It is important to understand the difference between institutional Medicaid and Home and Community Based Services. Institutional Medicaid is provided in nursing homes. Home and Community Based Services, as implied by the name, are Medicaid services provided to individuals living at home or “in the community”. The phrase “in the community” includes assisted living residences or assisted living specifically designed for persons with dementia called “Memory Care”.
Institutional / nursing home Medicaid is an entitlement in all 50 US states, meaning should the individual be eligible for Medicaid, the state must pay for their nursing home care. Medicaid services at home or in memory care residences in most states is not an entitlement, meaning a person can be eligible for the program but may be placed on a wait list for services. Wait lists in some states can be several years long.
For most persons with Alzheimer’s or dementia, normal assisted living communities cannot provide adequate support. Instead, these communities have “memory care” (often a secured floor) or there are standalone memory care residences such as Evergreen Cottages. In almost every state Medicaid will pay from some care in assisted living / memory care residences. However, an important distinction must be made. 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. Medicaid can pay for their cost of care in those residences. This is a service that you must apply for.
Medicare is different.
Unfortunately, Medicare provides limited assistance for the costs incurred by families for Alzheimer’s and dementia care. Medicare’s benefits are strictly for medical needs and so much of providing care to individuals with Alzheimer’s or dementia is non-medical in nature. Supervision, assistance with dressing, bathing or eating, transportation are all time-consuming activities but are non-medical in nature and therefore Medicare does not provide coverage or financial assistance. To be clear, in-home care and memory care (assisted living) are not paid for by Medicare.
Medicare Supplemental Insurance policies, as a rule, do not offer areas of coverage that Medicare does not cover. Instead, Medicare Supplemental Insurance simply helps with co-payments. Therefore, unfortunately, these policies offer little additional assistance over Medicare.
Having said that, Medicare does provide help with diagnostic procedures, prescriptions and some assistance as these conditions progress and needs become more severe. Read a complete analysis of Medicare’s dementia benefits to learn about what is covered.
At Evergreen Cottages we are a private pay community. What that means for you is that we do not accept Medicaid, however we do make sure your medicare insurance is used in all approved medical areas, such as Physician visits, pharmacy charges, Podiatry, etc.
We work closely with all medical professionals to be sure that your insurance covers the services that are being provided by them. If for whatever reason your insurance does not cover that service we will work to determine what the cost is for you.
Private pay communities like Evergreen Cottages accept payments from many sources including your own savings, your social security benefits, veterans aid and attendance benefits, and family contributions. Medicare and Medicaid do not pay for room and board at private pay assisted living memory care communities.
Vanessa Trautwein RN is the operations manager at Evergreen Cottages Assisted Living specializing in care for people with Alzheimer's, Memory issues and other related Dementia. For advice and more information, Contact here here:https://www.evergreencottages.com/contact