Does Medicaid Cover Dementia Care [Get The Facts]

Do you or a loved one have a diminished capacity to remember, think, or make decisions, which interfere with daily activities? If you answered yes, you may qualify for dementia care.

Is this costly medical help, however, covered by Medicaid?

This issue, like the disease, is difficult to answer because Medicaid covers the elderly yet each state has the authority to control Medicaid coverage. 

So, for the best answer and, more importantly, the best strategy to use your benefits, continue reading to learn more.

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What is Medicaid?

Before we explain Medicaid and dementia care, let’s go over some of the keywords that will help you better comprehend the program.

Medicaid is a broad government assistance program for low-income individuals and families that require medical care. Because it is largely financed by states, each one has the authority to manage the Medicaid budget as they see proper. This might be extremely perplexing for new beneficiaries who are unsure of what this insurance covers.

There are two Medicaid programs, each of which is significant for dementia care:

  1. Institutional Medicaid

This type of Medicaid coverage is available to nursing home patients. Room and board, as well as medical treatments, may be covered.

Remember that not all nursing facilities take Medicaid, and even if they do, there are only a limited number of beds available for those patients. 

For further information, you should contact your Medicaid agent.

  1. HCBS Medicaid

Home and Community-Based Services (HCBS) Medicaid allows patients to stay in their homes for as long as feasible. If home help is not an option, adult daycare or foster care are the next best options.

Both Medicaid systems often provide some form of assistance to demented patients, although there are notable variances. So, stay tuned to learn more.

Does Medicaid Cover Dementia Care?

Yes, Medicaid covers dementia care in the majority of states.

There are several options for dementia care, depending on the patient’s condition and location, as well as a few other criteria. 

Because this is not a single disease, but rather a catch-all word encompassing disorders in which the patient has difficulties with memory, judgment, and everyday chores.

The most frequent kind of dementia is Alzheimer’s disease. 

Though dementia mostly affects older persons, it is not a natural component of the aging process. However, because Medicaid covers people of all ages, you should expect to be covered for the majority of dementia care-related expenditures.

Dementia is a progressive disease, thus it is important to remember that it is treated and covered differently depending on the stage of the condition.

Early stages of dementia

Patients who have just been diagnosed may still perform most daily duties and do not require continual care at first.

This is why, in most cases, Medicaid will cover:

  • In-Home Care – In-home care is one of the most effective treatments for people who are just starting to show signs of dementia. They can be treated in the comfort of their own homes, with regular visits from medical personnel who can assist with everyday duties and check the patient’s status.
  • Adult Day Care Programs – If a family home is not sufficient for daily care, institutions that function as adult day care programs are available. This is an excellent opportunity to avoid nursing homes while obtaining the finest possible care for the demented condition.

If you are unsure about what is covered in your state, contact Medicaid help for additional information.

Later stages of dementia

Once dementia has set in, people typically do not get better. Most of the time, they require greater assistance with everyday duties, which are frequently carried out in some form of facility.

  • Continuing Care Retirement Communities – CCRC’s are for those who can still live independently but whose condition is deteriorating. 

While Medicaid will not pay the expense of these communities, it is critical to secure a space there before the sickness worsens. In this manner, the institution will be conditioned to take Medicaid funds in the future.

  • Adult Family Homes – Smaller adult family homes are another fantastic option for people with dementia. This is not covered by Medicaid, but it can be a fantastic method to offer excellent care for your loved ones.
  • Nursing Home Facilities – When dementia patients can no longer live without 24-hour care, the best place to go is a nursing home. In most places, Medicaid will pay for this, and the staff will assist patients with every activity and medicine.

How much does dementia care cost?

Dementia, as a general term for a variety of memory-loss illnesses, is not inexpensive to diagnose, treat, or manage. This is one of the reasons why so many people are concerned about the overall cost and whether Medicaid would pay it.

The average lifetime treatment cost is roughly $350,000, or $4,500 per month for basic care.

This is a significant sum for many low-income families, and it is heartening that Medicaid is willing to cover the expenditures.

How to get Medicaid to cover dementia care costs?

One of the biggest difficulties with dementia is that people with it typically don’t have enough clear judgment to appraise a situation, thus family members must make all of the decisions.

This is why, as soon as you receive a diagnosis, you should establish a power of attorney or seek court permission.

This will help with all of the documentation that will be required in the future for appropriate treatment and convergence by Medicaid.

Final Thoughts

Dementia and other associated disorders may be extremely difficult for both the sufferer and his or her family. This is why one of the most essential things you can do for your loved ones is to provide them with good care.

Fortunately, Medicaid provides a variety of programs that can assist patients and families in need and cover the majority of the costs associated with dementia care.

David Duford
Author: David Duford