Does your state actually cover memory care through Medicaid?
The answer depends entirely on where you live, which type of Medicaid program you're asking about, and what "cover" means. If you're asking whether Medicaid pays for a private room in a memory care facility with all meals included, the answer is no in every state. If you're asking whether Medicaid might help pay for some of the care services your parent receives while living in memory care, the answer might be yes, depending on your state's specific programs.
This distinction confuses almost everyone who starts researching Medicaid coverage for memory care. The programs exist. The coverage is real. But what Medicaid actually pays for versus what families assume it covers creates a gap that's difficult to navigate without understanding how these programs work state by state.
What Medicaid Actually Covers in Memory Care (as of 2025)
Medicaid approaches memory care coverage through two distinct pathways, and neither covers room and board costs in residential memory care facilities.
Institutional Medicaid (Nursing Home Medicaid) pays 100% of nursing home costs, including room, board, and all care services, for eligible individuals in all states and Washington, D.C. If your parent needs memory care in a nursing home setting rather than an assisted living or dedicated memory care facility, Medicaid will cover the full cost in facilities certified to accept Medicaid. This coverage is an entitlement, meaning all eligible applicants are guaranteed coverage without waiting lists.
Home and Community-Based Services (HCBS) waivers, authorized under Section 1915(c) of the Social Security Act, allow states to provide long-term care services outside of nursing homes. These waivers can cover personal care assistance, skilled nursing, medication management, specialized memory care programming, adult day care, respite care, and other support services delivered in assisted living facilities, memory care facilities, or at home. What HCBS waivers explicitly do not cover is room and board costs in residential settings.
Some states also offer coverage through Aged, Blind, and Disabled (ABD) Medicaid, which is state plan Medicaid that can include long-term care benefits. Like HCBS waivers, ABD Medicaid covers services but not residential costs.
The practical reality is that if your parent lives in memory care and qualifies for Medicaid waiver services, Medicaid might pay $1,500 to $3,000 per month for care services while your family pays $3,000 to $5,000 per month for room and board. Total memory care costs typically range from $4,500 to $8,000+ monthly depending on location and level of care needed.
Eligibility Requirements (2025 Guidelines)
Medicaid long-term care eligibility requires meeting financial criteria and demonstrating medical necessity. Requirements vary by state and by which Medicaid program you're applying for.
Financial Eligibility for HCBS Waivers
In most states as of 2025, HCBS waiver applicants must meet an income limit of $2,901 per month for an individual. This limit, set at 300% of the Federal Benefit Rate, applies in the majority of states but significant exceptions exist. California's individual income limit for its Assisted Living Waiver is $1,732 per month (as of April 2024, subject to annual adjustment). New York's income limit is $1,800 per month. Income limits for married couples where both spouses are applying typically double, reaching $5,802 per month in most states.
When only one spouse needs memory care, special protections exist. The applicant spouse faces the individual income limit ($2,901 in most states), but the non-applicant spouse's income is not counted. The applicant spouse may transfer income to the community spouse to prevent financial hardship, up to $3,853.50 per month in 2024 (this Monthly Maintenance Needs Allowance adjusts annually).
Asset limits for HCBS waivers are $2,000 for an individual in most states. For married couples with both spouses applying, the combined limit is typically $3,000. When only one spouse applies, the applicant spouse faces the $2,000 limit while the community spouse can retain up to $157,920 (2025 figure) through the Community Spouse Resource Allowance.
State exceptions to these standard limits are significant. California has no asset limit for Medicaid long-term care programs (though this changes January 1, 2026, when limits of $130,000 for individuals and $195,000 for couples will be implemented). Illinois allows $17,500 in assets for individuals. Florida's asset limit is $5,000. New York permits $32,396 in assets.
Financial Eligibility for ABD Medicaid
ABD Medicaid programs typically have more restrictive income limits than HCBS waivers. Individual income limits for ABD Medicaid in 2025 range from $967 per month to $1,795 per month depending on the state. Married couple income limits range from $1,450 to $2,658 per month combined. Asset limits are usually $2,000 for individuals and $3,000 for married couples, though state variations apply.
Functional Eligibility
Beyond financial requirements, applicants must demonstrate they need nursing facility level of care (NFLOC). This means requiring the type of constant supervision and assistance with activities of daily living typically provided in nursing homes. Functional assessments are performed by healthcare professionals working with state Medicaid programs. Assessments typically evaluate ability to bathe, dress, eat, toilet, transfer, and manage medications. Some states require applicants to need assistance with a specific number of these activities. Others use broader criteria considering cognitive impairment and safety risks.
Some states accept "at risk of" needing nursing facility level of care rather than requiring current need for institutional care. The specific functional criteria vary by state and sometimes by which waiver program you're applying for within a state.
Exempt Assets
Certain assets don't count toward Medicaid limits. Primary vehicles, personal belongings, household furniture and appliances, and clothes are typically exempt. A primary home is exempt in many cases, though rules about home equity limits vary by state. In most states, home equity up to $730,000 or $1,097,000 doesn't affect eligibility. Retirement accounts and life insurance policies have complex rules that vary by state.
State-by-State Variations in Coverage (2025)
This is where things break down. Medicaid is a joint federal-state program, meaning while federal guidelines exist, each state designs and operates its own programs. The variations are extensive and affect whether memory care services are available in your state, how much coverage exists, and how long you might wait for benefits.
States with Dedicated Memory Care or Dementia Waivers
Several states operate HCBS waivers specifically designed for individuals with Alzheimer's disease or dementia, though most states include memory care services within broader elderly or disability waivers.
California operates the Assisted Living Waiver (ALW) program that covers residents in licensed Residential Care Facilities for the Elderly, including memory care units. Income limits are lower than most states ($1,732 monthly for individuals as of April 2024). California has no asset limit currently but has reinstated limits as of January 1, 2026. The waiver has extensive waiting lists, with some areas showing multi-year waits.
Florida offers coverage through several programs including the Assisted Living for the Elderly waiver. Florida's ABD Medicaid asset limit is $5,000, higher than most states. The state has made significant investments in HCBS services but waiting lists exist for waiver programs.
Texas provides coverage through the STAR+PLUS Waiver, which had approximately 24,000 enrollment slots as of 2025. Texas calls assisted living facilities "Personal Care Facilities." The program is not an entitlement, so waiting lists apply once slots fill. Texas Medicaid for the Elderly and People with Disabilities (MEPD) provides another pathway but with more limited long-term care coverage.
New York offers coverage through its Assisted Living Program (ALP) and various HCBS waivers. New York's asset limit is significantly higher than most states at $32,396 for individuals. Income limits are lower at $1,800 per month. New York has invested heavily in home and community-based services as alternatives to institutional care.
States with Extensive Waiting Lists
Some states maintain particularly long waiting lists for HCBS waiver services, affecting when coverage becomes available even for eligible applicants.
Maryland's Community Options Waiver had 24,015 people on its waiting list (called a Service Registry) as of January 31, 2025. The state invites approximately 700 people per month to apply, suggesting multi-year waits for community residents. Maryland prioritizes applications from individuals currently in nursing homes.
Oregon allows individuals to join waiting lists before full eligibility screening occurs. Waiting times vary by county and can extend multiple years in high-demand areas.
Georgia, North Carolina, and Tennessee also maintain substantial waiting lists for elderly waiver programs. Wait times fluctuate based on state budget allocations and the number of people leaving programs.
States with No Waiting Lists or Shorter Waits
Some states have structured their programs to minimize or eliminate waiting lists, though this doesn't guarantee immediate coverage.
Minnesota manages its waiver programs to generally avoid extensive waiting lists, though regional variations occur.
Wisconsin offers several waiver options including IRIS (Include, Respect, I Self-Direct) with generally manageable waiting times depending on county.
States with Multiple Waiver Options
Many states operate multiple HCBS waivers targeting different populations or offering different service arrays.
Arizona operates the Arizona Long Term Care System (ALTCS) with various waiver options for different eligible populations.
Colorado runs the Elderly, Blind, and Disabled (EBD) Waiver alongside other programs.
Illinois operates Supportive Living Facilities as an alternative model, with asset limits of $17,500 (significantly higher than most states).
Ohio offers several waiver programs with varying eligibility requirements and covered services.
Pennsylvania operates Community HealthChoices and LIFE (Living Independence for the Elderly) programs that can cover memory care services.
Michigan uses the term "Home for the Aged" for what other states call assisted living and offers waiver coverage through various programs.
States Where Room and Board Coverage Varies
While no state covers full room and board costs through waivers, some states provide supplemental payments that effectively offset a portion of residential costs.
North Carolina offers State-County Special Assistance payments that can help with room and board costs in assisted living facilities for eligible individuals. These payments supplement rather than replace Medicaid waiver services.
Missouri operates the Supplemental Nursing Care program alongside its Aged and Disabled Waiver.
Connecticut provides a Personal Care Assistance supplement through its Connecticut Home Care Program for Elders (CHCPE).
States with Recent Program Changes
Medicaid programs change frequently. Recent modifications affecting memory care coverage include:
North Carolina expanded Medicaid in December 2023, affecting overall program enrollment though not specifically changing memory care waiver rules.
South Dakota expanded Medicaid in 2023.
Oklahoma implemented Medicaid expansion in 2021 and continues refining its waiver programs.
Mississippi updated its Assisted Living Waiver regulations with changes taking effect June 1, 2025.
States That Haven't Expanded Medicaid
Ten states had not expanded Medicaid under the Affordable Care Act as of 2025: Alabama, Florida, Georgia, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming. This affects coverage for working-age adults but doesn't directly change elderly waiver program availability. However, it reflects state approaches to Medicaid funding that can influence waiver program generosity and waiting list lengths.
Program Names Vary by State
States use different terminology for similar programs, complicating research. California's "Residential Care Facilities for the Elderly," Colorado's "Alternative Care Facilities," Illinois's "Supportive Living Facilities," Michigan's "Homes for the Aged," and Texas's "Personal Care Facilities" all refer to settings other states call assisted living or memory care.
Key Point for All States
Even in states with generous programs, not all memory care facilities accept Medicaid waiver participants. Facilities must be certified as Medicaid providers and must choose to accept Medicaid payment rates, which are typically lower than private-pay rates. Some facilities accept a limited number of Medicaid participants. Others don't accept Medicaid at all. Eligibility for Medicaid doesn't guarantee you'll find an available memory care placement that accepts Medicaid in your preferred location.
How to Find Current Information for Your State
Given how frequently Medicaid programs change and how specific rules are to individual states, families must verify current information through authoritative state sources rather than relying on general guidance.
Contact your state's Medicaid office directly. Most states operate dedicated long-term care divisions or aging services departments that can explain current programs. State names for Medicaid vary: California uses "Medi-Cal," while Maryland calls it "Medical Assistance."
State Medicaid websites provide program details, eligibility criteria, and application instructions. Search for "[your state] Medicaid HCBS waivers" or "[your state] Medicaid long-term care."
Certified Medicaid Planners specialize in helping families navigate eligibility requirements, particularly when income or assets exceed limits. These professionals can employ legal planning strategies to help individuals qualify.
How Spend-Down Works
In practice, this is where things break down for many families. The spend-down requirement means individuals with income or assets above Medicaid limits must reduce those resources to become eligible.
For assets, spend-down involves legally reducing countable resources to meet the $2,000 limit (in most states). Acceptable spend-down methods include paying off debt, making necessary home repairs, purchasing exempt assets like a more reliable vehicle, prepaying funeral expenses, or working with Medicaid planners to establish certain trusts. What's prohibited is simply giving assets away. Medicaid's look-back period (60 months in most states) examines transfers made within the past five years. Improper transfers create penalty periods during which applicants are ineligible for coverage.
For income, individuals whose monthly income exceeds limits but is still insufficient to pay for care may qualify through Qualified Income Trusts (also called Miller Trusts) or through Medically Needy pathways where medical expenses effectively reduce countable income. The specific strategies available depend on whether your state is an "income cap" state or a "medically needy" state.
The emotional and practical difficulty of spend-down surprises many families. Parents who worked their entire lives to accumulate savings face having to deliberately deplete those resources to qualify for help. The process requires careful legal and financial planning to avoid mistakes that could result in periods of ineligibility.
Application Process Overview
Applying for Medicaid memory care coverage involves multiple steps and typically takes several months to complete.
First, contact your state Medicaid office to determine which programs might apply to your situation. States operate different pathways (HCBS waivers, ABD Medicaid, nursing home Medicaid), and you need to know which to pursue. Some states require you to apply for Medicaid itself before applying for specific waiver programs. Others allow concurrent applications.
Gather required documentation. Standard requirements include proof of identity, Social Security cards, birth certificates, proof of citizenship or legal residency, bank statements covering the past several months (often 60 months for long-term care), documentation of income including Social Security statements and pension information, asset documentation including property deeds and vehicle titles, and insurance policies. States also require medical documentation demonstrating need for nursing facility level of care.
Complete functional assessments. A healthcare professional working with the state Medicaid program will evaluate your parent's care needs. This assessment determines whether they meet the medical necessity criteria for coverage.
If applying for HCBS waiver services, understand that even after approval for Medicaid, you may face waiting lists before waiver services begin. Some states prioritize individuals currently in nursing homes over community residents. Others operate strict chronological waiting lists.
Working with professionals experienced in Medicaid applications can accelerate the process and reduce errors that delay approval. Elder law attorneys, certified Medicaid planners, and social workers who specialize in long-term care placement often assist families through these applications.
What Happens After Approval
Once approved for Medicaid memory care coverage, understanding what you're actually receiving matters for planning and budgeting.
For waiver services in memory care facilities, Medicaid typically pays the facility directly for covered services. Your family remains responsible for room and board costs. The facility will bill separately for Medicaid-covered services and non-covered residential costs.
HCBS waiver participants can typically keep their income (up to the allowable limit) to pay for living expenses including room and board. This differs from nursing home Medicaid, where recipients must contribute nearly all income except a small personal needs allowance (ranging from $30 to $200 monthly depending on state) toward their care costs.
Coverage continues as long as your parent remains eligible. States conduct periodic redeterminations (typically annually) to verify continued financial and medical eligibility. Changes in income, assets, or care needs must be reported and may affect ongoing eligibility.
The Bottom Line on Medicaid and Memory Care
Medicaid can help pay for memory care services, but coverage is partial, complex, and varies dramatically by state. No state pays room and board costs in memory care facilities through waiver programs. The care services Medicaid covers—personal assistance, skilled nursing, medication management, specialized programming—can significantly reduce overall costs, but substantial private payment obligations typically remain.
Whether Medicaid represents a viable option for your family depends on your state's specific programs, whether you can meet financial and functional eligibility criteria, whether acceptable memory care facilities in your area accept Medicaid, and how long waiting lists are in your state.
The most important next step is contacting your state's Medicaid office directly to determine current programs, eligibility requirements, and application procedures. This article provides general education about how these programs work, but only your state can tell you exactly what's available where you live right now.