Medicaid, What Does It Cover?

MedicaidWhat is Medicaid?


Medicaid is a joint federal and state program that helps with medical costs for some people with limited income and resources. Medicaid also offers benefits not normally covered by Medicare, like nursing home care and personal care services.

The Health Insurance Association of America describes Medicaid as a “government insurance program for persons of all ages whose income and resources are insufficient to pay for health care”. Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 74 million low-income and disabled people (23% of Americans) as of 2017.

If you have limited assets and a low income and you need help paying for assisted living care, Medicaid might help you pay for your care.

Every state must pay for nursing facilities for Medicaid recipients, and they must pay for home health care services for recipients who would qualify for assisted living care.

Assisted living is considered long-term care and consists of not just medical services, but also personal services, for people who have a disability or illness. As an example, a resident in assisted living might pay for assistance with bathing and dressing in addition to medical treatment. Medicaid rules for long-term care are significantly different in many ways than their rules for other services.

Not all senior living communities will accept Medicaid. Please check with your community to make sure they accept Medicaid patients. Those communities must be licensed by the state and subject to periodic inspections to ensure that the facility meets federal standards.

Before Medicaid will pay for a senior living community, it must be proven “medically necessary” for the patient. States have different rules that determine when long-term care is medically necessary, but all states require that your doctor certify that you need to be in a nursing facility for it to be covered by Medicaid.

Make sure you check with your doctor as well your specific state requirements to see if you physically qualify for Medicaid.

Does Medicaid Cover Dementia Care?

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. Some of those include:

  • Memory Care – Memory Care is a specialized facility that is designed around the specific needs of patients with dementia and Alzheimer’s. Those patients can expect to participate in social activities, physical therapy, and medical services. Medicaid offers plans to help cover Memory Care.
  • Senior Living Communities – 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. Medicaid will cover senior living care for dementia patients.
  • Adult Day Care Programs – Programs 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. These programs are often times paid by Medicaid. Please check with your state and the facility,
  • In-Home Care – This type of 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.

Medicaid can ease the financial burden by offering different options for your loved one. Look at what your state will specifically cover and talk to your loved ones doctor.