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Does Medicaid Pay For Memory Care?

September 22, 2023 / Memory Care

Memory care is an important long-term care option for seniors who are dealing with memory loss as they age, whether it is from dementia or another condition. Memory care facilities provide specialized care for individuals with memory loss, including supervision, safe and secure facilities, cognitive activities to aid in stimulating the mind, and assistance with the activities of daily life specially designed for those who have memory issues. Memory care is very necessary for many seniors, but it can be costly. The team at Senior Care AZ, a senior placement agency in Arizona, is breaking down Medicaid and memory care: does Medicaid cover it, if your loved one is eligible for Medicaid and other payment options for memory care.

What Is Medicaid?

Medicaid is a joint state and federal health insurance program that provides coverage to more than 65 million low-income Americans. Medicaid plays a vital role in providing individuals with coverage so they can receive life saving treatments and essential care, with the goal of breaking down barriers in health care systems. Medicaid is not the same as Medicare in that it is designed to serve low income individuals instead of taking an age-based approach.

Does Medicaid Cover Memory Care?

There are millions of Americans who are enrolled in Medicaid, and many individuals use Medicaid as their primary form of insurance. Medicaid covers some of the costs of memory care, but it will not cover the costs completely. 

Memory Care Services Covered by Medicaid

The memory care services covered by Medicaid include: 

  • An assessment of cognitive impairment, diagnosis of health conditions and care planning services. 
  • Annual wellness visits to a primary care physician.
  • Hospitalization to treat injury or illness. 
  • Durable medical equipment.
  • Up to 100 days of skilled nursing care.
  • Home health care, if required by a doctor.
  • Hospice care costs for pain and pain management in the end-stages of dementia or Alzheimer’s.
  • Care for inpatient clinical studies.

How Medicaid Pays for Memory Care

There are two primary ways that Medicaid will cover memory care costs: 

Institutional Medicaid

In all states, Medicaid will pay 100% of the cost of nursing home care for Medicaid-eligible adults with Alzheimer’s or dementia. This includes the cost of room and board as well as all health care services provided in the facility. It will also cover any memory care and personal care services provided by the facility. Institutional Medicaid can only be used to cover the costs of facilities that are licensed and certified as Medicaid Nursing facilities.

Home and Community-Based Services (HCBS)

This Medicaid coverage will cover the costs of certain long-term services or assisted living facilities, adult day-care centers, memory care facilities, or other community based support centers and facilities. Home and community based service coverage is provided in the form of 1915 waivers, some of which are reserved for aging adults with dementia or other disabilities. 

Does Medicaid Cover Dementia Care in Assisted Living?

Medicaid will not cover all of the costs of care in an assisted living facility. In some cases, some of the costs could be covered through a Home and Community-Based Services waiver. Generally, the cost of room and board will not be covered in assisted living, but other dementia care services may receive coverage from Medicaid.

Does Medicaid Cover Dementia Care in Nursing Homes?

Nursing homes are considered institutional care, which is a guaranteed right for individuals who are eligible for Medicaid. As such, dementia care in a nursing home will be covered completely by Medicaid for individuals who are eligible and who are determined to need skilled nursing care by their physician. 

Is My Loved One Eligible for Medicaid?

Medicaid is a term that covers a number of different programs, so determining eligibility ultimately depends on the program for which they are applying. Individuals must fall under a certain income threshold to apply, which is based on the average gross income of the location where they live. To determine eligibility for your loved one’s area, you can visit their local Medicaid office. 

How to Apply for Medicaid

You can apply for Medicaid through your local office or online. Medicaid is based on financial need, so in order to apply, you will need information such as bank statements, medical expense records, information about savings or investments, and information about any assets or property.

Other Ways to Pay For Memory Care

While Medicaid will cover the costs of room and board for eligible residents in nursing homes, it will not cover 100% of the costs of room and board in memory care facilities or assisted living facilities, and the costs of room and board can be expensive. Planning for alternative payment sources is important to ensure costs will be covered throughout your loved one’s stay. Additional options for payment include: 

  • Veteran’s Benefits: Eligible veterans suffering from dementia may be able to receive coverage in part from the Office of Veterans Affairs. 
  • Long-Term Care Insurance: Long term care insurance plans may cover some of the costs of a memory care facility, provided your loved one has a policy they have been paying into for many years.
  • Private Sources: Some individuals choose to pay for the additional costs of memory care facilities out of other funds, including savings accounts, retirement savings, or sale of assets such as a home.