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

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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: Apply for the Assisted Living Investing Mastermind for expert coaching.

Got questions? Drop them in the comments below! ⬇️

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