Reviewed by Letha McDowell, CELA, CAP Certified Elder Law Attorney Letha Sgritta McDowell is a past president of the National Academy of Elder Law Attorneys.
The cost of care for someone with Alzheimer’s or another form of dementia can become expensive, and care needs tend to rise as the disease progresses. When specialized memory care becomes essential, seniors can receive these services in memory care facilities, assisted living communities, or nursing homes. Funded jointly by the federal and state governments, Medicaid is a state-run program that offers health care to low-income adults, including the elderly and disabled — and luckily it can help with long-term memory care costs. Let’s explore what coverage is available through Medicaid for memory care services, how specific Medicaid programs can help, and which memory care facilities accept Medicaid.
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Take our free care quizMedicaid may cover memory care services in a memory care community, assisted living community, or nursing home. The services Medicaid will cover, the amount it will pay, and how it will pay for the care all vary greatly by state and by type of community.
Medicaid doesn’t cover the cost of room and board in memory care or assisted living facilities. However, Medicaid may cover some memory care services if your loved one has the appropriate waiver and is receiving essential support in a memory care facility that accepts Medicaid.
Seniors can receive dementia care through a dedicated memory care community, or they can opt for specialized dementia care in addition to the basic services provided at the assisted living community or nursing home they live in. We’ll go over the differences between each type of senior living community and explore how Medicaid waivers can help your loved one pay for the memory care services they need.
Some memory care communities accept Medicaid, but the community must be licensed as a Medicaid-certified facility. While it’s possible to find a dedicated, Medicaid-approved memory care community, it’s fairly uncommon.
Each state licenses and certifies memory care facilities differently. Because each state’s Medicaid program is unique, finding an approved community in your loved one’s state may not be possible. In many cases, memory care services are offered by an assisted living community or a nursing home. Medicaid pays these types of communities differently, which we’ll discuss in more detail below.
If your loved one still wishes to live in a specially designed memory care community, they may need to apply for Home and Community Based Services (HCBS) waivers to cover the cost.
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Take our free care quizMedicaid won’t cover the entire cost of assisted living or the memory care services it provides. However, it might pay for some of the cost of assisted living services through HCBS waivers. In general, the cost of your loved one’s room and board won’t be covered, but certain care services provided within the facility will be.
Assisted living may be a good care option for a loved one in the early stages of Alzheimer’s or another form of dementia. Assisted living offers services helpful to someone with memory loss, such as medication reminders and assistance with daily tasks like bathing and grooming. However, as dementia progresses, you may find that caregivers in an assisted living community lack the specialized training that you would find from caregivers in a memory care community.
Yes, Medicaid covers the cost of memory care services in a nursing home because nursing homes are considered institutional care communities. Institutional care is an entitlement designated by Medicaid, meaning this type of care will always be provided to Medicaid recipients in all 50 states.
However, it’s important to note that seniors must need skilled nursing care in addition to memory care to qualify for coverage. This means your loved one would likely need help with several activities of daily living as well as medication administration, wound care, or other specialized services. Each state has its own guidelines for determining whether a senior needs the level of care provided in a nursing home. Intellectual disabilities may also qualify someone for this level of care. [ 01 ]
If your loved one does qualify for a Medicaid-sponsored nursing home, Medicaid will likely pay for room and board there. [ 02 ]
Both memory care communities and nursing homes offer 24-hour supervision for seniors, but you may not find the specialized memory care supports that your loved one needs in a nursing home. When exploring nursing home options, be sure to request information on what specific memory care services are offered for residents with dementia.
Because Medicaid is jointly administered by federal and state governments, what’s covered and how it gets paid out to beneficiaries and care communities will vary. If a community is classified as providing institutional care, Medicaid will pay the facility directly.
The following benefits are mandatory under Medicaid: [ 03 ]
The following are considered optional benefits: [ 03 ]
Your loved one’s care needs, their eligibility, and the HCBS waiver programs in their state affect how much Medicaid will pay for memory care. Medicaid’s waiver programs are designed to enable eligible individuals in need of memory care to remain in their home or local community without having to move to institutions or other isolated settings.
Waivers vary greatly across states, so it’s important to check with your state agency to see what waiver programs are offered. It’s also important to understand that even if a person qualifies for Medicaid, they may not have access to a waiver. Each state handles their waiver program differently, offering different types and amounts of waivers. Some states have a limited number of waivers and may have waiting lists that are years long.
Depending on your state, HCBS waivers may cover the following services: [ 04 ]
