Reviewed by Letha Sgritta McDowellLetha Sgritta McDowell is an attorney practicing in both Virginia and North Carolina. She is a fellow of the American College of Trusts and Estates Council, a certified elder law attorney, and a past president of the National Academy of Elder Law Attorneys.

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As one of the largest sources of health coverage in the United States, Medicaid offers a range of programs and savings plans to help people pay for health services, which may include memory care. But, only individuals who meet specific requirements can qualify. Help your loved one determine if Medicaid is the right fit by learning about its eligibility criteria, coverage, and more.

Key Takeaways

Memory care falls under Medicaid’s nursing facility services umbrella. Medicaid covers memory care and a number of other services, but it won’t cover room and board costs.
Medicaid is administered by each individual state. Actual coverage will depend on factors like your loved one’s location and eligibility status.
Medicaid waiver programs help seniors afford their care. States decide which specific programs they’ll provide and what they cover.
Not all assisted living and memory care facilities accept Medicaid. Finding a community that does can be difficult.

Medicaid eligibility for memory care

It’s important that you and your loved one both understand Medicaid’s eligibility criteria as it varies from state to state. As you read the following information on eligibility, keep in mind that many states are in the process of updating their requirements to expand coverage to more people with limited income.^[01]

Exact state requirements vary. However, for those who are 65 or older, have a permanent disability, or are blind, Medicaid eligibility is based on the same methodologies as the Supplemental Security Income (SSI) program administered by the Social Security Administration. Seniors already receiving SSI are considered a mandatory eligibility group and will automatically qualify for Medicaid in most states.^[02]

Because Medicaid is designed to help low-income individuals with limited assets get health coverage, applicants must meet strict financial eligibility requirements. Generally, an individual applicant can have countable assets up to $2,000.^[03] Some assets are considered exempt, or non-countable. Also, some states have programs that offer a little more flexibility for asset limits.

Income limits are typically based on the Social Security Administration’s set Federal Benefit Rate (FBR). The income cap in 2023 for an individual Medicaid applicant is $2,742.^[03] The income cap is adjusted every year according to any changes made to the FBR, so be sure to stay up-to-date on this requirement. Note that unreimbursed medical expenses can lower an applicant’s countable income in certain states.

In addition to meeting financial requirements, your loved one will need to reside in the state they receive care in and be a citizen of the U.S. or a qualified non-citizen.^[03] They’ll also need to meet the specific functional and/or medical eligibility requirements for the Medicaid program they’re applying for.

To learn more about determining their Medicaid eligibility, your loved one can contact their state’s department of health. They can also learn more by visiting the State Profiles page of Medicaid’s official website.

Medicaid memory care coverage

Each state Medicaid program is required by federal law to cover certain services. States also have the option of providing additional Medicaid benefits. Memory care services are covered as a part of Medicaid’s nursing facility level of care, which is one of many mandatory benefits.

Alongside nursing facility care, other mandatory Medicaid benefits include:

Physician and home health care services
Inpatient and outpatient hospital visits
Transportation to medical appointments
Laboratory services and X-rays ^[04]

Some states opt to include additional services in their Medicaid coverage, such as:

Prescription drugs
Physical, occupational, and speech therapy
Other diagnostic, screening, preventive, and rehabilitative services
Dental and optometry services
Personal care
Hospice ^[04]

Keep in mind that Medicaid only covers the cost of room and board in a skilled nursing facility. If your loved one resides in a memory care facility or assisted living community, they will need to rely on another source of funding to cover the cost of rent and meals.

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What you need to know about Medicaid waiver programs

The actual amount Medicaid pays for memory care will depend on your loved one’s care needs and eligibility status. Also, each state offers Medicaid waiver programs, some of which may help cover memory care services. Waiver programs are intended to expand coverage for certain groups of people and certain types of care that aren’t included in the mandatory federal guidelines. While these waiver programs aren’t specific to memory care or dementia care, they can help those with dementia and memory-related conditions receive the care they need in their preferred setting.

Many states, for example, offer Home- and Community-Based Services (HCBS) waiver programs. These amend the terms of regular Medicaid coverage to allow seniors to receive long-term care in their own homes, assisted living communities, or memory care facilities instead of skilled nursing facilities.

There are currently more than 300 active HCBS waiver programs in the U.S., and nearly every state offers services through such a program.^[05]

HCBS waiver programs can cover a combination of medical and non-medical services, including the following:

Homemaker and home health aide services
Case management
Assistance with activities of daily living, such as eating, grooming, and bathing
Skilled nursing and adult day health services
Respite care services ^[05]

Keep in mind that each state offers different waivers with different coverage and eligibility requirements. It’s important to understand that even if your loved one qualifies for Medicaid, they may not have access to a waiver program. Help them check with their state agency to see what waivers they may qualify for and have access to.

How to apply for Medicaid

To apply for Medicaid’s memory care coverage, your loved one will need to contact their local Department of Social Services or Department of Health for an application. They may also be able to apply through the Health Insurance Marketplace.

Because Medicaid is based on financial need, they’ll likely need to provide the following information during the application process:

Household size
Where they live
Annual household income
Total amount of assets like cash, savings, and investments
Records of their medical expenses^[06]

How to find memory care facilities that accept Medicaid

Medicaid covers institutional long-term care for seniors who need nursing care in a residential facility. In order for a facility to accept Medicaid, they must be licensed and certified by the state . Compared to nursing facilities, fewer assisted living and memory care communities accept Medicaid, so they can be difficult to find.

Check with your loved one’s local Area Agency on Aging or visit their state’s Medicaid site to find more information on local Medicaid memory care facilities.

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Additional funding options and ways to offset costs

There are many ways to pay for memory care. Ask your loved one about their savings and insurance coverage. They may be able to use a combination of the following payment sources:

Personal funds, including assets, savings accounts, stocks and bonds, and 401k or IRA plans
Home equity, which would involve using the value of their home to pay for their care
Long-term care insurance, which can cover personal care and medical expenses in many settings, including nursing homes, assisted living communities, and memory care communities
Life insurance policies, which your loved one can either cash in, sell, or, in certain circumstances, borrow against to pay for memory care
Veterans benefits, such as the Aid and Attendance pension
Medicare savings programs (MSPs), which are Medicaid-administered programs designed to help seniors and people with disabilities save on Medicare costs ^[07]

Note that this list is not extensive. There’s a variety of ways to pay for memory care. Your loved one may also be able to offset some costs by asking about move-in incentives during community tours or sharing housing costs with a roommate.

Finding care options when your loved one doesn’t qualify for Medicaid

Navigating senior care on your own can feel daunting. Consider contacting your loved one’s local Area Agency on Aging for assistance. You can also reach out to a Senior Care Advisor for one-on-one guidance in your search for senior living options that suit your loved one’s needs, preferences, and budget. However, please note that we do not refer families who are using public pay options like Medicaid to cover senior living services.

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References

U.S. Center for Medicare and Medicaid Services.State Profiles. Medicaid.gov.
U.S. Center for Medicare and Medicaid Services. Medicaid Eligibility. Medicaid.gov
Centers for Medicare and Medicaid Services. Tsai, D. (2023, May 11). 2023 SSI and Spousal Impoverishment Standards CIB. Department of Health and Human Services.
U.S. Center for Medicare and Medicaid Services. Mandatory & Optional Medicaid Benefits.
U.S. Center for Medicare and Medicaid Services. Home & Community-Based Services 1915(c).
Alzheimer’s Association. Medicaid.
National Council on Aging. (2022, January 26). Medicaid and Medicare Savings Programs.

Meet the Author

Grace Styron

Grace Styron is a writer at OurParents specializing in assistive technology, memory care, and home care. Before writing about healthy aging, she worked for an online women’s lifestyle magazine and as a grant writer for a nonprofit regenerative permaculture farm in Virginia. She earned her bachelor’s degree from Missouri State University.

Edited byKristin Carroll

Reviewed byLetha Sgritta McDowell

The information contained in this article is for informational purposes only and is not intended to constitute medical, legal or financial advice or create a professional relationship between A Place for Mom (of which OurParents is a trademark) 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 recommend or endorse the contents of the third-party sites.

Does Medicaid Cover Memory Care?