Medicaid can help pay for dementia care, but it doesn’t cover everything. In most cases, Medicaid won’t pay for room and board in memory care or assisted living, though it may cover care services like help with daily activities or skilled nursing. It does fully pay for nursing home care for eligible seniors, including housing and services. Coverage depends on the care setting, your loved one’s needs, and your state’s Medicaid program, so understanding these differences is key.
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Medicaid is a joint program of the federal and state governments that’s designed to support people who have low incomes and certain conditions or disabilities.[01] It can often be used to pay for dementia care services, but it won’t pay for housing, which means families will need to pay for that with the senior’s Social Security benefits, pension, or other personal funds.
“This is why it’s important to locate a memory care facility with room and board fees that are affordable for the senior or their family,” says Melissa O’Connor, an estate lawyer and elder law attorney based in the Miami-Fort Lauderdale area.
For many families, the type of care setting their loved one needs – and what Medicaid will cover in that setting – plays a major role in planning next steps. Medicaid may not cover memory care in every situation. Medicaid plan requirements and benefits vary by state, so coverage may be limited if your loved one doesn’t meet care or financial requirements, or if the type of care they need isn’t covered in that setting. Also, not all senior care communities or care providers accept Medicaid payments.
Yes, Medicaid may pay for in-home memory care services, as well as skilled nursing care and help with activities of daily living (ADLs) for seniors who are still living in their own home.[02]
Medicaid won’t cover room and board in an assisted living facility. Depending on your loved one’s needs, the state they live in, and the program they qualify for, Medicaid may cover some dementia care services in assisted living.
Yes. Medicaid will cover 100% of nursing home costs, including care services, room, and board, for eligible seniors who have dementia.[02]
Whether Medicaid will cover your loved one’s care depends on factors such as their medical needs and financial situation, which are explained in more detail below.
Medicaid covers the cost of long-term services and supports for eligible seniors with dementia in two ways: through the Medicaid nursing home or institutional care program (ICP) or Medicaid Home and Community-Based Services (HCBS) waivers.
Federal requirements ensure that certain aspects of Medicaid state plans are consistent across all states, including coverage for nursing home care.[03] One such program is Medicaid’s Institutional Care Program (ICP), which helps eligible older adults and adults with disabilities pay for long-term care services provided in Medicaid-certified nursing homes. Because Medicaid is an entitlement program, seniors who meet their state’s financial and functional eligibility requirements for ICP and other covered services are entitled to receive those benefits.
Medicaid’s HCBS waivers allow states to “waive certain Medicaid eligibility requirements, covering care for people who might not otherwise be eligible for Medicaid.”[04] States design their waiver programs (within federal guidelines) to expand coverage of and access to certain services for specific groups of people beyond what the state plan permits. Unlike the state plans, most waiver programs aren’t entitlement programs. This means that enrollment is usually limited, so even if your loved one qualifies, they may be put on a waiting list to receive services.
“Wait lists are based on who has the greatest need in the community,” says O’Connor, not first-come, first-serve. Still, it’s worth a senior signing up for a local waiver program sooner rather than later, suggests O’Connor.
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A person must meet both functional and financial requirements to qualify for Medicaid long-term care.[05]
A physician must assess and document an applicant’s need for a certain level of care. Level of care criteria vary from state to state and from program to program, but Medicaid typically considers an applicant’s medical needs and ability to perform ADLs. [06] Cognitive function and the need for supervision for safety reasons may also be factors in determining whether a senior who has dementia qualifies for Medicaid coverage.
Medicaid is a need-based program, meaning that applicants must also have limited financial resources to qualify for coverage. State income and asset limits also vary. When applying for Medicaid, keep in mind that Medicaid has a look-back period of five years. “At the time of application, they’re going to ask you, under penalty of perjury, if you have transferred any assets in the past 60 months,” says O’Connor, adding that this can include sales of assets. “You have to answer honestly, otherwise that is Medicaid fraud,” she says.
For more information on available Medicaid programs and their specific eligibility requirements, contact your state’s Medicaid agency.
Depending on your loved one’s needs, the state they live in, and the program they qualify for, Medicaid can be used to cover long-term care services and supports in various settings, including but not limited to:[02]
The Area Agency on Aging (AAA) in your loved one’s area may provide a list of Medicaid-certified communities and providers of memory care services. You can find their local AAA by using the Administration for Community Living’s Eldercare Locator.
Once you’re in touch with the AAA or another agency, you’ll need to have a clear understanding of your loved one’s care needs and the type of Medicaid coverage have: are they already covered by their state’s regular plan or a waiver program, or is their Medicaid application pending?
Once you have a list of potential communities, talk with or visit them to understand more about how they work with Medicaid.
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If Medicaid isn’t an option, or isn’t an option right now, other ways to pay for memory care include:
If you’re looking for a memory care facility, an assisted living community, or a home care agency, reach out to a Senior Living Advisor at A Place for Mom for tailored advice. Our experts can connect you with local care providers and help you navigate the process of finding the right fit for your loved one. However, please note that A Place for Mom doesn’t refer families who are using public pay options such as Medicaid to pay for senior care services.
Yes, Medicaid approval can take weeks or months, depending on the state.
Yes, a spouse can apply for Medicaid coverage of memory care on their partner’s behalf. However, a married couple’s income and assets are treated differently in Medicaid’s eligibility determination.
If your loved one no longer qualifies for Medicaid while they’re in memory care community, they may need to explore other payment options or move to a different community.
U.S. Centers for Medicare and Medicaid Services. Medicaid.
U.S. Centers for Medicare and Medicaid Services. (2017, August). Medicare and Medicaid benefits for people with dementia.
U.S. Centers for Medicare and Medicaid Services. Institutional long-term care.
U.S. Centers for Medicare and Medicaid Services. Home & community-based services 1915(i).
U.S. Centers for Medicare and Medicaid Services. Medicaid eligibility.
Medicare Interactive. (2025, March 31) Types of Medicaid for people with Medicare.
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