
If you want to:
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Serve Medicaid residents,
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Maximize revenue legally and ethically,
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And build a sustainable assisted living business…
Then Medicaid could be your path forward.
But you have to do it right. The setup, the certifications, and the math all matter.
๐ฏ Ready to test your numbers? Download my free Underwriting Calculator right now!
Need help figuring out where to start? Join the next Roadmap Challenge and build your launch plan with me.
Show full transcript ๐
Transcript
00:00:00 - 00:00:50
hey friend I'm Brandon Gustafson and I help beginners like you launch their Assisted Living business in the next 12 months in today's video we're going to be getting into the topic of $122,000 per month per room with Medicaid can you do it I'm super excited to get into this with you if you need some help getting started I'd love to also give you my free underwriting calculator if you just go over to Assisted Living investing. net you can grab that at the glue box in the top right corner and download that free
00:00:25 - 00:01:24
tool to help you understand if this is going to be profitable for you or not welcome back to Assisted Living investing to in today's video we're going to be getting into how I can get $122,000 per month for a room with Medicaid in Assisted Living so if you've been trying to figure out how to do this I wanted to get to give you a little bit of context on how I can actually do this and how you can be profitable uh and we we had talked about this in a live video a few months ago and so we're going to
00:01:00 - 00:01:59
link that up above um so you can understand a little bit more about specifically what Medicaid is and some of the strategies that you can Implement there and then this video we're going to be getting really deep into that $112,000 per room per month with Medicaid residents in there now the first thing I want to talk about is a little bit about Medicaid to just kind of set the stage Medicaid is not Medicare Medicare is a federally funded program it's a federal program it it it works with you've got part A B and D so
00:01:29 - 00:02:35
you have inpatient you have outpatient and you have medication Pharmaceuticals basically it deals with much more traditional Healthcare is what I would say so you're working with that type of of a group Medicaid on the other hand is something that is administered at a state basis and your ability to qualify is not solely age-based though there are other ways to qualify for Medicare but your qualification with Medicaid is much more contingent on like a disability or your income is a big driver for it and
00:02:02 - 00:03:00
the the funds and the assets that you have and so that's how you qualify for Medicaid so it's a big difference while they do offer some parallel types of of benefits and you could have Medicare and Medicaid at the same time and you can tandem those benefits together they are not the exact same benefits they work in different areas oftentimes Medicaid is going to help supplement whatever Medicare or any other health insurance that you may have uh it's going to supplement that and be a second payer
00:02:31 - 00:03:29
and and really allow you to maximize those benefits and that's kind of how Medicaid works with Assisted Living number one it's a state administered program so funding comes from the federal government but it is administered at a state basis it's approved at the legislature level and so you are told hey the way that it works is they they give you all of the codes so there's hundreds of different codes that can be built for inside of the world of healthcare and Medicaid will have all of these codes assist Ed living
00:03:00 - 00:03:56
is one of those codes so it's it's kind of an all-inclusive rate that you Bill it's a daily rate that you're going to bill to Medicaid and they will reimburse you for it that daily rate is something that it's set at a state level sometimes there's ways to adjust it based off of level of care we're going to talk about that here in in a few minutes but it's something that I want you to be aware of that it's not you I get to set what my Medicaid rate is they will tell you what
00:03:28 - 00:04:25
that Medicaid rate is what that daily rate is going to be that's one of the mechanisms that you are going to get paid as you are trying to figure out what that Medicaid reimbursement rate is going to be so state will tell you and then you can start basing your underwriting off of that and once you have that daily rate in place there's actually other ways that you can get paid with Medicaid there's what I like to call a rough Ruf rent utilities and food payment that payment is going to
00:03:57 - 00:04:49
come directly from the resident themselves it comes through through their social security so you have to remember for an individual to qualify for Medicaid there's a financial requirement that means that they don't have a job or if they do it's a very minimal amount they're not making a ton of money they don't have any other assets they don't have a house that they could do a reverse mortgage on or sell to get a bunch of money if that's what they find themselves the situation that
00:04:23 - 00:05:13
they find themselves in they're not going to qualify for Medicaid and so they're going to have to be a private pay resident for you that's kind kind of the difference there between a Medicaid and a private pay individual I've I've received this question a lot like how how do residents pay for the service like it's so expensive you know $5,000 a month $6,000 a month whatever number it is that that you've heard they're real numbers 3,000 to 10,000 and and and even higher than
00:04:47 - 00:05:42
that um so how how do people pay for this and oftentimes it is because they have a house that they've done a reverse mortgage on or they have sold it and so they have a chunk of money that's available they may also have long-term caring insurance they could have a retirement fund that's where that money is going to come from now if all of those things go away they can continue to receive care from you through Medicaid they qualify for Medicaid and then they receive that they're still
00:05:14 - 00:06:07
getting their social security income you get to collect the state will tell you how much but you get to collect about 90% of that money for of their social security income as rent utilities and food a rough payment is what we call it the other component to that is maybe they have a trust or they've got something like that they've got a little extra money coming in from somewhere in order for them to continue to qualify for Medicaid they have to spend that down it's called a spend down now when
00:05:41 - 00:06:40
they're spending that down what that means is that money's got to go to you and so the state will evaluate individuals and and they have to recertify their ability to be qualified for Medicaid on a regular basis generally it's annually and in doing that they will say okay there's a share of cost that also comes into this they get $300 from this investment from this trust something along those lines and and they have to pay that to you or else they don't qualify for Medicaid if if
00:06:11 - 00:07:03
they do that so there's actually three ways that you are getting paid when you are working with Medicaid which is actually it's kind of a cool thing when you think about it there's multiple streams of income as as you're trying to move things along here with with Medicaid now let's talk a little bit about becoming certified as a Medicaid provider the process that you're going to go through is number one you have to be a licensed facility so if you want to be an unlicensed facility you cannot go
00:06:36 - 00:07:28
this route of Medicaid because it is a requirement it's part of the application process to be a licensed facility so you're going to have to have that in your back pocket you're going to have to get the license so that you can serve this Medicaid population if you want to do that so that's number one beyond that the rest of the application process is pretty similar to getting your facility license the thing that you have to be aware of though is you're working with a different government agency you're going
00:07:02 - 00:07:51
to have your licensing body for assisted living and you're going to have the certification body for Medicaid and it every State's going to be different they're going to be in different departments they're going to be called something different so I can't tell you you know Medicaid is this office and and assisted living licensing is this office there's no consistency across the states every State's going to be different but you have to figure out what those different departments are and then work
00:07:26 - 00:08:15
with them what's difficult is often times those Department departments they don't really talk to each other like they're aware of the other department they probably know somebody over there but they're not having regular meetings and and they don't coordinate at all and so that's something you also want to be aware of that you're going to have to go into this and do a lot of the coordinating and things like that all on your own which which can be frustrating there's a lot of hiccups that can also
00:07:51 - 00:08:51
come into play in this as I was getting things ready from my Colorado facility it took us 4 months to get our Medicaid application approved and get a CER which really was detrimental to us from a from a cash flow perspective it made things pretty difficult there and so that's something that I'd like you to avoid and I can help you navigate those hiccups because I told you Colorado took us about four months in Idaho took us about 3 four weeks it it accelerated things a lot uh because I learned so much as I
00:08:21 - 00:09:12
was making those mistakes so if you need help as you're trying to figure this out I'd love to see if I could help you out go apply to The Mastermind program Alim mastermind.com simple application lets me see if I can help you out if I can I will send you all the details and we'll go from there so again that's Alim mastermind.com all right now before I get into the whole $112,000 per room per month with Medicaid and the example that I have for my facilities I wanted to know which
00:08:47 - 00:09:43
state are you in that you're trying to figure this out because each state is going to be different so type in the state down below for which state you're in and and if you are if I see a bunch of a specific State I'll probably create a specific video on how to navigate that for your state and ones that are going to be a little bit more difficult to navigate are California for sure so but I I I also know that there are a lot of you that are in different states and so I want to meet you where you're at and
00:09:15 - 00:10:09
give you some guidance so type in the state down below for where you are looking to start serving a Medicaid population all right let's get into the deal now let's get into the example specifically for my facility and show you exactly how we get to $112,000 per month with a single room with Medicaid residents really excited to kind of go through this and and what I found here is as I was kind of just looking at things and and getting new residents in and and looking at the money I was like
00:09:41 - 00:10:32
oh my gosh look at this amount here in Idaho where we do this there's no way I could charge $122,000 for a room uh it just wouldn't work we're able to do this with Medicaid now the the first thing that I want you to be aware of and I know there's some of you that listen to this and and you don't think that this is something that should be done in assisted living but it is the reality um this is a multi-tenant room it's a multi-resident room we have two residents in this room there are
00:10:07 - 00:11:06
different classifications for that there's different regulations that you have to follow if you're going to put multiple residents in a room in a single room it's generally 100 square feet for that Resident so a 10x1 room if you're working with multiple residents then you need 80 square feet per resident in that room so you need larger rooms it needs to be like a 10x 16 room 160 ft at at a bare minimum so these are not tiny rooms we're not like putting them into sardine cans or anything like that they're big
00:10:36 - 00:11:24
rooms there's a lot of space for them so I just want to make sure that that's clear so if you're not okay with that it's not something you want to do this strategy won't work for you but if you are open to doing Medicaid and you're okay having multi-resident rooms then this strategy is is going to work very well for you and also what I want to say is like we still make it an incredible experience for our residents even though they're multi-resident rooms it's it's
00:11:00 - 00:12:07
okay to do that um and you can still be successful with it now let's talk about the specifics for this example right here the the first resident that we have this resident they have a daily rate of $136 per day that's their Medicaid daily rate if we take that out to a 30mon day um which is we're just going to say that's an average month then we're getting $4,080 per month with that from the daily rate they have a rough payment that rent you ities and food payment that we talked about earlier of
00:11:33 - 00:12:46
$1,817 per month and so that means that they're getting a lot of money from some other source and in order for them to continue to qualify for Medicaid they have to spend that down and where the people that are providing that service so we are the ones that are collecting that money so again that's $1,817 for that we combine those two that $4,080 and the $1,817 and that turns into $5,895 for that resident in the room now resident number two has a daily rate of $150 per day so in a 30-day month that's
00:12:10 - 00:13:29
going to be $4,500 and then their rough payment is $1,600 so again they actually have a pretty high rough payment the state will set a bare minimum typically what I've seen is it's around 900 but because these residents have circumstances in their lives they have a lot more income coming in and they have to spend it down so that's $1,600 for that specific resident $4,500 plus the ,600 is $6,100 so we combine those two we have resident one at $5,895 and we have resident two at $6,100 combined that is
00:12:48 - 00:13:59
11,997 so we're off by $3 but that room right there and if we have a a 31-day month then all of a sudden we're going to increase that by $136 for one resident and $150 for another Resident so that's $286 there and that gets us over that $1,200 $112,000 Mark for the month which is really pretty cool when when you think about it so this is a real example my facilities we able to get $112,000 for a room with Medicaid residence inside of that room and that's a consistent income coming in for that
00:13:25 - 00:14:19
specific room which is really incredible when you think about it um because there's a stigma around with Medicaid that you can't make money with it and and that it's you know it it just has this bad perception and I really want to bust that myth for you because they're incredible people number one that's the most important but there are ways that you can kind of take advantage of this again we're going to link that video up above where I kind of went through how you can increase those those rates
00:13:52 - 00:14:43
because what you're going to find as you start looking into Medicaid is there's going to be a daily rate that the state's going to set they're going to publish that online and it's going to be $100 a day in in Colorado it's $13 a day I think but there is the ability to increase rent in certain States increase that daily rate based off of the care that you are providing those residents as long as you're documenting it correctly you can do them so again we'll link that video up above so you can go
00:14:18 - 00:15:13
watch that one and understand a little bit more about the specifics on how you can go about doing that so today we went through a lot we talked about what Medicaid is and what it's not how it works how to get certif ified as a Medicaid provider and then we got really deep into a specific example to show you that with Medicaid you can get $122,000 per room per month with Medicaid residence it's it's very possible for you to do that if you found this information to be helpful number one
00:14:45 - 00:15:26
like the video subscribe and ring the bell so that I can help you out and and you get notified as I'm making content and if you need some extra guidance go apply to The Mastermind program again it's Alim mastermind.com would love to see if I can help you out does residential Assisted Living sound interesting to you but you don't know how to get started at Assisted Living investing I'm here to help beginners like you launch their Assisted Living business in the next 12 months and I
00:15:06 - 00:15:34
also want to remind you that it doesn't take a lot just a little bit just keep making progress step by step by step and I promise you that if you do and you're consistent and persistent you're going to be successful thanks for watching and have a great day [Music]
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