Medicaid Benefits for Dementia & Alzheimer’s Care: At Home, In Memory Care & Nursing Homes

What is Medicaid?

Medicaid is a public health insurance program for financially limited Americans of all ages. It’s funded by the federal government and administered by state governments, which means Medicaid’s rules, benefits and even its name can change depending on the state.

Medicaid is often confused with Medicare, but they are not the same. Medicare is for all Americans age 65 and over. Medicaid, as mentioned above, is for Americans of all ages who are financially limited. There are, however, certain Medicaid programs designed specifically for seniors. These are the programs that can cover both medical needs and non-medical long-term care needs for individuals with Alzheimer’s disease and other dementias, and they are described next.

Medicaid Programs for Dementia

There are three Medicaid programs most relevant to seniors, including those with Alzheimer’s disease and other dementias: Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid.

Nursing Home Medicaid
Medicaid will cover essential nursing home expenses, including room and board, for qualified applicants in all 50 states and Washington, D.C. Nursing Home Medicaid is an entitlement, which means all qualified applicants are guaranteed coverage. This doesn’t mean they’re guaranteed a place in any nursing home they choose – not all nursing homes accept Medicaid and those that do might have a waitlist for new residents.

HCBS Waivers
These Medicaid programs cover long-term care for beneficiaries who need a high-level of care but live in their own home or the home of a loved one. In some states, HCBS Waivers also cover care in other settings in the community, such as assisted living residences, including memory care facilities, although they will not cover room and board. HCBS Waivers are not an entitlement. Instead, they have a limited number of enrollment spots, and once those spots are full, additional applicants will be placed on a waitlist.

ABD Medicaid
This is also known as regular or state Medicaid, but it should not be confused with the regular Medicaid that’s available to financially limited people of any age. ABD Medicaid will also cover long-term care in the community, but in most states its coverage is not as extensive as HCBS Waivers, and the ABD Medicaid financial requirements tend to be more restrictive. ABD Medicaid is an entitlement, so all qualified applicants are guaranteed coverage without wait.

Medicaid Benefits for Alzheimer’s & Dementia by Location

Medicaid is known for its long-term care nursing home benefits, but, as mentioned above, it also covers care at home. In some states, it covers care in other locations in the community, such as assisted living residences, memory care facilities, adult day care and adult foster care.

It’s important to remember that Medicaid’s long-term care benefits, eligibility requirements and rules can all vary by state. To learn more about the Medicaid rules in your area, find your state page here. Or consult with a professional.

At Home

Medicaid will cover care in a beneficiary’s home or the home of a loved one (if that’s where the beneficiary lives) in every state via HCBS Waivers and/or ABD Medicaid. This is in addition to covering doctor’s visits, prescription medication and short-term hospital stays, including emergency room visits. Again, these at home benefits can change depending on the state and the program, but in general they include:

• Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
• Personal care assistance with the Instrumental Activities of Daily Living (shopping, cooking, cleaning, paying bills, medication management, etc.)
• Transportation
• Meal delivery
• Personal Emergency Response Systems/Medical Alert Devices
• Home modifications for safety and accessibility (hand rails, wheel chair ramps, stair lifts, etc.)
• In-home skilled nursing and doctor’s visits
• Physical therapy
• Occupational therapy

Many of these benefits are critical for Medicaid recipients with Alzheimer’s disease or other dementias who are living at home, especially the personal care assistance. What’s more, many Medicaid programs that cover at-home care allow the beneficiary to select a caregiver of their choice to provide the personal care assistance, including family members and even spouses in some states. In many cases, the family member is paid by Medicaid for care they were already providing. Learn more about how Medicaid compensates loved ones who provide care.

In Assisted Living/Memory Care

Many assisted living residences provide enough care to support people in the early stages of Alzheimer’s disease or other dementias. When the disease progresses and patients require a higher level of care, a memory care facility designed specifically for people with dementia can be an excellent option. Most states will cover long-term care services and supports in either of these settings via an HCBS Waiver or their ABD Medicaid program. However, Medicaid will not cover room and board expenses in assisted living residences or memory care facilities with only a few exceptions, like California’s Assisted Living Waiver, for example.

Medicaid benefits available in these settings can very by state and program. In general, they include:

• Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
• Personal care assistance with the Instrumental Activities of Daily Living (shopping, cooking, cleaning, paying bills, medication management, etc.)
• Transportation
• Meal delivery
• Personal Emergency Response Systems/Medical Alert Devices

To find out if there’s an HCBS Waiver in your state that covers care in assisted living and/or memory care, consult the table on this webpage that organizes these Waivers by state.

In Adult Day Care

Adult day care centers can provide daytime supervision, meals, activities, exercise and, in most cases, healthcare services and supports. This can be critical for dementia patients who are living in the community. Many states cover adult day care costs via their ABD Medicaid program or an HCBS Waiver.

Adult day care is also a benefit of PACE (Program of All-Inclusive Care for the Elderly), which coordinates Medicaid and Medicare long-term care coverage for people who are over age 55 and require a high-level of care and live in the community. The National PACE Association estimates that more than half of program participants have dementia. All PACE programs have adult day health centers. The services in these centers can vary by location, but in general they include:

• Supervision
• Medical oversight
• Nursing services
• Vision, hearing, dental and foot care
• Physical therapy
• Exercise programs
• Social activities
• Lunch/snacks
• Transportation

In Adult Foster Care

Adult foster care homes are often the homes of private individuals who “take in” adults (including people with dementia) in return for compensation, sometimes from Medicaid. Medicaid’s coverage of adult foster care is difficult to generalize. In a few states, Medicaid has programs that pay for it, but most states do not have explicit laws defining their Medicaid policy for adult foster care, or laws that distinguish between adult foster care and assisted living. In those states, Medicaid can probably be used to cover care costs in adult foster care, but not room and board.

Adult foster care is similar to assisted living in that people with Alzheimer’s or dementia would live in this location full-time. However, there are far fewer residents in adult foster homes. Instead of the 10 to 100 residents that normally reside in an assisted living residence or memory care facility, there may be only 1 to 4 residents in an adult foster care home.

Adult foster care homes can have different names in different states. They can be referred to as adult family homes, group homes, adult family living, family care homes and community care foster family homes.

In Nursing Homes

As mentioned above, Nursing Home Medicaid will cover essential nursing home expenses for qualified applicants in all 50 states and Washington D.C. These expenses typically include:

• Room and board
• Nursing and medical services
• Medication management
• Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
• Mental health counseling
• Emergency dental services
• Routine hygienic items and services (toothbrush, nail clippers, soap, shampoo, etc.)
• Diet appropriate meals
• Social activities
• Exercise programs

Essentially, Medicaid will cover any nursing home expenses that are considered medically necessary. However, there are plenty of nursing home expenses that Medicaid will NOT usually cover. These include:

• Private room
• Phone and TV
• Personal comfort items like sweets or tobacco
• Clothes
• Grooming items not considered routine
• Personal reading materials
• Flowers and other plants
• Specially prepared food
• Care services not considered medically necessary

Dementia Medicaid Eligibility

All applicants, including those with Alzheimer’s disease and other dementias, have to meet financial and medical eligibility requirements to qualify for Medicaid long-term care. The requirements can change depending on the state, the Medicaid program and the applicant’s marital status, and many of them are updated on an annual basis.

These eligibility requirements, including the asset and income limits, are discussed in our article that you can read by clicking here. The article also discusses how dementia patients can qualify for Medicaid if they don’t immediately meet the financial limits. To see if you or your loved one is eligible for Medicaid, click here to use a free online test.