A question for many of our clients is: Will Medicaid cover memory care for my loved one or family member? Happily, the answer is yes, but a qualified yes. While health insurance and Medicare do not cover care associated with Alzheimer’s and dementia, Medicaid will cover memory care but only in certain settings.
Yes, Medicaid will cover memory care for those in need of such long-term care due to dementia, Alzheimer’s disease or other memory related challenge. The presence of Alzheimer’s, memory loss or impairment, or other dementia does not disqualify a loved one from qualifying for any Medicaid program. Memory care is provided to those in need through Medicaid eligibility, thankfully.
However, Medicaid only provides full Medicaid coverage for those in need of memory care services in a skilled nursing home setting. In recent years, providers have developed a variety of new and innovative care options have arisen to provide dementia care in a variety of settings, some even incorporating community based services for in home care (if certain activities of daily living can still be performed). Additionally, memory care facilities have begun to provide care services in more residential settings, or in settings more resembling an assisted living facility than skilled nursing care. Additionally, small group homes are now being built to provide fully residential care senior living settings, often in small facilities that house 6 to 20 residents, with caregivers often living on the premises.
In these settings, the cost of memory care can be very high. Additionally, these services are typically paid out of pocket from private funds or long-term care insurance available to the care recipient. Most, if not all, of these services are not available for funding through Medicare or through state Medicaid programs.
The good news, however, is that nursing home care in a nursing facility is available and can be paid for through Medicaid benefits. Many of these skilled care memory care communities are available for financial assistance through Medicaid pay. Typically, the application process and the eligibility requirements are no different than the requirements for other skilled care recipients; the care plan simply addresses memory care if the situation warrants. The resident’s healthcare needs are met regardless of memory care needs, with the level of care appropriately adjusted.