I specialize in helping families secure assistance through Medi-Cal, which covers skilled care costs. People often reach out to me seeking financial aid for memory care. Regrettably, the “Memory Care” facilities sprouting up all over town do not offer skilled care. They are essentially Assisted Living facilities that have added locked doors to prevent residents from wandering off. Even though they purport to cater to individuals with dementia, the level of care provided does not qualify as skilled care, even with a nurse on staff.
Defined by the CMS (Center for Medicare Services), a Skilled Care facility is one where RNs are on duty for each shift, offering necessary services seven days a week, along with Physical Therapy, Speech Therapy, or Occupational Therapy. Medi-Cal covers the custodial care provided at these institutions, which resemble hospitals designed to serve individuals with substantial medical needs, not merely those with dementia. Since memory care facilities do not provide skilled care, they are not funded by Medicare or Medi-Cal, causing confusion for many.
A common misconception is that memory care falls under skilled care, making it eligible for Medicare or Medi-Cal coverage, but this is not the case. There is a limited program that finances Assisted Living, but it has stringent qualification criteria and a lengthy waiting list. As I assist families, my role encompasses not only facilitating Medi-Cal qualification, which is relatively straightforward in California, but also evaluating all viable options to figure out the best solution for their loved ones. If memory care is the optimal choice, we must devise a strategy for private payment that meets our loved ones’ needs while minimizing expenses.
Having supported well over a thousand families in making these vital decisions and obtaining Medi-Cal coverage, I am here to assist you if your loved one requires memory care.
