How to Get Approved for Medicaid in Assisted Living (Step-by-Step)

assisted living licensing assisted living medicaid certification back billing medicaid colorado medicaid assisted living how to get medicaid approved idaho medicaid waiver medicaid application process medicaid for assisted living starting an assisted living facility Jun 20, 2025

Want to accept Medicaid in your assisted living home? You’re not alone. Medicaid can open your doors to more residents and steady income. But the process isn’t always easy. In fact, it can be a bit of a mess.

Good news? I’ve been through it. I figured it out. And now, I'm breaking it down for you.

Why This Matters

✅ Helps fill your beds faster
✅ Supports underserved residents
✅ Gives your business more stability

If you're planning to serve Medicaid residents, you’ll need to get certified. That means paperwork, phone calls, and a whole lot of patience. But if you know what to expect, you'll move faster and avoid common mistakes.

Let’s go step-by-step.

Check out this video, too:

1. Know if Your State Supports Medicaid for Assisted Living

Not every state offers Medicaid coverage for assisted living (or it might be called something different in your state, like a waiver program).

✔️ Check your state’s Medicaid website
✔️ Look for programs like waiver programs or HCBS (Home and Community-Based Services)
✔️ Make sure it covers assisted living and not just nursing homes

Example: In Idaho and Colorado, Medicaid does help pay for assisted living. But the process is different in each state.

2. Get Pre-Certified with Your State

Before Medicaid pays you, you need to get certified.

📝 Apply for Medicaid certification through your state
📞 Be ready to follow up (a lot)
📂 Have your license, EIN, NPI number, and business paperwork ready

In Colorado, it took about 4 months. We had to resubmit paperwork multiple times—even things they already had!

📌 Tip: Put everything into one complete packet up front—voided checks, bank info, business licenses, NPI, all of it.

3. Understand the Players: State vs. Managed Care

Medicaid isn't just one thing. Depending on your state, multiple groups might manage it.

💡 In Idaho, for example we work with:

Idaho Health & Welfare (the state itself)
Blue Cross of Idaho
Molina Healthcare

You’ll need to contract with each one separately if you want to serve all types of Medicaid residents.

💡 In Colorado:

The state certifies you
Then you contract with a 3rd-party administrator who handles payment

Each state is different, so learn the process for your state early on.

4. Expect Delays (and Plan for Them)

Let’s be real: Medicaid isn't always a quick process.

⚠️ In Colorado, it took 4 months before we got approved and received any payments.
⚠️ In Idaho, we waited it was much faster (about 1 month) before we were able to get approved.

💸 Yes, you can back-bill Medicaid once you're approved (that means, up to the date that you submitted the original application, you'll be able to bill for all those services).
But during that wait, money can get tight. We had to juggle payroll and bills while we waited for tens of thousands of dollars to show up.

✅ Plan ahead
✅ Build a cash cushion
✅ Expect delays in your first few months

5. Why Medicaid Is Still Worth It

Even with the paperwork, delays, and government headaches—Medicaid is still worth it for many homes.

👍 Steady resident demand
👍 More consistent monthly payments (once it starts flowing)
👍 Ability to serve residents who truly need help

You're often helping an underserved group. If that’s something you care about, Medicaid is a powerful way to grow your business and do some good.

Next Steps: Take Action Today!

🚀 Want to launch your assisted living business in the next 12 months?

✅ Step 1: Download the Business Plan Checklist to start planning.
✅ Step 2: Need help figuring out where to start? Join the next Roadmap Challenge and build your launch plan with me.

Got questions? Drop them in the comments below! ⬇️

▶️ Watch on YouTube

Show full transcript 👇

Transcript

00:00:02
hey friend it is Brandon Gustafson with Assisted Living investing I'm so excited to have you here on our live today we're going to be talking about how to get approved for Medicaid as a residential assisted living facility this is something that I've actually seen a lot of people ask questions on and some of my most popular videos on the YouTube channel are around Medicaid it's it's something that I think a lot of people they kind of push away they're they're scared of of getting into it and there

00:00:28
are a lot of complexities to us I want to be honest with you about that but there's also some really good things that that come from being a Medicaid provider so we're going to talk about that in today's video before we get started uh want to remind you to get over to the website Assisted Living investing. netb checklist and I forgot to put my ticker along the bottom but I will have links down below uh for you to get that uh go to Assisted Living investing. netb checklist and you can

00:00:55
get access to that free business planning checklist which is going to help you along your investment Journey before we uh jump into the topic of how to get approved for Medicaid as a residential assisted living facility I wanted to give you a quick overview of who I am so that you have some of that background on on me um oops sorry I just clicked the wrong button there um anyways so I own and operate two assisted living facilities and I live in Utah and those facilities are in Colorado and in Idaho so I do that out

00:01:28
of state I've been able to secure over one and a half million in SBA funding so I know that process really well and I have a masters in healthcare administration have worked in the healthcare industry for over a decade so I've got a lot of experience gives you hopefully some comfort level in watching what I am putting out here to help you out at Assisted Living investing I'm here to help you launch your Assisted Living business so excited to help you along that process if you are new here

00:01:53
type in newbie and uh if you are an operator and you're like a I've heard about Medicaid I I I think it's interesting concept um I don't know how to do it then type in operator down below and that will let me know who's here watching and how I can best help you you have questions as we dive into this topic as well make sure you type those in I will have some time here at the end of the video for some Q&A to to answer those questions and Medicaid is great but if it's anything else um feel

00:02:22
free to to type those in now let's talk about what Medicaid is so Medicaid is a federally funded program so it is it's something that is done at a federal level in the United States and they set aside a certain amount of money that will will be distributed to people similar to Medicare but Medicare is a federally funded federally administered program Medicaid is federally funded but administered at a state level and so oftentimes what you're going to see um and how this works actually is the the

00:02:54
federal government will tell a state you have $10 million and that's well um very well but they they'll say here's your chunk of money here's a hundred million and you can allocate it however you feel you need to to serve that population and so you might have people there's there's different waivers for Medicaid so it could be elderly people it could be disabled people it could be somebody that deals with mental health it could be any number of things but these people will apply as as an individual you'll

00:03:23
apply for Medicaid and you get those benefits and so that is administered by the state those people that have Medicaid can then go and receive services for for different types of care for us in this instance it's Assisted Living we are able to get certified as a Medicaid provider which means we're going to be able to accept somebody that's on Medicaid and we will be able to build those services to the state or their third party administrator to give us those funds so that's kind of how

00:03:51
that that process works uh but those funds they come at a federal level they trickle down they come to the state the state says yes um you get certified and and we're going to pay you um for for the services that you're providing to that person that's kind of at its core how Medicaid Works Medicare is not something you can do in assisted living it is um not a not a benefit for that so you have to Medicaid Medicare I wish they would have called them something different so that it wasn't so confusing

00:04:20
but they are different programs there so I just want to make sure that you are aware that that that is the case now let's talk a little bit here about um what does Medicaid certified mean so you're going to hear a lot of people they're they're going to say Medicaid approved um Medicaid certified really that means the the exact same thing in fact Medicaid approval is more at the individual level but Medicaid certified is for you at a provider level so when you are certified to to serve

00:04:52
Medicaid it means that you can work with certain waivers there's a an application process and we'll get into that here in just a second but that application process in there there's some boxes that you check for which type of waiver which type of population you want to serve and you're going to check those boxes just to say yes I serve an elderly population I serve a a disabled population they're they're going to have little acronyms on them associated with it and if you have

00:05:21
questions as you're going through that then reach out to me on the website or just Google it you're going to be able to find that or talk to the person at the state and they'll be able to say yeah this is what is entailed in this type of a waiver for for Medicaid for this person but um when once you become certified you're able to accept residents who are on Medicaid that fall under those waivers that you are certified to serve if you bring in a resident who is on Medicaid but they're

00:05:49
not on one of those waivers that you that you can serve then you're not going to be able to get reimbursed for them so as you are going through the process of of accepting Medicaid res residents you want to make sure that they are on the correct waiver that they have the long-term care uh in place that they're their Medicaid stuff is active and current and everything's good before you accept them because if not you might be giving services to somebody that isn't able to pay you um that you can't get

00:06:19
reimbursed for from the state so that's one of those hiccups and one of those headaches that come with Medicaid is there's a an extra level of vetting that has to go into it just to make sure that they have the ability to to allow you to get reimbursed from Medicaid um as as you're trying to to bring new residents in so you just want to keep that in mind as you're trying to bring in Medicaid residents and with the waivers and and the different things that kind of go into that there's there's a lot there

00:06:48
and it all hinges off of that application process as you are getting certified for to be a Medicaid provider so what does that process actually look like what does it look like to become certified as a Medicaid provider there is going to be a governing body and typically this is going to be like Health and Human Services or Health and Welfare it falls under that most of the time in in Most states that's kind of the department that you're looking for it's not going to be the health department that would license you as as

00:07:17
a as a facility it's going to be more in the line of Health and Welfare because this is a a benefit that people typically are on when they need welfare from from the state and and this is just like an extra thing so if you think about it um chip or Wick or um some of those types of programs that are out there Medicaid falls under that as well so that's who's administering this that's your governing body that's who you need to go to to talk to to figure out what the application process is like

00:07:47
to become Med Medicaid certified as a provider the next thing is that you could do if you just can't find that and you're like I I don't know who this is you can do an internet search for becoming a Medicaid provider in my state I did a I did this a little bit before I created the video just to make sure that that search term would work and it does so I looked I think in California I looked in Idaho I looked in Arizona uh I went I think I picked Texas I picked some random States and it all got me the

00:08:18
information that I needed to make sure I was looking for the correct um you know correct governing body that's going to help me get certified as a Medicaid provider now let's talk a little bit about that certification process so here in the certification process there's going to be an application form and it's a lot of paper you know it's it's it's going to be pretty similar actually to the form that you would be filling out to become a a provider an assisted living provider uh but it's going to

00:08:48
have some slight tweaks to it so and it's going to look different as well but the the the information that you're providing them is is very similar you need to also um get proper insurance coverage as you're going through that so one of the things that they're going to ask for as you are applying for Medicaid is a Certificate of Insurance just like basically it's it's a certificate from your insurance company that says yes they have this much coverage on there they want to make sure that you have

00:09:18
that liability coverage just in case something happens to the resident that you're able to cover those types of of instances so that's one thing you need to have your insurance in place as you are applying for Medicaid and then you're going to also have to get the bank account information and I'll share a little bit of a horror story with this one um so as we were applying for Medicaid in Colorado there was uh the application process and uh we we filled everything out I got it to them

00:09:46
submitted it thought everything was good they came back and said oh we need this Bank letter like a signed Bank letter and so I went to my bank I grabbed that uh sent it back to them they came back and said well it needs to be on letterhead and needs to be a wet signature I was like okay here you go do it again and every time I would submit it and I had to wait like 10 days for them to process so this ended up taking us about four months to get through it was it was extremely stressful so um I I gave them that

00:10:16
they're like oh we need a voided check I like I gave it to you the first time why don't you still have it I had to give them a voided check they needed something else so the fifth or sixth time that I went through this I got every single piece of banking documentation that I could possibly find put it together in a packet and I submitted it to them and said here you go and uh we finally got uh we were finally able to get per certified for Medicaid in Colorado and it was a huge relief for us like I mentioned it had

00:10:45
been about four months that we hadn't gotten payment luckily what Medicaid will do is they will let you back bill for those payments so if you're doing that uh it does allow you to to get back and and make that money back up it's just for that four-month period where we didn't have the money coming in made finances extremely tight so that's something you want to to look at the other thing you want to be aware of as you're doing this is there's going to be different administrators sometimes the

00:11:14
state itself will do this so in Idaho the state administers Medicaid but there are two other providers so there's three total in in in Idaho and so we have to get um certified number one with Idaho Health and Welfare but we need to get um I I wouldn't call it certified but we need to get um contracted with all three payers so there's Idaho that we have to do Idaho Health and Welfare there's Blue Cross of Idaho and there's Molina Healthcare so we had to do separate um separate things if we wanted to accept

00:11:47
all types of Medicaid residents inside of the state of Idaho and we wanted to do that is it just opens and broadens our our um pool of residents that we can work with so if you're doing that you want to be aware of that in Colorado it was uh there's one 30 third party administrator but you have to get certified with the state and then you have to go and uh you you have to go and get the approval or the contract in place with that third party administrator so your state could look some look very similar to that it could

00:12:18
be different each state is going to look different this is where Medicaid is uh is is kind of sticky because each state is going to have their own rules and regulations and and things they want to adhere to I know some states don't even do Medicaid for assisted living and that's kind of a pain um if you wanted to to go the route of doing Medicaid Medicaid is is a really good way to broaden your base of residents though and I've talked a lot about Medicaid in the past and the benefits of it there

00:12:48
are hiccups and and things that that you're you're dealing with a government entity and and so they will go slow they they do not go at your own pace and so you have to understand that when you're doing paperwork that story I told you about waiting having to wait four months I mean we were just waiting on Idaho to to process the payments for about two months and it just came through last night um for us and was a huge chunk of change which is really nice because we were struggling to just be like okay where where are we

00:13:16
going to pull from so we can make sure the payroll doesn't get skipped or or or things like that money came in now we're totally fine um but there are some hiccups and things headaches that you need to just be aware of as you're getting started if you want to go the Medicaid route you want to build in contingencies for that but it is a good route if you're willing to kind of deal with the headaches and figure out the process and work with those residents because honestly like you're dealing

00:13:43
with an UND served population that's why they're on Medicaid and if that's something that speaks to you then it's a really good opportunity to serve that type of population so uh that is Medicaid that's kind of how you apply how you get into it how you get certified and the process there if there are any questions um please type those in down below I know I've had a few people kind of come in and out as we've been recording today and uh but I want to thank those of you who have watched

00:14:11
if you are on YouTube make sure you like And subscribe and then ring the bell as well so you get notified we go live every Tuesday morning and then if you're on Facebook then make sure you like and share the video um so that people get notified as well if you have any questions um now is the time to ask those but I want to thank you for watching thank you for being here excited to to chat with you uh and and just provide you the content that's going to help you launch your Assisted Living business because that's that's

00:14:38
what I'm here for I love doing this I love coaching people love helping people out along their investment journey and giving them the resources that they need so that they can reach that time and Financial Freedom they are seeking on their investment Journey again want to remind you to get over to the website Assisted Living investing. net get the business planning checklist by going to Assisted Living investing. netb checklist I will have links down below for that on YouTube I've got the links

00:15:06
for all of the free resources so make sure you get over there and uh see you know pick and choose which ones you want uh because it's going to help you along your investment Journey again thank you for watching have a great day

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.