Senior Living: Navigating Medicaid Spend-Down Process

21 June 2023

Navigating the Medicaid spend-down process is a significant challenge that many families face. In this article, we will demystify the Medicaid spend-down, offer valuable insights, and provide pro-tips for choosing the appropriate senior living community. By following these guidelines, you can ease the process and make informed decisions for your loved-one’s well-being.

Understanding the Medicaid Spend-Down

People looking at Medicaid Spend-Down documents and files

Medicaid is a government-funded safety net program designed for low-income individuals. The Medicaid spend-down process allows Seniors who don’t initially qualify for Medicaid due to their income or assets to become eligible by “spending down” their resources on medical expenses, living costs, or other qualifying costs. Once income or assets are reduced to meet eligibility requirements, they can receive Medicaid benefits.

Tips for Identifying the Right Senior Living Community that Accepts Medicaid (Step by Step):

  • Use Washington State’s License Locator and review those who state they do accept Medicaid. Most require a prospective must have 2 years of private pay funding first before spending down to Medicaid. 
  • Set up a tour of the community and at the end, request their specific Medicaid policy, which they are required to have on hand to provide to you. This policy will indicate any restrictions and be your guidebook to ask deeper questions, such as:
    • How many Medicaid contracts do you have + how many current residents are on Medicaid? 
    • Is there a plan to shrink your Medicaid contracts?
    • Have you discharged anyone due to Medicaid conversion? If so, why and where did they go? 
    • How long is your waiting list for Medicaid conversion/spend-down? 
  • Consider future needs: if there is a concern your loved one may require memory care due to dementia or other cognitive issues, inquire whether both the assisted living and memory care units have a Medicaid contract. It’s crucial to understand the implication if one area has a Medicaid contract while the other does not.
  • Clarify financial responsibility: when signing move-in admission paperwork, ensure that it is explicitly stated in writing that your loved one can convert to Medicaid within their specific allowance. Avoid signing any forms that make you personally guarantee financial responsibility, instead, sign forms on behalf of your loved one’s estate. Ensure you do not sign personal guarantor forms unless you are personally prepared to pay your loved one’s costs to live there. 

Securing Guarantees from Senior Living Communities

Happy Elderly Couple in a senior living community

If possible, obtain written guarantees regarding their acceptance of Medicaid and availability of Medicaid-funded beds. Many Senior Living Communities will not do this, so it is imperative to closely read their Medicaid Policy. If the policy states they allow Medicaid conversion after 2 years but does not state they limit Medicaid beds to a specific number, it means they must allow Medicaid conversion after those 2 years no matter what. This policy is imperative to understand and keep on hand. Thoroughly review the contract you sign, paying close attention to provisions related to Medicaid acceptance and bed availability. 

Stay in close communication with the Senior Living Community billing person, especially during the Medicaid spend-down process. Ensure they are aware at 12 months, then 6 months’ out of the Medicaid conversion. 

Keep all documentation related to the Medicaid spend-down process and your loved one’s transition to the senior living community. This may include medical records, financial statements, and any correspondence with the community or Medicaid. If an Executive Director at the community leaves or the property is sold or new management arrives, your documentation will be vital to your Medicaid conversion success. 


Navigating the Medicaid spend-down process and finding the right senior living community for your aging parent can be a complex and challenging task. While there is no guarantee of finding the perfect place or a “one-stop community” that meets all your loved one’s needs, there are steps you can take to increase your chances of success. 

Researching potential communities, visiting them, and asking the right questions about their Medicaid policy and availability of Medicaid-funded beds are essential steps. It’s crucial to receive and review the Medicaid policy of that specific senior living community and keep copies of all signed move-in agreements. 

Maintaining an open communication with the senior living community throughout the Medicaid spend-down process is important. By keeping documentation and staying informed about your parent’s progress and financial situation, you can ensure a smoother transition.

For specific questions on financial asset allowances, further benefits for in-home care or help with aging at home, contact Pierce County Aging and Disability Resource Center, they are located at 4301 South Pine St, Tacoma WA 98409 and phone is 253-798-4600, website is 

Authored by Jen Drake, the Marketing Director at Cascade Park Communities. Jen brings a wealth of experience in promoting exceptional senior care to the community. With her dedicated approach and passion for compassionate care, Jen is committed to providing affordable and reliable health care services to the Tacoma and Pierce County areas. Her expertise in marketing, combined with Cascade Park’s emphasis on safety, comfort, and competent assisted care, make for an unbeatable combination in senior care.

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