Can You Really Get $122,000 Per Room with Medicaid in Assisted Living?

assisted living medicaid certification assisted living payment models assisted living profit strategy how to get paid with medicaid in assisted living medicaid assisted living reimbursement multi-resident room regulations ruf payments medicaid shared rooms 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:

🧠 First, What is Medicaid?

Before we get into the money, let’s clear up some confusion.

✅ Medicare vs. Medicaid

Medicare is a federal program—think of it as traditional healthcare for older adults. It covers inpatient, outpatient, and meds (Parts A, B, D).
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.

💵 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.

You can’t choose your rate—the state tells you.
You bill Medicaid daily for each resident.
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:

You’re allowed to collect about 90% of it.
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.

That money goes directly to you.
This is called their “share of cost.”

🔁 These three income streams make Medicaid powerful—even stronger than private pay in some cases.

✅ 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

Each state has a different agency for Medicaid (separate from the licensing department).
You’ll need to fill out an application, often similar to your facility license process.
Expect little coordination between departments—you’ll be the one doing the follow-up.

🕒 In Brandon’s case:

Colorado took 4 months.
Idaho took just 3–4 weeks after learning from earlier mistakes.

If you want help navigating this, check out the ALI Mastermind Program

💡 How We Reached $122K Per Room

Now let’s break it down with a real example.

The Setup:

This is a multi-resident room (shared by 2 residents).
These rooms are large—160+ sq ft, not cramped.
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:

Let’s say the daily Medicaid rate is $250/resident.
$250/day × 30 days = $7,500/month
Multiply that by 2 residents = $15,000/month
Add their Social Security RUF payments (≈ $1,000 each) = $17,000/month
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.

⚠️ Important Note on Multi-Resident Rooms

This only works if:

You’re okay with shared rooms.
The rooms are properly sized and compliant with state regulations (e.g. 80 sq ft per resident).
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.

📍 Your Next Steps

If you want to:

Serve Medicaid residents,
Maximize revenue legally and ethically,
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.

🎯 Ready to test your numbers? Download my free Underwriting Calculator right now!

Download Your FREE Calculator

Send Me My Calculator

Stay connected with news and updates!

Join our mailing list to receive the latest news and updates from our team.
Don't worry, your information will not be shared.

We hate SPAM. We will never sell your information, for any reason.