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My father has Alzheimer’s and we working to get him into a memory care facility for long term care. We have been told he will more than likely qualify for Medicaid. However we are mixed signals as to how to get the process started. Do get a Medicaid waiver or are we looking for Medicaid in nursing home. What is the difference?

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What - to me - you need to clearly find out is IF this facility is run as an AL with a locked & monitored MC unit under a waiver OR is it is a full on Skilled Nursing facility with locked ward for residents who require this under State LTC Medicaid program.

What a waiver does is shift $ that is dedicated funding under Federal law to go instead to fund another program for same demographic. (Fwiw Federal budget has all sorts of waivers not just health care stuff.)

Under Medicare initial public laws, $ dedicated only for SNF aka a NH. Waivers - as they are not dedicated - require submission to CMS as to why, how, cost benefit, on a time frame, etc for approval. Renewal not guaranteed. Some States flat do not want to deal with waivers at all, some do for teeny tiny % of beds in nonSNF and importantly State can get the waiver to use the $ to go to programs with wider service of population use rather than 1-on-1 waiver, which AL would be. So bc of all this, even in States with a AL or MC waiver, some AL MC have zero interest in participating as more oversight + reporting and if the waiver stops they are stuck with an impoverished resident that the States will not pay a penny for.
So to encourage participation, States can allow for AL to do a private pay waiting list. This is the 2 yr system that JoAnn refers to for her State of NJ. For my State -LA- it has AL waivers but are being phased out with payment for those currently in one but no new ones as $ shifting to PACE whenever possible. For my moms tiered (IL 2 NH) facility in TX, the limited # of waiver beds in AL used exclusively by longtime residents as placeholder beds for the NH, like those in the AL waiver bed were 100% ready for SNF and just soon as someone died in the NH they moved over to the NH.

You need to ask clearly as to precisely how this facility runs its system and then determine if it can work financially. Hopefully they allow a waiver from Day 1 of entry. If not, I’d suggest that you try to do whatever to get dad’s health chart beefed up to show he is definitely “at need” for skilled nursing care, so he can have placement in a NH.
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Reply to igloo572
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This is a question for a Medicaid caseworker. Members have mentioned getting Medicaid vouchers so a LO can go to Assisted Living or Memory care but not sure if all States do that. Medicaid paying means a Long-term facility. In my State you have to pay privately for two years in an AL or MC before you can use Medicaid and thats only if the AL/MC except it and if they do, have not reached their quota.
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Reply to JoAnn29
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cover9339 Jul 14, 2024
I didn't think Medicaid paid for AL
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"Medicaid Waiver programs help provide services to people who would otherwise be in an institution, nursing home, or hospital to receive long-term care in the community. Prior to 1991, the Federal Medicaid program paid for services only if a person lived in an institution."

So it may cover a portion of in-home care.

Source: https://en.wikipedia.org/wiki/Medicaid_waiver

FYI Medicaid rules and coverage may vary by state.
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Reply to Geaton777
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