Make the best senior care decision

In this article:

• Defining Medicaid
• Medicaid eligibility for Memory Care
• Medicaid waiver programs, prescriptions, and care services
• Medicaid memory care facilities
• Other memory care funding options

Medicaid offers health care to low-income adults, including the elderly and disabled. It is jointly funded by state and federal governments, but it is administered by states. Each state has their own benefits and ways of determining eligibility. Some states are expanding their coverage, so it’s important to check back often to see if your eligibility has changed.

To be eligible, individuals need to fall under an income threshold. The income limit is determined using your modified gross adjusted income, or MAGI, as a percentage of the federal poverty level, or FPL. For 2022, the FPL for the 48 continental states and the District of Columbia is $13,590 annually for an individual. However, you can make more than this and still qualify for Medicaid. For example, in Louisiana, the eligibility income limit is defined as 133% of the FPL, or an annual income of $18,075 for an individual. You can view your state’s information, factoring in household size, in this spreadsheet offered by The Office of the Assistant Secretary for Planning and Evaluation of the U.S. Department of Health and Human Services.

In addition to income, there is a limit on an applicant’s total assets. You can view your state’s information on the state profiles section of the Medicaid website.

Eligibility can be figured out in several ways:

• Seniors receiving Supplemental Security Income (SSI) from the Social Security Administration are eligible as this is a mandatory eligibility group.
• Seniors purchasing health insurance through the Health Insurance Marketplace®, a database of state organizations selling Affordable Care Act (ACA)-compliant insurance plans, can determine eligibility by answering income-related questions during the application process.
• Seniors can also apply directly to Medicaid by contacting their state’s department of health.

Since Medicaid is based on financial need, you may be asked to provide the following documents:

• Bank statements
• Medical expense records
• Information about investments or savings
• Information about property or other assets

How much Medicaid pays for memory care is dependent upon the care needs of an individual, their eligibility, and the waiver programs available in their state. Medicaid’s waiver programs are designed to enable individuals with memory illnesses to remain in their home and local community without having to move to institutions or other isolated settings.

The waivers vary greatly across states, so it’s important to check with your state agency to see what you or someone in your care qualifies for. It’s also important to understand that even if one qualifies for Medicaid, they may not have access to a waiver. This is because states have a limited number of waivers, and some states have waiting lists that are years long. For all states, prescriptions are covered for persons with memory-related illnesses.

Through Medicaid’s home and community based services (HCBS) waiver programs, care services may be covered in the home or in an assisted living community. Depending on your state, HCBS waivers may cover the following services:

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• Homemaker and home health aides
• Case management and caregiver training
• ADL & IADL assistance
• Skilled nursing
• Respite care
• Adult day health services

It is important to note that if you’re receiving care in an assisted living community, the cost of your room and board is not covered, only the cost of the care services received within the facility. Room and board options are covered in the next section.

Institutional care is an entitlement in all 50 states. Under Medicaid, institutional care refers to care provided in an inpatient, residential long-term care facility. These include inpatient hospitals and nursing facilities, like some memory care communities.

Memory care or assisted living communities may accept Medicaid, but the community must be licensed and certified as a Medicaid-sponsored facility. Check the local area to see if there are Medicaid-sponsored communities nearby. These communities will sometimes even help a prospective resident apply for Medicaid. Again, each state may have slight variances in coverage.

In general, you can expect the long-term care services listed above, as well as an individual’s room and board, to be covered in these institutional settings.

Medicaid covers many aspects of memory care, but a person may face hurdles in the application process. An individual’s assets might be too high, or they may be on the Medicaid waiver waitlist. Keep in mind that other memory care payment options may be available. These could include life insurance policies, veterans benefits, Medicare, or long-term care insurance. Cash and counsel programs and spending down assets can also help someone become eligible for Medicaid.

If you have questions about whether Medicare or Medicaid will cover the cost of memory care, view your state’s information on the Medicaid website, or speak to someone at Medicare.gov.

However, if you’re already looking for a home care agency or a memory care facility, connect with a Senior Living Advisor at A Place for Mom for tailored, local advice. Our experts can guide you towards local resources and navigate the process of finding you or the person in your care the perfect senior living community.

Sources

Dementia Care Central. (2022, January 21). Medicaid Assisted Living Waivers | Helping Persons with Dementia Afford Residential Memory Care.

Medicaid Planning Assistance. (2022, March 9). Medicaid-funded nursing home alternatives for long-term care.

Office of the Assistant Secretary for Planning and Evaluation. U.S. Department of Health and Human Services. Povertyguidelines. HHS.gov.

Talk with a Senior Living Advisor

U.S. Center for Medicare and Medicaid Services. Medicaid. Medicaid.gov.

U.S. Center for Medicare and Medicaid Services. State profiles. Medicaid.gov.

U.S. Center for Medicare and Medicaid Services. Eligibility. Medicaid.gov.

U.S. Center for Medicare and Medicaid Services. Home and community-based services 1915(c). Medicaid.gov.

U.S. Center for Medicare and Medicaid Services. Medicaid and CHIP coverage. Healthcare.gov.

U.S. Center for Medicare and Medicaid Services. Institutional long term care. Medicaid.gov.

U.S. Center for Medicare and Medicaid Services. Prescription drugs. Medicaid.gov.

U.S. Center for Medicare and Medicaid Services. Beneficiary resources. Medicaid.gov.

U.S. Department of Health and Human Services. Who is eligible for Medicaid?

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal, or financial advice or to create a professional relationship between A Place for Mom and the reader. Always seek the advice of your health care provider, attorney, or financial advisor with respect to any particular matter, and do not act or refrain from acting on the basis of anything you have read on this site. Links to third-party websites are only for the convenience of the reader; A Place for Mom does not endorse the contents of the third-party sites.