Medicaid doesn’t cover room and board in residential memory care facilities, but it may pay for dementia care services provided there. Coverage may include assistance with activities of daily living (ADLs), skilled nursing care, and other services. General dementia care is available in many different settings, such as a person’s home, an assisted living community, and even a nursing home. Available Medicaid programs, their eligibility requirements, and their coverage details vary by state.
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In general, Medicaid covers the cost of long-term services and supports for eligible seniors with dementia in two ways: through regular state Medicaid plans or Medicaid waivers.
When it comes to long-term care, Medicaid state plans focus on covering medically necessary care for individuals who require a high level of care and/or supervision. Federal requirements ensure that certain aspects of these plans are consistent across all states, such as coverage of home health care and institutional nursing home care.[01] State plans are entitlement programs, meaning that all seniors who meet the eligibility requirements for covered services are entitled to receive those services.
Some states may choose to add optional benefits like Home and Community Based Services (HCBS) to their state plan.[02] These benefits help seniors avoid or delay moving to a nursing home by providing the care they need in other settings. Optional state Medicaid programs may cover some of the costs of dementia care provided in a person’s own home, a loved one’s home, an independent living community, an assisted living community, and/or a memory care community.
Home and Community Based Services may be offered via Medicaid waiver programs as well. Waivers allow states to “waive certain Medicaid eligibility requirements, covering care for people who might not otherwise be eligible for Medicaid.”[03] States are able to design their own waiver programs (within federal guidelines) to expand coverage of and access to specific services for specific groups of people beyond what’s permitted by their state plan.[04]
Waiver availability, coverage, and eligibility requirements vary widely from state to state. Unlike Medicaid state plans, waivers aren’t entitlement programs. This means that enrollment is usually capped at a certain number of people. Even if a senior qualifies for a waiver program, there may be long wait lists that can delay receipt of covered services. Availability of waiver programs may vary by location within a state, too.
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A person must meet both functional and financial requirements to qualify for Medicaid long-term care.[05]
A physician must assess and document an applicant’s need for a certain level of care. Level of care criteria vary from state to state and program to program, but Medicaid typically looks at an applicant’s medical needs and ability to perform activities of daily living.[06] Cognitive function and the need for supervision for safety reasons may also be factors in determining whether a senior with dementia qualifies for Medicaid coverage.
Medicaid is a need-based program, meaning that applicants must also have limited financial resources to qualify for coverage. Income and asset limits vary from state to state and program to program as well.
For more information on available Medicaid programs and their specific eligibility requirements, contact your state’s Medicaid agency.
Depending on your loved one’s needs, the state they live in, and the program they qualify for, Medicaid can be used to cover long-term care services and supports in various settings, including but not limited to:[01]
Your local Area Agency on Aging (AAA) may provide a list of Medicaid-certified residential memory care facilities. You can find your local AAA by using the Administration for Community Living’s Eldercare Locator.
Medicaid won’t cover room and board in an assisted living facility. Depending on your loved one’s needs, the state they live in, and the program they qualify for, Medicaid may cover some dementia care services in assisted living.
Read more:Does Medicaid Pay for Assisted Living?
Yes. As long as your loved one meets the functional and financial requirements for nursing home coverage in their state, Medicaid will cover 100% of their costs for services, room, and board.[07]
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If Medicaid isn’t an option, or isn’t an option right now, there may be other ways to pay for memory care. These could include:
If you’re looking for a memory care facility, an assisted living community, or a home care agency, reach out to a Senior Living Advisor at A Place for Mom for tailored advice. Our experts can connect you with local care providers and help you navigate the process of finding the right fit for your loved one. However, please note that A Place for Mom doesn’t refer families who are using public pay options such as Medicaid to pay for senior care services.
For eligible seniors, Medicaid will pay the full cost of dementia care in a nursing home. Medicaid will cover part of the cost for dementia care provided in an assisted living or a memory care facility, but the amount varies.
Long-term care addresses broader needs for assistance, like help with activities of daily living. Memory care provides this assistance as well as specialized support for people with dementia. This might include environments and activities designed for those with cognitive impairment.
Yes, Medicaid may cover in-home memory care services, depending on the state.
Yes, Medicaid approval can take weeks or months, depending on the state.
Yes, a spouse can apply for Medicaid coverage of memory care on their partner’s behalf. However, a married couple’s income and assets are treated differently in Medicaid’s eligibility determination.
If your loved one no longer qualifies for Medicaid while they’re in memory care facility, they may need to explore other payment options or leave the facility.
Key Takeaways
U.S. Centers for Medicare and Medicaid Services. Institutional long-term care. Medicaid.gov.
U.S. Centers for Medicare and Medicaid Services. Home & community based services 1915(i). Medicaid.gov.
U.S. Centers for Medicare and Medicaid Services. (2025, February 7). State Medicaid plans and waivers. Medicaid.gov.
U.S. Centers for Medicare and Medicaid Services. Home and community-based services 1915(c). Medicaid.gov.
U.S. Centers for Medicare and Medicaid Services. Medicaid eligibility. Medicaid.gov.
Medicare Interactive. Types of Medicaid for people with Medicare.
U.S. Centers for Medicare and Medicaid Services. Nursing Facilities. Medicaid.gov.
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