Dementia Care: What’s Covered by Medicaid and What’s Not

As dementia worsens, many caregivers start to wonder what they can expect of long-term care through Medicaid. The mind begins to deteriorate, and unfortunately, it’s no longer possible for that individual to continue to live independently.

Dementia Care: What's Covered by Medicaid and What's Not

In this article, Senior Planning Services, a NJ-based Medicaid planning company that assists seniors and their families with Medicaid-sponsored senior care, discusses what’s covered by medicaid and what’s not during this time.

Dementia Care

Dementia begins with custodial care: routine personal care that does not require the attention of trained medical staff. Intermediate care is the step beyond that, when medical care is necessary, but not constant; and at the level of skilled care, your loved one with dementia is in need of constant medical care in order to maintain what quality of life they can.

Where does Medicaid factor into that? For many, Medicaid offers the financial provision that makes it possible for elderly dementia patients to receive the quality of care they need. There are a variety of care options available for dementia patients depending on the level of care they currently require.

In-Home Care

For many dementia patients, in-home care is the preferred style of care for as long as possible.

In-home care allows for dementia patients to receive daily visits to help with personal care and other tasks, including food preparation, without needing to leave the comfort of their own homes.

In-home care is often covered by Medicaid. The only qualification is that the patient would otherwise be in need of moving to a nursing home or other care facility if the in-home care had not provided.

Adult Day Care Programs

Adult day care programs are designed to provide care during the day for individuals who are unable to stay at home by themselves and who have no one to care for them, but who aren’t yet in need of full-time nursing home care.

At adult day care programs, individuals with dementia are watched over and cared for. They’re also able to interact with other adults, which can help keep their minds sharper and functioning longer.

This is another service that is often paid for by Medicaid.

Continuing Care Retirement Communities

Continuing care retirement communities (CCRC’s) are designed to offer a tiered approach to care. Individuals who are able to live somewhat independently are allowed that independence.

As their condition deteriorates, they are moved to higher-care levels of the facility. These services typically aren’t paid for by Medicaid, and often, individuals who wish to live in a continuing care retirement center must move in when they are still able to live independently in order to ensure a place when they need higher levels of care.

Another benefit of this type of setting is that the spouse of the dementia patient can join the patient in the CCRC.

Adult Family Homes

For dementia patients, adult family homes are often a wonderful option for continuing care.

In many cases, these homes will have around six adult patients who are able to interact with one another and with the staff. They live in a residential home, so patients are more comfortable than they might be in other nursing home-style settings. In adult family homes, occasional medical care is sometimes available.

Again, however, these services are not provided by Medicaid.

Nursing Home Facilities

When a dementia patient deteriorates to a point where they can no longer live alone at all and they need a high level of medical care, a nursing home is usually the best place for them.

Nursing homes are designed to allow dementia patients to receive the care they need while still maintaining their quality of life for as long as possible.

Medicaid will cover nursing home care for dementia patients.

Memory Care Units

Memory care units are specialized facilities that are designed around the specific needs of patients with dementia and Alzheimer’s.

In these facilities, patients are able to participate in structured activities. They’re able to be social, receive physical therapy and other medical services as needed, and have meals brought to them or offered in a dining room.

Memory care units offer private or semi-private rooms. Medicaid does offer plans that will help cover memory care units.

The financial burden of caring for an elderly dementia patient can be heavy. Many people struggle with finding the best type of care for their loved one, and the additional thought of how to pay for it can be overwhelming.

Thankfully, programs like Medicaid help make it possible for families to provide their loved ones with the care that they need without going into debt. Careful research and consideration of the available facilities in a given area will ultimately provide the best determination of the care needed for a particular individual.

What changes to Medicaid surprised you the most? What questions do you have about these changes? Share your thoughts on Medicaid in the comments below.

About the Author

Benny Lamm is a communication specialist and blogger at Senior Planning Services, an industry leader in helping seniors and their families achieve Medicaid-sponsored long-term care. He enjoys playing the guitar, spending time with family and social networking.

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Please leave your thoughts and comments

  • ethel cohen

    I an desperate to find a compassionate and helpful place for my husband who is suffering for serious demtia

    • caitlinburm

      Hi Ethel,

      Can we help you? Please feel free to contact Alzheimers.net if you feel that we can be of any assistance in finding a helpful community and home for your husband: (877) 475-3309.

  • Allison

    Hi Ethel , we have just placed our mother in care at mayfield nursing home the staff are absolutely beautiful. Our mother has fits of violence and is very strong for an older lady the staff handle her with respect, safety and compassion. As we all had major reservations in placing her in care and it has been extremely difficult to do, we are now happy (as we can be) in our decision as her health and safety became paramount.

  • Tammi

    Hi everyone, looking for some information in regards to my uncles care. We are dealing with the age of only 59! Advanced dementia, verbally aggressive at times, needs secured premises because he is a wanderer, toilet issues, feeding issues, and of course Medi-cal. Having difficulties with finding a place. Suggestions and positives thoughts would be helpful please. Thank you.

  • daysleaper

    I am trying to find a facility in Northern California that will take private pay, until the loved one becomes eligible for Medicaid. Not enough money to take care of himself for the rest of his life, but too much to eligible for any help from the government. I have learned that I cannot navigate this system by myself. Any help would be appreciated.

    • Susan

      My mother will be eligible financially in 2021 for Medicaid. She is in a memory care facility now. If we bring her to live with us a couple years before her money runs out, will she qualify for Medicaid while living with us in 2021, even though we have money in the bank? Will our money disqualify her from getting it? Or does she need to find a memory care place that accepts Medicaid before her money runs out and stay in it? Is it hard to enroll in a Medicaid facility, when she is eligible, if she isn’t in one now?

      • Sally Parker

        Did you get any kind of response from anywhere?

  • Rita Coats

    My husband is a veteran but not during a war time, so is ineligible for veteran benefits. Alzheimers, dementia, COPD, diabetes plus he is bi-polar and aggressive. Has Medicaid but can’t keep up with the liability. Bill is climbing and threats of discharge. Please help!

  • Cindy LaMontagne

    My husband is 73 with dementia, can be aggressive at times and very verbal abusive. He is on medicaid but I can’t find any place to put him. The only place I’ve found doesn’t do transport to Dr. visits so whenever I take him out he won’t go back. He doesn’t believe there is anything wrong with him., so it would have to be a lock down facility. Please help…

    • Margie Espada

      Hi my name is Margie and my mother is 80 and has dementia, she also is very aggressive and verbal abusive with my dad who is 83. what is the name of the place you found but doesn’t do transport to Dr’s visits? Thank You

  • snowshoe

    do nursing facilities receive more medicaid $$$ by placing regular patients with assisted
    living needs in dementia wards …… is this legal? is the nursing facility trying to
    get more $$$ from medicaid?? This is in a facility in PA

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  • Annie

    I have a 95 year old mother with Alzheimers. She has lived with me for 15 years, 31/2 with alzheimers. I have her on a waiting list for assisted living memory care waiver program as she is on medicaid. The county of Sacramento medi-cal or medicaid does not normally pay for assisted living facilities. The waiver program was started in 2016, then it was discontinued until May 2017. On that date an application was submitted on my mothers behalf. There is no way to find out where she is on the list. I have been trying to get her into a nursing home in the meantime ,but have had no success. Mom mom is not an invalid or sick. She walks on her own including upstairs without a cane or walker. Her only medication is for her thyroid.
    They wont take her because she has sun downers syndrome and sometimes she has hallucinations and will com to my room, as my light is usually on. she does not know day from night so sometimes she will get dressed in the middle of the night. occasionally she will go down stairs turn on the light in the family room and sit for about 5 to 10 min. Then she comes back up to her room. Because that is considered wandering the skilled nursing homes wont take her because they don’t want the other patients disturbed and they are not lock down facilities. My mom has never tried to leave my house. She has macular degeneration so she cant see well. She sees the big picture to walk around but cant read or see things up close. My mom is this little lady about 4′ 8″. She is reclusive and shy. I can’t seem to find an interim facility until her name comes up on the assisted living waiver program. Something needs to be done about all these people that don’t have money and are on medicaid that have dementia & alzheimers. I feel like I don’t have any other options to place her. I have had fibromyalgia for over 25 yrs. I am under a doctors care myself. I’m going to be 70 in 2 months. She is sucking the life out of me. I so need my on life. What do you suggest? In home care is not an option as this will not alleviate my stress. She stays in her room all day. help!!

    • Kuffkitten Cox

      Dear Annie: does she ever go to the hospital for anything? I know here there are social workers to help. What if she does go to the hospital and you told the social worker that you are an able to care for her in a safe environment because of your room medical issues? It would seem that they would have to help find placement if you refuse to take her back home with you. It is unfortunate that in this day and age we still have to make hard decisions like this about our loved ones. I honor your commitment to her for the last 15 years.

  • Mary

    Hello! My name is Mary Serviss and I am reaching out in order to inquire about your potential interest in a research opportunity. I would like to perform a study requiring participation from residents with Alzheimer’s. I have done behavioral research for two years on aquatic animals and now feel I have the tools and experience to begin to tackle a bigger issue.

    I live in Little Egg Harbor, NJ and am currently looking to find a contact that would be able to connect me with a nearby Alzheimer’s facility or nursing home with residents diagnosed with dementia and was wondering if you knew any contact information of administrators I could pitch to. Attached is a project plan outlining my specific methodology and objectives for this study. I am really passionate about this project, finding some way to help those who suffer, and am prepared to put in the work it will take.

    Please let me know if you are interested or able to help me in any way; you can reach me at [email protected].

    https://docs.google.com/document/d/1wCqzm0uFqCeHoZMTD-zIB4h0vKUBzfOBFTd7iU4pv_0/edit?usp=sharing

  • Carolyn

    Carolyn

  • Carolyn

    What Medicaid programs in California assist with paying for memory care facilities?

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