Does Medicaid Pay for Memory Care?

According to the Alzheimer’s Association, there are more than 5 million Americans living with Alzheimer’s disease and dementia. Many of these individuals require long-term, residential memory care. This type of care is provided by caregivers trained in dementia who can provide support to seniors experiencing frustration, anxiety and other symptoms related to their condition. For most seniors who live with dementia, memory care is a vital service that ensures their safety and well-being. However, the cost of memory care is often too much for seniors to afford on their own. In some cases, seniors may qualify for Medicaid assistance to cover these expenses.

Medicaid Assistance for Memory Care

Medicaid is a financial assistance program that helps low-income individuals and family’s access health care services. While Medicaid is subject to federal regulations, programs are administered by individual states. Each state is responsible for determining its own eligibility requirements and programs.

In most states, seniors aged 65 and older can qualify for regular Medicaid assistance if their monthly income is below $2,349 per month. While some states may cover the cost of memory or assisted living care under regular Medicaid, seniors in some states may be required to apply for coverage under state Medicaid waivers.

Medicaid Waiver Programs

Many states offer assisted living waivers, which amend the terms of regular Medicaid coverage to allow seniors to receive long-term care in assisted living or memory care facilities instead of nursing homes. This type of waiver helps states reduce their Medicaid costs by providing seniors with less expensive long-term care options. Waiver programs also allow seniors to live in facilities that are better suited to their needs.

Unlike regular Medicaid, waiver programs are typically not entitlement programs. That means that instead of qualified individuals automatically receiving approval for benefits, they’re required to apply for assistance. If a program is at capacity, they may be placed on a waiting list until a spot is available. While this can be inconvenient for seniors hoping for a more immediate solution, it’s often the best option for those who are unable to afford the cost of memory care on their own.

Assisted living waivers don’t cover the cost of room and board in memory care facilities. Instead, they allow the state to provide financial assistance for the services provided in these communities, such as personal care, help with activities of daily living, specialized programming, medication management and transportation. That means that seniors may need to rely on other funding to cover the cost of housing and food. This may come from other state assistance programs, long-term care insurance or a variety of other sources.

It’s important to note that these waivers may be known by a variety of names, depending on the state. For example, in New York, the waiver is known as the Assisted Living Program, while in Oregon, seniors can receive funding via the Community First Choice Plan, which operates the state’s assisted living waiver.

Find your state below to learn more about memory care where you live and the Medicaid programs available to help pay for it.