In 2021, households making between $52,000 and $156,000 annually were classified as middle-income (Pew, 2022). Middle-income seniors are not eligible to qualify for Medicaid long-term services and housing subsidies (West and Dubay, 2019).
Roughly 14 million middle-income seniors will require assisted/independent living community services by 2029, 60% of whom will have mobility issues, 20% will have heavy healthcare needs, and 54% will have financial resource limitations (Pearson, 2019).
Figure 1: Counties with high housing costs for seniors. Shaded Missouri counties have between 20% (dark blue), 20-30% (light blue), and 30-40% (yellow) of seniors (65 and older) who spend more than 30% of their income on housing costs. Data from the Harvard University Joint Center for Housing Studies.
The U.S. Dept. of Housing and Urban Development Section 202 program provides federal funds (up to $175 million in 2022) to nonprofit organizations that offer senior living communities with supportive services (cleaning, cooking, transportation) (HUD, 2022; 2022) or convert housing units into senior assisted living units (HUD, 2022).
Thirty-five percent of individuals in assisted living (often more affluent) enroll in Medicare Advantage (MA) plans, which offer tailored services a patient may anticipate needing (such as wellness programs, medical transportation, vision, dental, or hearing)(Medicare, 2023).
Medicaid is the largest funding source for long-term care (LTC) services (KFF, 2022). While middle-income seniors do not automatically qualify for Medicaid, many states (including MO) have initiated LTC partnerships for Long-Term Care Insurance Plans (LTCIP) holders to qualify for Medicaid coverage once their private policy plan maxes out (James, 2017; NCSL, 2005).
LTCIPs cover the costs of senior living (including nursing homes, home health care, and assisted living) that extend past 100 days after a recent hospitalization that is covered by Medicare (ACL, 2021). Plans can vary significantly in the monthly or lifetime maximum of covered service costs (MO Dept. of Insurance, 2022).
For more information, please read our memo on Long-Term Care Insurance Plans.
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U.S. Department of Housing and Urban Development (2022) Hud Makes $174.6 Million In Grant Funding Available For Construction And Ongoing Project-Based Rental Assistance For Low-Income Seniors. https://www.hud.gov/press/press_releases_media_advisories/HUD_No_22_177
U.S. Department of Housing and Urban Development (2023) Assisted Living Conversion Program (Alcp). https://www.hud.gov/program_offices/housing/mfh/progdesc/alcp
Missouri Department of Insurance (2023) Long-Term Care FAQs. https://insurance.mo.gov/consumers/LongTerm/FAQ.php
U.S. Centers for Medicare and Medicaid Services. (2023) Medicare Advantage Plans cover all Medicare services. https://www.medicare.gov/what-medicare-covers/what-medicare-health-plans-cover/medicare-advantage-plans-cover-all-medicare-services
U.S. Department of Housing and Urban Development (2023) Section 202 Supportive Housing For The Elderly Program. https://www.hud.gov/program_offices/housing/mfh/progdesc/eld202
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