Medicaid Covered Home and Community Based Care for Individuals with Dementia

by | Sep 6, 2022 | Medicaid, Long-Term Care | 0 comments

husband with dementia wife caregiverDementia is a loss of cognitive functioning, whether it be thinking, remembering, or reasoning.  It is not a specific disease, but a group of conditions characterized by impairment to an individual’s brain functions.  When an individual’s dementia becomes so severe that it interferers with daily functioning, he or she will typically need assistance to compensate for his or her loss of ability to manage his or her daily life.

Fortunately, Indiana has many Medicaid covered home and community based alternatives to institutionalization for individuals who need assistance because of dementia.  Under Indiana’s Aged and Disabled Medicaid Waiver, an individual can obtain financial help for home care, assisted living care, adult day care, and adult family care among other services.

To meet the medical criteria for the Aged and Disabled Waiver, an individual must need “nursing facility level of care.”  This determination is made by an individual’s local Area Agency on Aging (AAA).

The statutory definition of “nursing facility level of care” requires the person have one of the following:

  • An unstable, complex medical condition, which requires direct assistance from others for the following conditions: decubitus ulcers, comatose condition, or management of severe pain
  • Need for direct assistance from others for medical equipment, such as ventilator, suctioning, tube feeding, central intravenous access (I.V.)
  • Need for direct assistance for special routines or prescribed treatments from others, such as tracheotomy, acute rehabilitation conditions, administration of continuous oxygen
  • Need for medical observation and physician assessment due to a changing, unstable physical condition
  • Other substantial medical conditions.

Dementia typically falls in the “other substantial medical conditions” category.  When discussing an individual’s condition with the AAA, it is important to highlight how the individual’s dementia interferes with his or her daily life. Most individuals will require 24 hour supervision for their safety.  However, the dementia may just as likely affect their daily physical functioning.  For example, just because the individual has the physical ability to dress, bathe, or eat does not mean that they do not need assistance with these functions.  Often individual’s with dementia will need someone to cue them to complete these tasks.

Of course the medical determination is just step one of a two-step process to obtain Medicaid assistance for home care.  An individual must also meet Medicaid’s financial criteria. It is important to note that an individual need not be completely impoverished to qualify.  He or she will need a legal plan, though, to fit within Medicaid financial eligibility rules.  If you need assistance in protecting assets and obtaining Medicaid covered home and community based long term care services for a loved one, contact us at www.stinsonlawfirm.com or at 317-622-8181 to schedule an appointment.