How Medicaid and Medicare Address Behavioral and Mental Health in Dementia
When it comes to addressing behavioral and mental health in dementia, both Medicaid and Medicare play significant roles, though they cover different aspects of care.
Medicare primarily focuses on medical services related to dementia. It covers outpatient mental health services, including therapy sessions, though it only pays for 80% of the approved amount. Additionally, Medicare fully covers a yearly depression screening, which is crucial for individuals with dementia who often experience depression. Recently, Medicare has also started covering certain medications for Alzheimer’s disease, such as Leqembi and Kisunla, which target amyloid beta proteins in the brain. However, these medications are only covered for early stages of the disease and require participation in a centralized registry.
On the other hand, Medicaid provides more comprehensive coverage for long-term care needs, which are often critical for individuals with dementia. Medicaid covers services like personal care assistance, which includes help with daily activities such as bathing and dressing. This can be provided in the home or in certain care facilities. Medicaid also covers nursing facility services, which include memory care, though the specifics can vary by state. Some states offer additional benefits through Home and Community-Based Services (HCBS) waivers, allowing individuals to receive care in their own homes or in assisted living facilities.
One of the most beneficial aspects of Medicaid for dementia care is its ability to support family caregivers. In many states, Medicaid programs allow family members to be paid for providing care, which can be a significant relief for those who are already shouldering the emotional and financial burdens of caregiving.
While Medicare and Medicaid have their limitations, they both contribute to addressing the complex needs of individuals with dementia. For those who are dually eligible—meaning they qualify for both Medicare and Medicaid—these programs can work together to provide a more comprehensive level of care. However, navigating these systems can be complex, and it’s often helpful to consult with a professional to ensure that all available benefits are being utilized.
