Yes. State budget pressure is likely to lengthen waits for Medicaid-covered memory care and related community supports. Demand remains high while states have less room to add funded openings.
Memory care means residential or community care for people with dementia. Much of the Medicaid help for that care comes through home and community-based services, called HCBS. These programs often use waitlists when funded openings run out.
Medical information disclaimer: This article is for general educational purposes only and does not provide medical advice, diagnosis, or treatment. Always consult a physician or other qualified health professional about symptoms, medications, tests, or treatment decisions.
Table of Contents
- Why state budgets are tight right now
- How long are waits already?
- Which memory-care supports face the most risk?
- What should families do now?
- How should readers interpret waitlist numbers?
Why state budgets are tight right now
State Medicaid directors described a weak fiscal climate for fiscal year 2026, with slowing revenue. According to KFF, almost two-thirds saw a Medicaid shortfall as at least a 50-50 chance in KFF's fiscal 2026 Medicaid survey. Governors' early fiscal 2027 plans projected only 0.6% median general-fund growth.
Thirteen states reported $26.3 billion in projected gaps before balancing actions. That leaves little room to expand high-need services. When money is short, states often freeze new openings, slow eligibility reviews, or trim optional services. Each funded waiver opening needs an appropriation, so demand can grow faster than supply.
How long are waits already?
Waits were already long before the newest cuts. In 2025, 41 states had Medicaid HCBS waiting or interest lists, with more than 600,000 people waiting. According to KFF, the average wait was about 32 months in KFF's 2025 HCBS waitlist review. That total rose 14% from 2024.
About 7.2 million Americans age 65 and older lived with Alzheimer's dementia in 2025, so need for memory-care beds stays strong. Fewer community openings can push more families toward private-pay care or nursing homes. Kentucky shows how funding controls access. More than 19,000 people were on three Medicaid waiver waitlists in December 2025 because each slot needs legislative funding. Funding has not kept pace with demand.
Which memory-care supports face the most risk?
Nursing-facility base rates kept federal protection under the July 2025 One Big Beautiful Bill Act. Community and dementia-specific options did not get the same shield. According to Bricker Graydon, elderly, disabled, and assisted-living waivers plus quality add-ons remain exposed in its Medicaid long-term care analysis. That matters for families seeking care outside a nursing home.
Affected services can include personal care, adult day programs, assisted living through waivers, and specialty dementia supports. States may also cut provider rates, which can reduce participating memory-care places. State officials warned that the roughly $990 billion federal Medicaid reduction threatened disability and HCBS services. Risks included round-the-clock care and community supports. Those are often the services that let a person with dementia stay closer to home.
What should families do now?
Apply early, even if placement is months away. Get on the Medicaid waiver or interest list, gather medical records, and ask what screening the state requires. Do not wait for a crisis discharge to start paperwork.
States are also changing how lists work. Some are streamlining eligibility and testing five-year plans to manage waiver waitlists. Those changes may help processing, but they do not add openings by themselves.
- Ask the state Medicaid office which waiver covers dementia or assisted living
- Confirm list rules, renewal steps, and what removes a person from the list
- Get a needs assessment in writing and keep copies of diagnoses and medications
- Compare private-pay, adult day, home care, and residential options for gaps
- Reconfirm contact details so eligibility notices do not go missing
How should readers interpret waitlist numbers?
Waitlists are a warning sign, not a precise count of need. According to KFF, lists are not comparable across states or years because eligibility screening varies in KFF's 2025 HCBS waitlist review.
Over half of waitlisted people are in states that do not screen for eligibility. Some people may not qualify, while others never join a list. Families should ask local officials how their state counts, screens, and updates its list.
