While trying to get the best care for your loved one with cognitive impairment, moving them to a memory care community might be the best option as it gives them access to amenities that help them in managing their condition and live a good quality life. However, this also could be financially draining as it requires a level of financial demand to cover the cost, hence the need to source funds through financial aid programs like Medicaid to cover the memory care cost.
Now, the question is, does Medicaid cover memory care? In general, Medicaid does cover memory care in Texas, but the specifics of coverage can vary depending on the individual’s specific circumstances. Here is a guide to give you insight into how to take advantage of Medicaid to cover the cost of memory care for your loved one.
Medicaid Categories
Medicaid in Texas is broken down into two main categories: traditional Medicaid and Medicaid Waiver programs.
- Traditional Medicaid
Traditional Medicaid coverage is available to individuals who meet certain financial and medical eligibility requirements. In general, to qualify for traditional Medicaid in Texas, individuals must have an income below a certain level and must meet other specific criteria, such as being over the age of 65, pregnant, or disabled. For those who qualify, traditional Medicaid will cover a wide range of memory care services, including inpatient and outpatient care, as well as skilled nursing care and home health care services.
- Medicaid Waiver Programs
The Medicaid Waiver programs provide additional options for individuals who require memory care. These programs are specifically designed for individuals who need a higher level of care than traditional Medicaid can provide. The programs provide services such as in-home care, case management and personal care services, and community-based services. Medicaid Waiver programs are designed to help people stay in their own homes and communities, rather than having to move to a nursing home.
Medicaid Eligibility Criteria
In Texas, the specific criteria to be eligible for Medicaid coverage of memory care can vary depending on whether the individual is applying for traditional Medicaid or a Medicaid Waiver program. However, generally speaking, the following criteria may be used to determine eligibility for Medicaid coverage of memory care:
- Income
To qualify for Medicaid, individuals must have an income below a certain level. The specific income limits can vary depending on the program and the individual’s circumstances.
- Residency
Eligible individuals must be a resident of Texas and be a citizen of the United States or qualified non-citizens.
- Age
For traditional Medicaid, the individual must be over the age of 65, while Medicaid Waiver programs could have different age requirements.
- Disability
Individuals must have a specific disability such as dementia or Alzheimer’s disease which renders them in need of memory care services.
- Homebound Status
Some Medicaid Waiver programs will require individuals to be considered homebound, meaning that leaving home is unsafe due to medical conditions.
- Asset Limits
Medicaid has asset limits in place and certain assets such as personal property, real property, cash, and investments may be considered when determining eligibility.
- Medical Necessity
The individual must have a medical need for memory care services, as determined by a licensed medical professional.
- Waiver Programs
Some Medicaid Waiver programs may have additional criteria that must be met, such as functional limitations, care needs, and care level requirements.
- Prior Institutionalization
Some Medicaid Waiver programs may require an individual to have been institutionalized in the past to be eligible for coverage.
- Income Cap
Some Medicaid Waiver programs may have a cap on how much income you can receive and still qualify for coverage.
