Why is it so hard to find a memory care facility that accepts Medicaid?

It's a no-brainer. Medicaid pays less than private pay!!

Medicaid does not pay much. In a for-profit economy, IMO, that is the big issue.

Im in the same boat with my dad. Just yesterday I learned to contact our local Alzheimer's Association, as I was told they have free placement assistance to help find memory care facilities that are straight Medicaid. Hope this helps.

Angeleyes you made this assertion:

"Great Britain no longer covers sedation for a colonoscopy"

and I happened to know that the assertion is not true. A patient who will not accept a colonoscopy without the assurance that they can be given sedation will be provided with it.

Reluctance to undergo colonoscopy at all is indeed an important problem, which the American paper I quoted does recognise. However, spreading a false belief that a person may be forced or tricked into undergoing the procedure without sedation is hardly going to help.

Interesting how viciously people attack someone they don't even know and make assumptions about my experience and/or knowledge, etc. Even some interesting assumptions about economics on here. All I'll say is the type of healthcare some people seem to want is not as simple to make happen as they think. "The rich" - the hated rich apparently (including your insurance companies) will never pay for anyone to get free or really low-cost anything. (Farmers don't grow you free food do they?)
Don't get me wrong - I'm not in love with insurance companies denying coverage if they think they can get away with it - it is not a perfect system, and I've been on the receiving end myself. I have fought many a battle over coverage & care for my elderly father and my medically handicapped son - and myself.
The only thing the rich will give are jobs and often benefits. Instead of hating them, if you want it comfy - emulate them! Or just smile when they have a $17 million wedding for their daughter because all that money is going to the people doing the jobs - flowers, dresses, hotel workers, caterers, hairdressers, coordinators, photographers, jewelers, etc. - there is nothing unfair about this. Everyone's lives are effected by the choices they make - rich, poor - a great deal of your own outcome is up to you.
Someone cried "immoral" - what's immoral is thinking you deserve the fruits of someone else's labor. Or begrudging entrepreneurs their massive fortunes because they took the risk. Very few people, especially businesses/owners want to work hard and take huge risks to give someone else ridiculous amounts of the money they earn in say, taxes. Leaves little incentive for them to continue their pursuits, which may include developing equipment for diagnosing or treating disease - or scads of other beneficial things for society. Besides - the government wanting a monopoly on healthcare is a terrifying idea - they have enough power over our daily lives and can't seem to fix the simplest problems!
One thing I think it's important to address is countrymouse's reply. Dear, I HAVE had a colonoscopy without sedation, and I do not recommend it! The worst thing that will come of this is not the pain of the procedure (it was excruciating). It is the people who will die from colon cancer, ulcerative colitis, etc. Most people must be dragged by someone who loves them to get a colonoscopy WITH sedation. Many, many simply will not go if sedation is not part of the deal. And about pain telling you something is 'wrong' during your procedure - I've had a colonoscopy exam stopped while under sedation because my doctor knew he was in dangerous territory, so he stopped. And I'm not alone in this. Doctors in the US are well-compensated, so the best doctors stay in the US. Good doctors come here too - to make money. We have many good doctors from Canada - I know a few, esp surgeons. They came to practice medicine AND make money. That's one reason why we have good doctors.
Our healthcare system isn't perfect, but don't blame immorality, the rich, or the boogyman.
I know someone in this thread was saying they would not hide their parents assets, they would use these funds to pay for their care until the funds are depleted, then possibly go on Medicaid. That's integrity!
And I must apologize if I didn't 'reply' in the proper order. I rarely post on this forum. Now I remember why.

Check with your local Dept of Social Services or Office for the Aging. I volunteer at our local OFA and found out quite by accident that a much nicer facility than I had Mom in that Medicaid had an agreement with for lower cost rent. So I was able to move her to the nicer ALF and pay the same rent that she was paying. Most Medicaid offices know the ALF that have agreements with them for lower cost rent. Check it out early as there is often a waiting list to get into these places. The place I moved Mom to only had 4 Medicaid beds available. My mother is on what is known as a Medicaid Spend Down and must pay the amount of her income that is above the Medicaid allowed amount to the ALF in addition to the agreed Medicaid amount. It also qualifies her for free Part D drug insurance with low copays and Medicaid insurance to go with her Medicare coverage. Check with her current ALF as to how the paperwork is filled out as to who is responsible for payment. You don't want to be stuck with that expense.

Depends on how/who signed all the paperwork. If you are a real guardian (court appointed) absolutely not. If you signed her in without any POA, etc they could potentially consider you responsible. Also beware that some states have filial laws,, which they *could* potentially use, if you are a child of the person.

It would be best to find an alternate location before the money runs out. No place of business wants to eat the cost of someone who cannot pay, for whatever reason. IF you can get her Medicaid approved, and move her to the first place that has an open spot, you can always look into moving her again if you find a better/closer place (yes moving sucks on many levels, but you don't need some collection agency hassling you, which they would likely do even if you have no financial responsibility - your name is associated with her!)

Your LO will have to apply for Medicaid and if she qualifies, she is allowed to own $2K of countable assets to move into an NH. You are not financially responsible for her care.

I have the same issue with my mom. There are “Nursing Homes” which also include care for patients with Alzheimers / Dementia. Which may be your only option. However, in Texas, I have yet to find a Memory Care facility that accepts Medicare/Medicaid. I guess as long as they have patients who will pay full price (out of pocket), they don’t need to accept insurance. Sorry

Hardly an answer, but I'll be facing this soon w my 98-year-old mother. She came to live with me in Florida. Anyone deal with this in Florida? I haven't applied for Medicare because she's been so healthy, but I see it coming. She has very little money. Thanks

California has a new program called ALWP, Assisted Living Waiver Program. It is designed to get people out of Nursing Homes because they cant afford assisted living, into Assisted Living (if they qualify). Its too long to explain, but it may be the answer to your problem. Please respond to me directly if you think this may be something you are interested in.
There may be similar plans in other States, but I am in California so wouldn't know.

The bottom line is money. With all this free healthcare it's going to get harder and harder to find places. The facilites only get a very small amount compared to what they are suppose to get...I can hardly blame them. Money doesn't grow on trees and it's going to get bad. If she or you has money; admit her private pay and when that runs out they will do the medicaid thing. Remember; facilities are ony required to accept just so many medicaid clients. Save the legislation stuff. It's the politicians who are in control and they're to busy ripping our president apart to care.

My question would be if your LO has Medicaid why is she in a privately owned facility to begin with. Nursing homes accept Medicaid. It won't be as nice I'm sure

Key issue imho is your state legislature, gonna be a long rant....
Last millennium, MediCARE & Medicaid went into law. Medicare was totally federal for support & availability to almost all the US population over age 65. As it’s federal, it’s portable, so Medicare works whether your at home or fall & go to ER while @Disney with grandkids. As long as provider takes MediCARE, coverage assured in US.
We pay into Medicare via FICA while working or from SS once retired.

- Medicaid was federal “dedicated funding” for “at need” (both medically & financially) for specific health programs with joint state funding alongside federal $. Medicaid programs are term limited, like CHIP for kids or WMH for pregnancy & relatively routine care & w/controlled costs; & a lot fall into preventive services which feds pay a higher % of.
Included in Medicaid was funding for skilled nursing care in a facility with the states paying a required % share of those costs as determined by their populations demographics. Basically means federal & state $$ assured to pay for care in a LTC facility that is a NH as that’s “skilled”. Medicaid LTC covers all ages who need skilled LTC in a facility.
BUT
- medicaid as it’s a joint program, has it set up so guidelines are under a overall federal umbrella but administered uniquely by each state. So each state can determine what criteria is for financial “at need” but based on federal poverty guidelines; and state determines what they will pay for daily room & board, & some states pay very little, like under $150 a day; and state is who reviews application to see if the applicant is medically “at need” based on chart or an on-site in person evaluation; for couples, state determines what degree of $ the community spouse can have; state determines how MERP can happen.

AND more importantly
- state decides if they want to divert or “waive” federal $ from NH to instead go to others like AL, or MC or community based program, like PACE.
Most states don’t see any need to deal with waivers at all as they have to have their own management & waivers are NOT permanent $. You gotta go every 3,5,7 years to get $ for your waiver program to be renewed or approved by state legislature. You gotta show cost benefit, yada yada.... Waivers are a bother as $ can just go into well established NH system. & NH have long existing lobbyists as for ages it was only NH in the aging care game.

For states that do waivers, the impermanence & uncertainty are a reason why a lot of facilities flat will not have waiver set aside beds. If you can fill your place with private pay, it’s not worth dealing with waivers.

Other states, like AZ, are more realistic about incoming tsunami of over 65 needing care & have heavily shifted to AL & community program waivers.

Right now, feds are encouraging (by add $) waivers to be done but to go for PACE. So elders stay at home but picked up by PACE staffed handicapped van then go to PAcE center 2-4 days wk w/all medical care being done at center or participating hospital group. For those more infirm, weekend caregiver visit(s) done. But they stay at home & family or private pay caregivers hired fill in as needed. If you have PACE, your elder may need to be evaluated for it before they can go into a NH or apply for another waiver, like AL or MC. We have one nearby (Benson Center) & it’s got a waiting list as super popular; it’s administration provider is Catholic Charities health care system & they do 4 PACE statewide.

Really it’s up to your legislature to do waivers.
Get politically active, find legislators who understand aging issues & support them.

As others have said, get mom “at need” medically for a NH. There’s gonna be a Medicaid bed in a NH somewhere. It might be a good idea to have your mom become the patient in private practice of the MD who is also a medical director of a NH or two. They will know what needs to be in her chart. Good luck.

Nursing homes can be 100% private pay, if that is how they have been established; they are not required to accept Medicaid.

Homes where most of the patients are Medicaid-only patients tend to be grossly understaffed and have a shortage of supplies, such as bed linens. That's because they operate on a shoestring budget and there is no money for "extras."

You'll need to find a nursing home that accepts Medicaid. Even some of those will limit the percentage of Medicaid-only patients that they accept, so that they can stay afloat financially.

The bottom line is that Medicaid does not reimburse enough in medical costs to make it worthwhile financially for places to accept it. For example, many physicians had to stop accepting Medicaid patients in their private practice, because the rate of reimbursement was so low that they could not even pay their office staff and utilities. For example, on a $100 office visit, Medicaid might only pay $31, and a follow-up visit for the same problem might only reimburse $11. So, Medicare-only patients cause medical practices to lose money.

Go talk to the social workers at the facility where she is and ask these questions. It is very likely they can give you the names of other facilities she can move to. Unfortunately, the name of the game is money. They can make more money from private pay so if they can keep beds full with priv pay patients, there is no real push for them to open up Medicaid beds.

What state? I have dealt with this very issue and won in 3 states.

Congress has legislated an adequate program in Medicaid, but it is thwarted by industry greed.

I have found a new respect for our Congress.

Medicaid requirements are very fair but rigorous, is why facilities will not accept.

A facility that will not accept Medicaid does so because they are not capable of guaranteeing the required, 'needed' level of care, long term, That tells me that they would not guarantee the needed care for private pay either.

Medicaid says of itself that it is intended to be equal to private pay.

Bottom line is the 'now dollar' in the cost of care.
I was facility engineer for an 80 bed skilled facility in the 1970's.
Daily, I saw the compassion for people with various needs.
I had much admiration for the workers and management until a corporation took over.

We opted to keep my wife home and Medicaid is very supportive.
This state happens to be one of the best in administration.

Each state has their own medicaid rules. Nothing is standard. Here in Orange County, CA, property values/taxes are VERY high so it's very expensive to own/operate a medicaid/Cal Optima facility/home. AND even though a home might "accept medicaid" (or a waiver), most often they fill their beds with private pay...for the obvious! $$$$$$$$$$$

If your mom has some money left, you should look for a nursing home that accepts Medicaid now and get her admitted private pay. After her money runs out, she'll get a Medicaid bed.

Be completely transparent about your plan. They will help you with it and take on the arduous task of applying for Medicaid.

Ganita, it would help if we knew what state you are in. Regardless, have you considered a small group home setting? We live in Tucson and they are all over the place. They may say AL, but many will take residents with dementia as MC is a type of AL.
Check with your state regarding options. In AZ, there is a website that lists facilities under the Health Department that evaluates them ever year.
Good luck!

It's not that they WON'T accept Medicaid, in most states they can't.

It's crazy because skilled nursing (aka a Nursing Home) is the most expensive care there is and the vast majority of people living with dementia don't need it. But, until the laws change, that's the way it is. Some states have waiver programs that can provide for AL (which is the licensing that memory care usually falls under), but, to my knowledge, most don't.

Once your Mom's assets are 'spent down', she will be eligible for long term care through Medicaid. Never sign anything that makes you personally responsible for your mom's expenses.

Hi! I am not sure where you live but I would look to see if you have any supportive living facilities in your area.
What is supportive living for seniors?
What Supportive Living is much like assisted living, most Supportive Living communities are designed for seniors (those age 65 and over*) who are no longer able to live on their own safely, but do not require the high level of care provided in a nursing home.
I live in Illinois and we have a handful. They often have waiting lists but are more likely to get in if you pay cash until you spend down and the can transition on to PA.
Good luck!

Medicaid doesn't pay for memory care, as you found out. Even though it's probably way too much care, a nursing home/long term care facility is where you will need to place your mother to get Medicaid assistance. This is one of the "holes" in elder care -- Medicaid rules need to change to include coverage in lesser-care (and less-expensive) facilities! My mother is in a nursing home, but there are folks there that (it seems) should be in an assisted living facility. I'm sure they are there because this is the only place Medicaid will pay for them. So nursing home beds are taken by people who should otherwise be in AS/MC. Sitting down with a Medicaid attorney and also an organization that assists with Medicaid applications was very enlightening for me.

The system is so broken and there are no advocates in government to change this -- if anything, for many politicians Medicaid is a system that needs to end. Can you imagine what would happen if Medicaid weren't available to the elderly?? We need to vote according to our family's needs.

I am using a service called carepatrol.com. He, Rick, is doing the legwork to find a place that fits my mother's needs and finances. There is also the My Choice Waiver. But I'm still learning about that and dont want to provide inaccurate information.

Does Mom have any money left? Depending where you live a LTC will cost at least 10k a month. I replied to one of the posts that Mom paid 2 months privately, this took her down under the cap allowed. Medicaid allowed me 90 days to get Mom spent down, provide paperwork and get her in a facility. Yes, it is overwhelming but can be done.

Try your local Office of Aging and see if they can help u thru the process. You can talk to a Medicaid case worker.

MC where I live is tied to Assisted Livings which are private pay. Some will take Medicaid but only after u have paid for at least 2 yrs. And they haven't the % of medicaid residents. The others have not met medicaid accreditation for what ever reason. You may have to have Mom placed in a LTC facility with Medicaid paying for her care.

Genita, may I ask a few questions? When she initially was admitted to this private facility did you sign to be financially responsible for her? Also, did you realize at that time that she only had funds to cover a certain amount of time? What has the private care facility told you as far as what they plan to do with her once the money runs out?

Hopefully you can find a nursing home that they can transfer her to that takes Medicaid. Maybe the private facility can help with that. You can spend the remaining amount of her money there and then they will help you get her on Medicaid. If you are somehow financially responsible to the private facility based on what you signed upon her admittance you should get her out now. If only she is responsible, I would assume the facility will start looking for places to send her, make sure you don't feel the need to pay her bill out of your money. Also make it clear you don't have a safe place for her. They will likely send her to the hospital but that's OK, the hospital is efficient at finding placement.

What I plan to do with my mother who currently resides in private pay memory care is this: apply for Medicaid about 6 months BEFORE her money runs out and get her into a skilled nursing facility (at that time) that takes Medicaid. I'll private pay her money down while awaiting approval. That way, she'll already be in the facility (they always accept private pay) and when Medicaid comes thru, we're all set. We are not responsible for paying their monthly fees for care, but if we don't do our due diligence, we may wind up taking them into our homes! That thought keeps me awake at night because there is NO WAY I can handle my 92 year old mother's issues at home......she can barely take a shower without falling and that's with caregivers helping her!

As far as getting your mom into the hospital goes, YOU can have the facility call an ambulance for her if you think (or they think) she's having a health issue that requires more attention. Ie: pneumonia or a UTI infection, vertigo or extreme dizziness, etc. She can be sent to the ER for evaluation at which time a social worker gets assigned to her case. You then tell the SW that you CANNOT, under ANY circumstances, take mother to live with you and she needs placement in a Skilled Nursing Facility (SNF). The social worker can help you find placement and apply for Medicaid as well. You may also want to consult with an Elder Care Attorney now and he can help you cover your options.
This is a VERY stressful situation, I know, as the only child of a 92 yo mother with tons of issues and running out of money herself. Rarely a day goes by where I don't worry about her future as well as my own. The elder care crisis we face in this country is REAL, and it's scary as hell. Modern medicine wants to keep us alive for a century or more with no plan in place for how to care for us with dementia and 14 other age related health issues. And our "golden years" are getting ruined with all the worrying and stress that goes along with managing THEIR lives and finances. A real mess, isn't It?
Best of luck

Have started the Medicaid process for the second time. DSS has informed me that my mother must be moved into a Medicaid-approved facility as well as monies spent down before she is approved!

Genita, sorry you are having trouble finding a Memory Care that takes Medicaid. It is my understanding that Nursing Homes will take Medicaid, if they have a bed opened. There might be a waiting list.

The reason why it is so hard to find a Medicaid open bed has to do with cost. An Assisted Living/Memory Care needs to make a certain amount of money to keep afloat and they can do that if the residents are mainly self-paid.

Some States will offer a waiver where the State pays a certain percentage, and the patient pays the rest, thus they can get into Assisted Living/Memory Care.

Otherwise, you will need to check your local nursing homes as they are more apt to accept Medicaid. There will be a mix of residents who are self-pay, and those who use Medicaid to pay for their room/board and care.