Medicaid’s In-Home Care, Services and Supports for Persons with Alzheimer’s or Dementia

Overview

In-home, long-term care can be especially helpful for seniors with Alzheimer’s disease and other dementias, who tend to fare better in familiar surroundings and can have strong negative reactions to change. In-home, long-term care allows them to stay where they feel most comfortable and still get the care they need. To be clear, long-term care is ongoing care that includes healthcare and personal needs. Medicare, a public insurance program for Americans age 65 and up, does not cover long-term care. Medicaid, a public insurance program for Americans with limited finances, will cover in-home, long-term care for eligible applicants, including those with Alzheimer’s disease and other dementias.

Medicaid’s in-home coverage can include medical support like on-site skilled nursing, physician’s visits and medical supplies and equipment. It can also include non-medical services like meal delivery, housekeeping help and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). In many states, Medicaid beneficiaries can even hire caregivers of their choice to provide housekeeping and personal care assistance, including family members.

Medicaid’s In-Home Care Benefits for Persons with Alzheimer’s or Dementia

The in-home, long-term care services and supports that Medicaid will cover depend on the needs of the beneficiary as well as the state and the Medicaid program. Since Medicaid is run by individual states, many of its benefits, eligibility requirements and rules can vary by state. Broadly speaking, however, Medicaid’s in-home care benefits for dementia patients and all eligible applicants can include:

• In-home skilled nursing
• Physician’s visits
• Physical therapy
• Occupational therapy
• Medication management
• Case management
• Assistive technology
• Personal Emergency Response Systems (PERS)
• Meal delivery
• Transportation (medical and non-medical)
• Home modifications for safety and accessibility
• Vehicle modifications for safety and accessibility
• Chore services
• Housekeeping help (cleaning, cooking, shopping, laundry, etc.)
• Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing/grooming, eating, toileting)

All of these benefits could be helpful to Alzheimer’s and dementia patients, but some that may be especially relevant include Personal Emergency Response Systems, which can help prevent wandering in addition to raising an alert in case of a health emergency; medication management and assistive technology like an automatic pill dispenser can help dementia patients keep their prescriptions in order; case management to keep healthcare appointments, coverages and benefits organized.

It’s important to note that Medicaid will not cover mortgage payments or rent of any kind, or food costs, for beneficiaries who are living in their own home or the home of a loved one. It will only cover long-term care services and supports.

There are two types of Medicaid programs that cover in-home care – Home and Community Based Services (HCBS) Waivers and Aged, Blind and Disabled (ABD) Medicaid, which is also known as regular or state Medicaid for seniors. In general, HCBS Waivers have more available in-home, long-term care benefits than ABD Medicaid and a more lenient income eligibility requirement, which is discussed below. ABD Medicaid, on the other hand, has a more lenient functional (medical) requirement, which is also discussed below.

Self-Direction of Care

Consumer Directed Care gives Medicaid beneficiaries some decision-making power when it comes to their long-term care. This can be something as simple as being able to choose a different type of medication or brand of medical equipment, but it can also be the ability to hire and pay caregivers of their choice, including family members and even spouses in some states. These family caregivers do not need to be medical professionals, but they may have to take a class, pass a background check or meet some other criteria in order to be paid via Medicaid.

Consumer Directed Care is an option for some HCBS Waivers as well as some ABD Medicaid programs, but not all. Consumer Directed Care is also known as Self-Directed Care, Participant Direction and Consumer Directed Services, and it was previously known as Cash & Counseling.

Medicaid Eligibility Requirements for In-Home Care for Persons with Alzheimer’s or Dementia

To qualify for in-home, long-term care via HCBS Waivers or ABD Medicaid, all applicants, including dementia patients, must meet functional and financial eligibility requirements.

Home and Community Based Services (HCBS) Waivers

The functional requirement for most Home and Community Based Services (HCBS) Waivers is needing a Nursing Facility Level of Care (NFLOC), although some Waivers only require applicants to be “at risk” of needing a NFLOC. As the name suggests, a NFLOC means the type of constant care and supervision associated with a nursing home, but exactly how a NFLOC is defined and measured depends on the state. However, in no state does a diagnosis of Alzheimer’s disease or another dementia automatically equate to a NFLOC designation. Cognitive abilities will be taken into account when the state evaluates Medicaid applicants, and many of them will qualify for a NFLOC, but there are no guarantees. Another option is retaining a 3rd party to assess if an individual’s level of care needs meets Medicaid functional requirements. One organization that provides this service can be found here.

In most states in 2025, the individual asset limit for HCBS Waivers is $2,000 and the individual income limit is $2,901/month. Some assets can be exempt from the limit, like a primary home (depending on its value and how much of it the applicant owns), furniture, appliances, clothing, a primary vehicle and personal items like wedding and engagement rings. Almost all income is counted. These limits can change depending on the applicant’s state of residence and marital status. To find the exact limits for a specific situation, use this Medicaid Eligibility Requirements Finder. To see if you or your loved one is eligible for Medicaid, use our online test.

Aged, Blind and Disabled (ABD) Medicaid

There is no functional eligibility requirement to receive basic healthcare coverage (primary care visits, emergency room trips, hospital stays, prescription medication) via Aged, Blind and Disabled (ABD) Medicaid. However, anyone who wants to receive long-term care services or supports via ABD Medicaid, including dementia patients, must show a functional need for that particular service or support. For example, Medicaid might pay to build a wheelchair ramp for an ABD Medicaid beneficiary has a need for a wheelchair but lives in a home without a ramp, but Medicaid won’t build a ramp for an ABD Medicaid beneficiary who does not need a wheelchair.

The individual income limit for ABD Medicaid in 2025 ranges from $967/month to $1,795/month, depending on the state. The individual asset limit, in most states, is $2,000.