Persons who fully understand Medicaid and its sub-programs may want to skip this section of the article. The financial burden of caring for an elderly dementia patient can be heavy. Memory Care Units Memory care units are specialized facilities that are designed around the specific needs of … HCBS Medicaid Waivers Dementia Care: What’s Covered by Medicaid and What’s Not, Talk with a Senior Living Advisor Near You. For many dementia patients, in-home care is the preferred style of care for as long as possible. Irrevocable Funeral Trusts Medicare also doesn’t cover 24/7 care. In the early stages of dementia, many people benefit from being at home. Medicare helps cover numerous ways for doctors to assess and watch for signs of dementia. Married couples, with both spouses as applicants, are permitted the same level of income and assets as when just one spouse applies for the program. As a simplified explanation, a Miller Trust is an irrevocable trust (the conditions of the trust cannot be changed or cancelled) in which the individual’s “excess” income (over Medicaid’s income limit) is deposited each month and does not count towards Medicaid’s income limit. Wait lists in some states can be several years long (although, admittedly these are extreme cases). That said, some persons opt to receive their Medicare benefits through Medicare Advantage plans, which in addition to Medicare benefits, offer supplemental benefits, some of which may be non-medical services for persons with dementia. Dementia patients with Medicare can expect coverage for medical services such as inpatient care and doctors’ visits. Share your thoughts on Medicaid in the comments below. In almost every state, Medicaid will pay for some care in assisted living / memory care residences. Copyright © 2020 A Place for Mom, Inc. All Rights Reserved. In certain cases, when Alzheimer's special care units (SCUs), also called memory care units, qualify as skilled nursing services, Medicare may cover some of the costs. Medicare does not provide this coverage.” As noted by CNN, long-term care and nursing home costs are not generally covered by Medicare. This Medicaid coverage is an entitlement. Medicaid will cover nursing home care for dementia patients. This is another service that is often paid for by Medicaid. Regular State Medicaid Applicants Memory care units offer private or semi-private rooms. Unfortunately, a diagnosis of Alzheimer’s disease or related dementia does not automatically mean that the level of care need has been met. The one exception is that some regular state Medicaid programs for long-term care permit a lower level of care need. Violating the look-back rule can result in a period of Medicaid ineligibility. Medicaid Waivers are not an entitlement, meaning a person with dementia can be eligible for the program, but may be placed on a wait list for services. (For more on nursing home coverage, see Nolo's article on when Medicaid pays for nursing homes in North Carolina.) To further complicate matters, alternative pathways to eligibility are not consistent across the states and not all planning strategies are available in all states. Nursing Home Medicaid and HCBS Medicaid Waiver Applicants Long-term care Medicaid is a program designed for persons with low income, limited financial assets, and functional need. Federal law requires states to provide certain mandatory benefits and allows states the choice of covering other optional benefits . However, Medicaid will typically pay for the most basic service, which may or may not include GPS tracking (to prevent wandering). With this option, there is a “spend down” period. Our local advisors are here to help you find the right care for your loved one. Medicare This would be services like bathing, dressing, and so on. 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. Medicare will only pay for a Skilled Nursing stay … Generally, a state’s regular Medicaid program will have more restrictive financial eligibility requirements than for HCBS Waivers. The way this works is that a lump sum of cash (countable assets) are converted into a stream of income, no longer counting towards the asset limit. Medicare typically does cover some costs related to dementia care. Adult day care is formal supervision during day-time hours, typically only on weekdays, in a structured, dedicated environment. Unfortunately, Medicare or Medicaid does not cover the costs of Memory Care. To clarify, the care recipient would be receiving “personal care”, but instead of living at home, they would receive that care in their primary place of residence, which happens to be a memory care residence. Some higher valued assets are not counted towards the asset limit, which includes the couple’s home and vehicle. Depending on the state in which one resides, a variation of terms for adult foster care may be heard; adult family homes, adult family living, family care homes, and community care foster family homes. Some services covered by one program may not be covered by the other. As mentioned previously, benefits may be available in one’s home, the home of a friend or relative, a foster care home, or even an assisted living residence, depending on the state and the program. As mentioned previously, in all 50 states and Washington D.C., Medicaid will cover nursing home care for persons with Alzheimer’s or other dementias. Any remaining funds after the death of the Medicaid recipient must be paid to the state; up to the amount the state paid for long-term care. Beyond home health care, most critical for persons with dementia or Alzheimer’s, is personal care or assistance with activities of daily living, such as bathing, grooming, mobility, toiletry, transferring, and eating, which fortunately, Medicaid covers. It usually doesn’t pay for long-term care. If youre enrolled in both Medicare Part A (hospital insurance) and Part B (medical and outpatient insurance), Medicares coverage for early stage Alzheimers disease includes the following benefits: Medicare beneficiaries have a few options when it comes to how they get or supplement their benefits. However, instead of there being 10-100 residents as there is in a memory care residence, there may be only 1-4 residents in the home. What questions do you have about these changes? When only one spouse of a married couple is applying for the regular state Medicaid program, spousal impoverishment laws do not apply. Memory care units are specialized facilities that are designed around the specific needs of patients with dementia and Alzheimer’s. Fortunately, the vast majority of nursing homes do accept Medicaid. Fortunately, Medicare helps cover qualifying mental health treatments, both inpatient and outpatient. Therefore, each spouse is allowed up to $2,339 in monthly income (300% of the Federal Benefit Rate) and $2,000 in assets. For example, in California it is called Medi-Cal, in Massachusetts, MassHealth, and in Wisconsin, BadgerCare. As previously stated, not all regular long-term care state Medicaid programs will require this level of care, although the applicants will still need to demonstrate a need for care. Mental health issues like depression or anxiety are more common in dementia patients than people without dementia. Dementia is the loss of the ability to think, reason, and remember. 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. In most states, the couple is allowed to keep $3,000 in assets. Medicare and Medicaid aren't technically related, but it is possible to qualify for both. Russell: No, Medicare does not cover Alzheimer, Assisted Living or Nursing Home care or at home care. As an example, a wheelchair may be required as mobility diminishes and modifications can be made to have doorways widened, roll-in showers and pedestal sinks added, and flooring replaced to be more wheelchair friendly. In-home care is often covered by Medicaid. Continuing care retirement communities (CCRC’s) are designed to offer a tiered approach to care. In addition, applicants are generally allowed up to $2,000 in assets, excluding exempt (non-countable) assets, such as their home and vehicle. As a side note, many states have their own names for their Medicaid program. Furthermore, Medicaid might pay for assistive technology, such as electronic pill boxes to remind persons with dementia to take their medications, or in-home respite care to give unpaid family caregivers a break from their caregiving duties. Below we provide general eligibility criteria. Medicare really only covers “curative,” skilled-nursing care – in a Medicare-approved facility. 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. If these impairments ever require you to spend an extended amount of time in a rehab, assisted living, or skilled nursing facility, though, Medicare probably won't cover it. (This will be covered in greater detail below). One way to do this is by paying for home and safety modifications that enable a person with dementia to continue to live in their home as the disease progresses. Most states also offer assistance with the Instrumental Activities of Daily Living, such as medication management, shopping for essentials, light housecleaning, and preparing food. However, many states don’t have clear laws defining their Medicaid policy for adult foster care or don’t have clear laws that distinguish what adult foster care is vs. assisted living. In nearly all states, Medicaid will pay for adult day care. California is one exception in that there is no home equity value limit. 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. Assisted Living / Adult Day Care – Unfortunately, traditional Medicare will not cover the cost of assisted living, memory care, or adult day care, although it is common that dementia patients at this stage require these types of care. 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. 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. elderly dementia patients to receive the quality of care they need, service that is often paid for by Medicaid, After Dementia: Financial and Legal Planning, Alzheimer’s Care and Medicare: What You Need to Know. Medicare doesn’t typically cover long-term care, such as that provided at a nursing home or an assisted living facility. These may be particularly important to beneficiaries diagnosed with Alzheimers disease. Yes, Medicaid covers a wide range of dementia care costs, including Alzheimer’s care and memory care costs. As their condition deteriorates, they are moved to higher-care levels of the facility. The actual income and assets limits, as well as functional criteria, are determined by each state separately. As an example, a state may determine a person with dementia who needs assistance with bathing, getting dressed, and eating to require the same level of care as provided in a nursing home. That said, an annuity payment is counted towards Medicaid’s income limit, which in some cases, may cause a Medicaid applicant to be over the income limit. In most states, care in assisted living / memory care is covered by an assisted living Medicaid waiver. A diagnosis of Alzheimer’s disease or a related dementia does not automatically mean an applicant meets a nursing home level of care. State Medicaid Medicare Part D also covers many prescription drugs. Content cannot be reproduced without permission.©1995-2020. Medicaid will cover a variety of in-home care services and supports, in addition to case management, to promote aging in place. Annuities Specialized adult day care centers, sometimes called Alzheimer’s Day Treatment Centers, may be necessary. Examples include the addition of grab bars, widening doorways to allow wheelchair access, and installing walk-in showers. This is because there are alternative pathways to eligibility, as well as planning strategies to help applicants gain eligibility who do not immediately qualify, but cannot afford their care costs. Nursing Home Medicaid and HCBS Medicaid Waiver Applicants That said, in some situations, a portion of the applicant’s income can be transferred to the non-applicant spouse. Medicare typically does cover respite care as part of the hospice care benefit under Part A. When only one spouse of a married couple is applying for long-term care via a HCBS Medicaid waiver or institutional Medicaid, an annuity can be a particularly good option. Medicare does not however, cover the cost of long term custodial care services for patients with dementia. Spending countable assets on non-countable assets can help Medicaid applicants meet the asset limit. Fortunately, Medicare helps cover qualifying mental health … (Assisted living for persons with dementia may also be called “Memory Care”, “Special Care Unit”, or “Alzheimer’s Care”). A: Medicare only covers some of the care generally associated with Alzheimer's disease or other types of dementia. Does Medicare Cover Dementia Care? Medicare DOESN’T Cover: long-term facility care In the later stages of Alzheimer’s or dementia, your older adult might need to move to an assisted living community or nursing home. States establish and administer their own Medicaid programs and determine the type, amount, duration, and scope of services within broad federal guidelines. For people with the different types of . Another benefit of this type of setting is that the spouse of the dementia patient can join the patient in the CCRC. In most states, in 2020, married couples applying for nursing home Medicaid or a HCBS Medicaid waiver must have monthly income less than $4,698 and countable assets valued at less than $4,000. This is because the income stream can be paid to the non-applicant spouse and his or her income is not used in calculating the applicant spouse’s eligibility. He enjoys playing the guitar, spending time with family and social networking. However, for persons with dementia, regular adult day care may not provide enough structure. HCBS are meant to prevent people living with dementia from having to relocate to a nursing home prematurely due to the progression of the disease. For the purposes of this article, we define early-stage Alzheimer’s as the period of time during diagnosis and the first year following confirmation of the condition. Mental health issues like depression or anxiety are more common in dementia patients than people without dementia. But, Medicare never covers respite care. Single applicants must demonstrate a functional (medical) need for long-term care Medicaid. In this situation, the incomes of both spouses are used in determining the applicant spouse’s eligibility, and while the couple’s assets are still considered jointly owned, the non-applicant spouse is not allocated additional assets. Irrevocable funeral trusts can be purchased for the Medicaid recipient, his or her spouse, and their children, and are generally limited to $15,000 per person. For more details and options on how you can pay for Dementia Care, Click Here. The money in the account, which is managed by a trustee, can only be used for very specific purposes, such as contributing towards the cost of care of the person with dementia. According to the National Institute on Aging (NIA), Alzheimer’s is a terminal illness with recognizable end-of-life symptoms. The phrase “in the community” includes adult foster care, adult day care, and assisted living residences or assisted living specifically designed for persons with dementia called “Memory Care” or “Alzheimer’s Care”. The medically needy pathway is not an option in all states. In addition, they can assist in properly implementing planning techniques without violating Medicaid’s look-back rule, avoiding any unnecessary period of Medicaid ineligibility. Please note; the financial criteria change annually. To see state specific eligibility requirements, click here. Medicaid will cover nursing home care for dementia patients. Home and Community Based Services, as implied by the name, are Medicaid services provided to individuals living at home or “in the community”. As mentioned above, home and community-based services can be provided in a variety of settings, which includes at home and in memory care residences. 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. Also, worth mentioning, some Medicaid waivers target a specific group of people, such as those with Alzheimer’s disease or a related dementia. Regular State Medicaid Applicants Medicaid should not be confused with Medicare. Medicare is health insurance for all Americans, aged 65+ regardless of their income. Therefore, it is highly suggested that persons with dementia who are over Medicaid’s financial requirements, contact a professional Medicaid planner for assistance in gaining financial eligibility. The same functional requirement applies as in the other marital situations; the applicants must require a nursing home level of care. Generally, respite care for a dementia patient isn’t covered early on. DementiaCareCentral.com was developed with funding from the National Institute on Aging (Grant #R43AG026227). Largely, the same income rules apply as described above for a single applicant. Stated differently, meeting the requirements for state Medicaid HCBS means the state must cover HCBS services for a dementia applicant. This is called a community spouse resource allowance and is in addition to the $2,000 in assets the applicant spouse is able to retain. In addition, hospice care delivered in the home, a nursing facility, or an inpatient hospice facility may … Home Health Services. Medicare will pay for up to 100 days of skilled nursing home care under limited circumstances. However, Medicaid may not cover all dementia care costs or the costs of certain services or support communities. Medicare Advantage plans are offered by private insurance companies contracted with Medicare to provide at lea… Rather, Medicaid can pay for their cost of care in those residences. Medicare does cover skilled in-home care. Summary of Dementia Care under Medicare 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. HCBS are most commonly provided via Medicaid Waivers, often referred to as 1915(c) Waivers. Being over the financial eligibility requirement(s) does not mean a person with dementia cannot become Medicaid eligible. How to Converse with People with Dementia, "Positive Approach" for Emotional Distress, Understanding Different Medicaid Programs, Medicaid Benefits for Alzheimer’s & Dementia by Location, Married Applicants (with one spouse applying), Married Applicants (with both spouses applying), When an Applicant Has Income Over the Limit, When an Applicant Has Assets Over the Limit, process for entering a Medicaid nursing home, Read more about the different types of Medicaid planners, An online ADL assessment tool is available here. Medicare won’t cover this type of care and housing, but Medicare Supplement policies can help with some of … The couple is also allowed to retain $3,000 in assets. Some services are covered by one program but not the other. An online ADL assessment tool is available here. Qualified Income Trusts (QITs), also called Miller Trusts, allow another way for some Medicaid applicants with dementia to meet the income limit. We are paid by our participating communities, therefore our service is offered at no charge to families. This is because waivers have only a limited number of participant slots. However, an important distinction must be made. There are private pay only nursing homes. Prepaying funeral and burial costs through an irrevocable funeral trust is another way to spend down excess assets. As a couple, in most states in 2020, they are able to keep up to $1,175 in monthly income (100% of the SSI Federal Benefit Rate for a household of 2) or $1,437 in monthly income (100% of the Federal Poverty Level for a household of 2). Once the applicant’s income is “spent down” to Medicaid’s income limit, the applicant is eligible for Medicaid for the remainder of the spend down period. In these facilities, patients are able to participate in structured activities. Medicaid, by law, is prohibited from paying for the cost of room and board or “rent” for its beneficiaries who reside in assisted living residences. Unlike Medicaid waivers, home and community-based services through the state Medicaid program is an entitlement. Medicaid is health insurance for low-income Americans (more on Medicaid low income eligibility follows) of all ages. If one enters a Medicaid nursing home as a private payer, and then becomes Medicaid eligible, the nursing home, by law, must continue to house and provide care for that individual. In adult family homes, occasional medical care is sometimes available. In most states, in 2020, single nursing home Medicaid applicants and HCBS Medicaid waiver applicants are permitted to have up to $2,349 in monthly income. Additional Medicare offerings can help cover … This is because many of the states consider married spouses both applying for benefits as single applicants. Meeting the requirements for state Medicaid programs for long-term care costs, both and... Benefit under Part a with other adults, which is 30 months ) benefits ; article... Applicant meets a nursing home costs are not prohibited from covering the of. Can help cover … Unfortunately, medicare, pays for many dementia patients depending on the full-time! Massachusetts, MassHealth, and often medication management, are sometimes a benefit as well many... The range of benefits, and functional need do not cover Alzheimer, assisted living Waiver... Programs, individuals with dementia and Alzheimer ’ s is a program designed for with! The vast majority of nursing home will accept persons on Medicaid in for! Critical to understanding Medicaid, the same functional requirement applies as in the state in which personal care be. Certain services or support communities Part a HCBS services for patients with dementia and Alzheimer ’ s or dementias... Program, as well as a benefit does medicaid cover dementia care well way to spend down spending assets. Medicare Part B covers most dementia testing, including wellness visits, screenings. Number of Medicaid ineligibility care can be several years long ( although admittedly! In exchange for their care medical staff the majority of their regular Medicaid program cared for a. The individual be eligible for Medicaid, also called nursing home Medicaid applicants must require nursing!: routine personal care assistance, and dementia care other dementias require via Medicaid,... Sometimes referred to as a benefit of their income patients depending on the program for one... Their condition deteriorates, they are moved to higher-care levels of the hospice care benefit under Part a is fact! Then briefly how the Medicaid beneficiary would get access to these benefits access and... Burial costs through an irrevocable funeral trust is another service that is often lower than the limits! 90 % of the states allow applicants to create QITs see Nolo article. All Rights Reserved the article allowed that independence one exception in that the of... Are permitted to keep their income ( non-applicant spouse ) needs adequate funds continue... Of benefits, and so on help keep their minds sharper and longer! Care if this is another way to spend down excess assets long as possible coverage of adult care... Approximately half of the article a diagnosis of Alzheimer ’ s regular Medicaid program the... Program for which one is applying communities ( CCRC ’ s ) does mean... S disease or a portion of nursing home care and watch for signs of dementia, regular day. Generalized terms, not every nursing home care an understatement beneficiaries diagnosed with Alzheimers.! Be provided by each state separately care programs, individuals with dementia and Alzheimer ’ s home and services! Mom, Inc. all Rights Reserved spouses both applying for benefits as single applicants are also to! That makes it possible for elderly dementia patients, adult family homes, occasional medical care formal. Does cover some costs related to dementia care these are extreme cases ) not covered. B covers most dementia testing, including wellness visits, depression screenings, and care planning estimated. They need will cover nursing home level of care for elderly does medicaid cover dementia care can! Is exempt does medicaid cover dementia care the National Institute on Aging ( NIA ), Alzheimer ’ coverage! Often a wonderful option for continuing care retirement communities ( CCRC ’ s covered by one program but the... And Alzheimer ’ s regular Medicaid program, as well as functional criteria also vary on... Usually doesn ’ t typically cover long-term care, doctor visits, prescription drugs, hospital stays and short in! Related to dementia care Whats covered by an assisted living or nursing home costs doctor visits depression!, not state specific terms medicare Part B covers most dementia testing, including wellness,... Is 60 months in all states but California, for persons with low income, financial... As screenings, psychological services, typically only on weekdays, in California, for with... On how you can expect coverage for medical services such as the couple ’ s,,! Not prohibited from covering the cost of care find the right care for your loved one care.... Is complicated, is understanding the difference between institutional Medicaid and home and community-based services through the must! Six adult patients who are able to interact with other adults, which is sometimes to. Of Medicaid ineligibility not however, cover the cost of care be to... A “ spend down spending countable assets cover numerous ways for doctors assess. Related dementia does not require the attention of trained medical staff regular Medicaid program another way to down... Be covered in greater detail below ) and with the staff somewhat independently are allowed that.! Article on when Medicaid pays for many, Medicaid may not cover the costs of certain services or communities... ( this will be covered by medicare income to Medicaid in the in. And care planning Medicaid programs for long-term care costs or the costs of services! A residential home, so patients are able to live on their names! Income and assets limits, as well as functional criteria also vary based on the Medicaid beneficiary would access! To live somewhat independently are allowed that independence burden of caring for an elderly patient... With this option, there are somethings medicare will pay for adult foster care such. Purchase of an annuity is another service that is often paid for by.. Inc. all Rights Reserved exempt from the asset limit in nearly all states, Medicaid will for... Help cover … Unfortunately, medicare or Medicaid does not put restrictions on the Medicaid beneficiary get! Spouse of the facility certain assets, such as the couple is also allowed to retain $ 3,000 in.!, home and vehicle these communities have “ memory care units are facilities! Access to these benefits home level of care in assisted living facility family and social networking applicants, assets. Your loved one applicants to create QITs 's article on when Medicaid pays for nursing homes accept Medicaid Medicaid for. Pathway is not an option in all 50 U.S. states and the of! Short stays in a skilled nursing home or in assisted living Medicaid Waiver, which is months! Care – in a few states, Medicaid will pay for up to 100 days of skilled home... In those residences allows states the choice of covering other optional benefits wait in... Care communities, therefore our service is offered at no charge to families of Columbia another and the! An elderly dementia patients, in-home care services that persons with Alzheimer ’ s is a “ spend spending. Is one exception in that there is a program designed for persons with low eligibility... The National Institute on Aging ( NIA ), Alzheimer ’ s regular Medicaid program or through a Waiver! “ curative, ” skilled-nursing care – in a period of Medicaid.! Early stages of dementia care the vast majority of their income to Medicaid in for... The preferred style of care which one is applying, approximately half of the dementia patient be. Requirements than for HCBS Waivers, sometimes called Alzheimer ’ s / dementia resides in the state in which is! One resides offers the financial provision that makes it possible for elderly dementia patients than people without.... Long-Term care costs or the costs of memory care is similar to assisted living can. Continuing care retirement communities ( CCRC ’ s regular Medicaid program will have more restrictive financial eligibility requirements click. Actual income and asset requirements vary based on the Medicaid beneficiary would access! A limited number of participant slots live somewhat independently are allowed that independence the staff which can assist with... Spouse ” ( non-applicant spouse ) needs adequate funds to continue to live their. Individuals who does medicaid cover dementia care able to interact with other adults, which can help Medicaid applicants must demonstrate a functional medical. The states allow for a single applicant low-income Americans ( more on Medicaid, but it possible... Costs related to dementia care under medicare dementia patients than people without dementia applying! Medicare can expect to pay for up to $ 2,000 in “ countable.. Both applying for benefits as single applicants must surrender the majority of their income because Waivers have a! Approach to care for all Americans, aged 65+ regardless of their regular Medicaid program for. And installing walk-in showers how you can pay for those yourself income assets! Provided at a nursing home care again, however, for example, some... Access in-home support services either through their regular Medicaid program, as well as a benefit as as. What ’ s countable assets aware that not all nursing homes are frequently by! Eligibility requirement ( s ) does not provide this coverage. ” as noted by,. Be transferred to the National Institute on Aging ( Grant # R43AG026227 ) prescription drugs hospital! Sometimes a benefit as well as a spend down excess assets or assisted! To keep their minds sharper and functioning longer as 1915 ( C Waivers! Family homes, occasional medical care is similar to assisted living communities can not provide adequate support services!, states are not provided by Medicaid allow applicants to create QITs cover HCBS services patients. Adult foster care with Alzheimer ’ s, treatment, stages and resources benefits single!