Does Medicaid Cover Dementia Care?

Yes, Medicaid covers a wide range of dementia care costs, including Alzheimer’s care and memory care costs.

However, Medicaid may not cover all dementia care costs or the costs of certain services or support communities. Before moving forward with a dementia treatment plan, it is essential to understand the limitations and requirements involved in using Medicaid funds.

What Is Medicaid and How Is Medicaid Different from Medicare?

Medicaid is government-provided health insurance for low-income Americans regardless of age.

While the two names are similar, Medicaid is not the same program as Medicare, which is government-provided health insurance for Americans over the age of 65 regardless of income level. Medicaid benefits include coverage for long-term non-medical services that people with Alzheimer’s disease and other types of dementia often need. Medicare does not cover these services except through some optional, supplemental Medicare Advantage plans.

Another critical distinction between Medicaid and Medicare is that Medicare benefits often require some out-of-pocket payments, whereas Medicaid does not. Many people over the age of 65 carry both Medicaid and Medicare insurance.

What Differences Are There in Medicaid Programs?

To fully understand how Medicaid handles dementia care costs, it is helpful to review the differences in two key Medicaid programs, Institutional Medicaid and Home and Community Based Services (HCBS) Medicaid. Each program has a distinct set of dementia-related benefits. Medicaid coverage benefits vary by treatment location and the level of care involved.

Institutional Medicaid

Institutional Medicaid is provided to residents living in nursing homes. States must provide Institutional Medicaid to eligible individuals.

Medicaid Nursing Home Benefits

In general, Institutional Medicaid covers all care that a patient receives in a nursing home setting. Medicaid nursing home benefits include:

  • Room costs, including housekeeping services
  • Meals
  • All health and wellness services

Not all nursing homes accept Medicaid-eligible patients, though most do. Each nursing care center is limited to a specific number of Medicaid beneficiaries. However, if someone enters the community as a private payer, and later becomes eligible for Medicaid, the memory care community or nursing home is legally required to provide them with housing and care.

HCBS Medicaid

HCBS Medicaid services help people living in home settings or who are taking part in programs like adult foster care and adult daycare. Medicaid can also be used by residents of supportive living communities or who live at specialized memory care centers.

HCBS Medicaid utilizes a waiver system. People eligible for a waiver may be placed on a waitlist before they receive services. Medicaid beneficiaries can apply for waivers through both federal and state-level agencies.

HCBS Medicaid Adult Foster Care Benefits

Adult foster care arrangements take place in home settings and typically include one to four residents. Private individuals can care for people with dementia in exchange for compensation from the HCBS Medicaid program in their state.

Medicaid-provided adult foster care in Maryland is administered through the Certified Adult Residential Environment (CARE) foster family program. Adult foster homes that house four or more residents can also apply for the Medicaid Assisted Living Subsidy. Maryland’s Community First Choice Program also provides benefits to people who live in adult foster care homes.

HCBS Medicaid Memory Care Supportive Living Community Benefits

Memory care communities are similar to other supportive living arrangements, but provide specialized support to people who have dementia, Alzheimer’s disease or other conditions that affect memory. Medicaid cannot be used to pay for the cost of housing or meals for supportive living residences, including memory care communities. However, Medicaid benefits can pay for the healthcare portion. Many Medicaid-eligible individuals use an assisted living Medicaid waiver to cover the room and board portion of their care.

HCBS Medicaid In-Home Dementia Care Benefits

HCBS Medicaid covers dementia health care costs provided in the beneficiary’s home. The coverage goes beyond this limitation to include a long list of benefits. Medicaid recipients can also apply their benefits to the cost of assistance with personal care and daily living activities. For example, Medicaid covers the cost of hiring assistants to help with:

  • Bathing
  • Grooming
  • Mobility
  • Transferring
  • Eating and food preparation
  • Medication management
  • Shopping for essentials
  • Light housekeeping

Often, HCBS Medicaid programs cover basic home maintenance services, medical alert services and modifications made to the home to allow people with advancing dementia to remain in their homes. Modifications might include grab bars, structural changes to allow for wheelchair access and walk-in showers.

Respite care benefits are also provided by most state Medicaid HCBS programs, allowing caregivers to take much-needed breaks. In Maryland, the Department of Health and Human Services provides in-home Medicaid dementia care benefits.

How Much Does Dementia Care Cost?

Alzheimer’s care costs, as well as other diagnoses of dementia, can be expensive as people begin to require more support over time.

One major factor impacting the cost is the round-the-clock nature of support needs in later stages of dementia care. Whether care is taking place in the home or within a homelike community setting, caregivers must monitor people with dementia at all times.

For many families, paying for dementia care out of pocket is out of reach. The Alzheimer’s Association reported that the total lifetime cost of care for someone with dementia in the US is around $350,000, on average. The average price per month to receive care in a memory care community costs American families around $4,500 per month. Dementia care in Maryland comes in around this mark, at an average of $4,400 per month.

It’s easy to see why financial assistance for elderly care is so crucial for so many families. Medicaid can provide a much-needed safety net for families who cannot shoulder these kinds of costs on their own.

How Do I Apply for Medicaid Coverage?

The American Council on Aging Medicaid Eligibility Test is a good place to start. People who think they may be eligible can apply for Medicaid coverage through their home state. In Maryland, eligible individuals can sign up through the Maryland Health Connection website or in person at a local state agency.

If you need to file for Medicaid coverage on behalf of someone with dementia, you may need to set up a power of attorney or get approval through the court system. This is a relatively straightforward process, but it’s a good idea to take care of these issues as soon after diagnosis as you are able.

Affordable Baltimore Dementia Care

Medicaid can help you pay for dementia care, but it likely won’t cover all your costs. When evaluating your options, you should also look for high quality, affordable dementia care.

Tudor Heights is one such option. Our Baltimore dementia care community provides a home for individuals and couples with Alzheimer’s disease and other forms of dementia. We focus all our services on personalized care that empowers every resident to live a stronger, healthier life. To make quality care affordable to more people, we also offer all-inclusive memory care pricing starting at $4,195 per month, several hundred dollars less than the national and Maryland state average.

Contact us for more information on our dementia and Alzheimer’s care options, as well as how we can help make the best care affordable for your family.

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