Private Pay Memory Care vs. Medicaid Facilities
Navigating the financial aspects of memory care for a loved one with Alzheimer’s disease or another form of dementia can feel overwhelming. Families often find themselves comparing private pay memory care vs Medicaid facilities, wondering which path offers the right balance of quality and affordability. At Lakewood Memory Care and Assisted Living in Brookfield, Wisconsin, we understand how personal and emotional this journey is. That’s why it’s important to understand the fundamental differences between these two options, so you can make an informed decision that best supports your family member’s needs.
Understanding the Basics of Private Pay Memory Care vs Medicaid Facilities
The primary difference between private pay memory care and Medicaid-funded communities lies in how services are paid for. Private pay means the resident or their family covers the cost of care through personal savings, retirement income, long-term care insurance, or veterans benefits. Medicaid facilities, on the other hand, are supported by a joint federal and state program that helps eligible individuals with low income and limited assets access care services.
While both options aim to support dementia patients, the scope and style of care, amenities, and flexibility can vary greatly.
How Medicaid Covers Memory Care Services
Medicaid may cover memory care services, but only under specific conditions. Most often, this coverage comes through Medicaid waiver programs, which allow individuals who would otherwise need nursing home care to receive support in home and community-based settings. However, not every state’s Medicaid agency offers the same benefits or availability.
In Wisconsin, these waiver programs can sometimes help with personal care services such as assistance with daily living, medication management, homemaker services, or limited health care support. However, Medicaid does not generally cover room and board costs in memory care communities unless the resident is in a Medicaid certified nursing facility.
For many families, this distinction becomes a deciding factor, especially if a loved one needs specialized support in a warm, community-focused environment rather than the more clinical setting of skilled nursing facilities.
Private Pay Memory Care: What to Expect
Private pay memory care allows for a more personalized and holistic approach to dementia care. At Lakewood, families who choose private pay enjoy access to a highly customized experience. Our community offers a Montessori-inspired memory care program designed to honor each resident’s life journey and promote meaningful engagement across every aspect of life—emotional, physical, spiritual, social, and intellectual.
Residents benefit from all-inclusive services that extend beyond the basics. From the MIND diet that nurtures brain health, to daily fitness classes and calming meditation sessions, the entire environment is built to support dignity and purpose. Our memory care units are designed to feel like home, not an institution.
Private pay also allows for greater flexibility in selecting a private room or semi private room, choosing amenities, and tailoring services to match personal preferences and needs. This kind of personalized care is often not available in Medicaid certified nursing homes, where care delivery is typically more standardized due to regulatory and funding constraints.
Medicaid Eligibility and Program Limitations
Understanding Medicaid eligibility is key to evaluating whether this option meets your loved one’s long-term needs. Medicaid eligibility is based on income and asset limits that vary by state. In Wisconsin, for example, individuals must meet strict financial criteria to qualify for the program. While Medicaid waiver programs can help cover memory care costs, there may be waitlists, and not all memory care communities accept Medicaid-funded residents.
In addition, Medicaid-funded services are typically more limited. For example, some programs may offer only part-time personal assistance or basic homemaker services, without the specialized training or holistic memory care support provided in private memory care communities.
Care Experience and Quality of Life
When considering private pay memory care vs Medicaid facilities, families must also weigh the differences in the daily care experience. In private pay memory care communities like Lakewood, every resident receives person-centered care that is tailored to their preferences and health needs. Our staff are trained specifically in dementia care and understand the importance of consistency, emotional reassurance, and enriching activities.
We provide meaningful engagement opportunities such as crafting for a cause, fitness classes, therapy dog visits, and our unique VR Bucket List Program; experiences that not only support cognitive well-being but promote joy and purpose. These types of offerings are generally not available in Medicaid nursing home care settings, where resources may be more limited and programming is often more medically driven.
Furthermore, private pay communities tend to have a higher staff-to-resident ratio, which means more time for personal care and attention. In contrast, Medicaid services are often stretched across larger populations, with fewer opportunities for one-on-one connection.
Payment Options for Private Pay Memory Care
Families who choose private pay often use a combination of sources to cover memory care costs. These may include:
Personal savings or retirement accounts
Long-term care insurance
Veterans benefits
Proceeds from selling a home
Support from family members
Understanding all the available payment options is essential, and many families work with a financial planner or elder care attorney to structure a plan that sustains care for the long term.
Lakewood’s all-inclusive pricing model also brings peace of mind by eliminating surprise costs. This predictability helps families budget effectively without sacrificing quality of care.
Home and Community-Based Services: A Middle Ground?
Some families look into home and community-based services as a way to bridge the gap between staying at home and entering a community. While Medicaid waivers may help cover certain in-home care costs or community based services, these options often lack the safety and consistent monitoring that memory care communities provide.
In many cases, caring for someone with Alzheimer’s disease at home can become overwhelming, especially as cognitive decline progresses. That’s why communities like Lakewood, which offer daily living support, medication management, and 24/7 safety, are often a better long-term solution for both the individual and their family.
Cover Memory Care Needs with Confidence
Ultimately, deciding between private pay memory care vs Medicaid facilities comes down to understanding your loved one’s current and future needs. Families who choose private pay are often able to access a broader range of support, more flexible living arrangements, and a deeper level of personalized care. While Medicaid programs serve a vital role for individuals with limited resources, the limitations in coverage details and availability can present challenges when specialized care is required.
For families navigating this important decision, speaking with a knowledgeable advisor or contacting a local area agency can be a valuable first step. The right care solution should not only meet physical needs but should also nurture the mind and body.
Schedule a Tour at Lakewood Today
If you're exploring memory care options in Brookfield and want to learn more about the exceptional care, support, and community lifestyle offered at Lakewood, we invite you to schedule a tour. Our experienced team is here to answer your questions and guide you through every step of the journey. Let us help you find peace of mind and the right path forward for your loved one.
Frequently Asked Questions
1. Can Medicaid be used temporarily before transitioning to private pay memory care?
Yes, in some cases, families begin with Medicaid services and later transition to private pay if their financial situation changes. However, not all communities accept Medicaid residents, so it's important to confirm before planning a transition.
2. Does Medicaid cover respite care for dementia patients?
Some Medicaid programs may cover short-term respite care, but the availability and length of coverage depend on your state’s Medicaid agency and waiver program structure.
3. How do I find out if a community is Medicaid certified?
You can ask the community directly or contact your local area agency on aging for a list of Medicaid certified nursing homes or memory care communities.
4. Are there income limits for veterans benefits that help pay for memory care?
Veterans benefits, such as Aid and Attendance, are income-dependent but offer more flexibility than Medicaid. These benefits can often be used in conjunction with private pay options to help cover memory care costs.