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Medicaid and Medicare Memory Care Coverage

Confusion sometimes occurs regarding whether Medicare or Medicaid provides coverage for individuals needing memory care services.

Considering whether these programs provide coverage, along with the extent of coverage provided likely aids in finding an ideal senior care provider or senior living facility that serves individuals with memory care needs.

Does Medicaid Cover Memory Care?

Millions of seniors in the U.S. receive Medicaid benefits. The website reveals that more than eight million senior Americans are dually eligible for both Medicare and Medicaid. This is an important factor for individuals in the planning stages of seeking memory care coverage or those actively seeking a memory care facility or care for their loved one outside of an assisted living facility, nursing home or other long-term care senior living facility.

Medicaid provides assistance to certain seniors, including Medicare recipients, who meet requirements of having low incomes and limited financial resources. Your state Medicaid office makes a determination whether you or your loved one qualifies for Medicaid and which benefits an eligible recipient receives under Medicaid. This does include eligibility for memory care coverage.

Individual states set their own guidelines for many covered services, making it crucial that you understand guidelines in the state where the individual in need of memory care resides. Some state Medicaid programs provide memory care coverage for individuals diagnosed with Alzheimer’s, various forms of dementia or other conditions both at a long-term care facility and outside a facility when an individual still resides at home. Other states do not pay for those in assisted living, only providing coverage and support for those remaining at home.

The Henry J Kaiser Family Foundation reveals that more than 45 percent of individuals currently living in nursing facilities and more than 20 percent of seniors living in the community probably have dementia, which often results in “Complex” medical needs, along with behavioral health care needs. The Kaiser Family Foundation further explains that Medicaid plays a crucial role in providing long-term services and support coverage for eligible seniors in need of memory care.

Some states provide comprehensive services to seniors needing memory care coverage by specifically targeting Medicaid-eligible seniors, providing services in the home, the community or within senior living facilities designated as Medicaid-approved facilities.

Some seniors with Alzheimer’s or another form of dementia may not know they qualify for Medicaid. Others sometimes assume that because they received a Medicaid denial in the past, they cannot receive memory care coverage now. A senior or their family members should not make assumptions about Medicaid eligibility for memory care coverage. The only way to know if you or your loved one qualifies for Medicaid memory care coverage is to apply for Medicaid.

Where Can I Find Medicaid Memory Care Services Near Me?

Medicaid memory care coverage and services vary by state, making it important that you do not assume the program provides identical coverage in all states. All facilities providing memory care coverage for Medicaid recipients have to be a Medicaid-certified facility. Some facilities choose not to accept Medicaid, which is the right of the facility or other memory care provider.

Find Medicaid memory care services near you or your loved one by first applying for Medicaid and asking the Medicaid case manager for assistance in locating services and facilities approved by Medicaid.

Call the facility of your choice and ask if they accept Medicaid for payment of memory care services.

Senior care and senior living resources online also likely provide a wealth of information about finding Medicaid-certified memory care facilities near you or your loved one.

Does Medicare Cover Memory Care?

The lack of Medicare coverage probably surprises some individuals seeking memory care coverage who assume that Medicare provides coverage for memory care facilities. Medicare does not specifically provide coverage for Medicare recipients in long-term care facilities.

The Alzheimer’s Association explains that while Medicare pays for some services, such as an annual wellness visit, health risk assessment, up to 100 days at a skilled nursing facility under certain limited circumstances, Medicare does not cover “Custodial long-term nursing care.”

A recent development affecting Medicare recipients with Alzheimer’s occurred with implementation of new guidelines for assessment and care planning. Effective January 1, 2017, Medicare now pays their portion of costs for access to cognitive assessment and person-centered care planning services.

Comprehensive assessment and evaluation of cognition and functioning for Medicare recipients with Alzheimer’s is an example of coverage under the new guidelines. However, Medicare still does not provide coverage specifically related to long-term care.

What Are My Alternative Options To Pay For Memory Care?

If you or your loved one has Medicare Part C, ask your Medigap provider if the company provides memory care coverage.

Medicare suggests several alternative options for paying for memory care. If the individual in need of memory care coverage has a case manager, talk to that person.

Ask for help from the hospital discharge planner, care coordinator or social worker. They often have resources for programs or facilities that help coordinate services for seniors that cannot afford the full costs of memory care not covered by Medicare.

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