Does Medicaid Pay For Dementia Care?

Written By: William Rivers
Reviewed By: William Rivers
Published: May 23, 2022
Last updated: July 28, 2022

Medicaid is a government-funded program that assists low-income individuals and families in receiving healthcare services. While federal regulations govern Medicaid, the programs are run by individual states. Each state is in charge of establishing its eligibility criteria and programs. 

Reviewing the distinctions between two important Medicaid programs, Institutional Medicaid and Home and Community Based Services (HCBS) Medicaid, is beneficial. Each program offers a unique set of dementia-related advantages. 

The benefits of Medicaid coverage vary depending on the type of treatment and the level of care required. Read on to understand further how Medicaid for dementia care works.

What To Know About Institutional Medicaid

Nursing home residents are eligible for Institutional Medicaid. Those who qualify will be privy to the following benefits:

Nursing Home Benefits  

Institutional Medicaid, in general, covers all of a patient's care in a nursing home setting. The following are Medicaid nursing home benefits:

  • Costs of rooms, including housekeeping
  • Meals
  • All wellness and health services

Although most nursing facilities do, not all accept Medicaid-eligible patients. Each nursing care center can only accept a certain number of Medicaid patients. If a person enters a memory care community or nursing home as a private payer and then becomes Medicaid eligible, the memory care community or nursing home is legally compelled to provide them with housing and care.

What Is HCBS Medicaid?

HCBS Medicaid services assist people who live at home or participate in adult foster care and adult day care programs. Residents of supportive living homes and specialized memory care institutions can also apply for Medicaid.

A waiver method is used for HCBS Medicaid. Before receiving assistance, people who qualify for a waiver may be placed on a waiting list. Medicaid recipients can seek waivers from both the federal and state governments.

The Certified Adult Residential Environment (CARE) foster family program in Maryland provides Medicaid-funded adult foster care. The Medicaid Assisted Living Subsidy is available to adult foster families with four or more individuals. Adult foster care residents in Maryland can also benefit from the Community First Choice Program.

Medicaid In-Home Dementia Care Benefits 

HCBS Medicaid covers the costs of dementia health care provided in the beneficiary's home. The coverage includes a vast number of perks in addition to this restriction. Medicaid beneficiaries can also use their benefits to cover the expense of personal care and activities of daily living. 

Medicaid, for example, covers the expense of hiring assistants to assist with:

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

Does Private Insurance Cover The Expense Of Dementia Care?

Employer-sponsored plans, long-term care insurance, and life insurance are examples of private insurance. Different plans cover different elements of dementia care, so make sure to read the fine print on your loved one's policy. Other non-profits and foundation assistance you can check out include:

America's Alzheimer's Foundation (AFA)

The Alzheimer's Foundation of America (AFA) funds local, non-profit member organizations to provide Family Respite Care Grants. To administer the grants, these groups interact directly with the families.

Alzheimer's Association of America (AA)

The local chapters of the Alzheimer's Association (AA) operate the Respite Grant Program.

The National Program to Assist Family Caregivers (NFCSP)

The National Family Caregiver Support Program offers in-home care, adult day care centers, and overnight residential facilities, depending on your loved one's requirements. The Area Agencies on Aging Network administers NFCSP awards on a regional basis.

Most seniors will require assistance with daily activities such as bathing, dressing, meal preparation, shopping, and getting to appointments. Moreover, many busy families are not equipped to give this degree of care to their aging relatives. 

It may be time to change if your loved one is frequently confused, discouraged, or has lost control of their life, even with assisted living, so it's best to do early planning. This includes understanding dementia care facilities that accept Medicaid to ensure long-term arrangements are taken care of. 

To learn more about dementia care facilities or dementia home care, read through our blogs at Senior Strong.

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William Rivers is an editor with a master’s degree in Human Services Counseling at Maine State University. He has more than 20 years of experience working in the senior healthcare industry.
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