Memory Care in Maryland

Table of Contents

Memory Care in Maryland

Table of Contents

• The Cost of Memory Care in Maryland
• Maryland Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Maryland?
• More Ways To Pay for Memory Care in Maryland
• Memory Care Laws and Regulations in Maryland
• Free and Low-Cost Resources for Seniors in Maryland
• Maryland COVID-19 Rules for Memory Care Facilities

Because of the specialized staff training and resources required to provide high-quality memory care, memory care typically costs more than other types of residential care. On average, memory care will cost 20-30% more than assisted living.

Taking into account the additional expense of memory care on top of traditional nursing services, we've added 25% to the costs found in the 2021 Genworth Cost of Care Survey to estimate the cost of memory care in Maryland.

The average senior in Maryland pays $6,560 per month for memory care, which is more than $1,000 above the U.S. average. The cost here is lower than in Washington, D.C., and Delaware, where seniors pay $7,435 and $7,494 per month, respectively, but significantly higher than in neighboring Pennsylvania, which carries an average cost of $5,125.

Keep in mind that even within the state, factors such as location, quality of care and access to government programs can impact care. In cities such as Baltimore, Cumberland, Hagerstown and Salisbury, average costs range from $5,788 to $6,560 per month.

State Medicaid programs help individuals and families that can't afford medical care obtain the health services they require. Maryland's Medicaid program doesn't provide direct coverage for memory care, but there are multiple waiver programs you may be able to enroll in to be able to offset the cost of care.

Community First Choice

The Community First Choice program helps those who want to continue to lead lives as part of the community but recognize the need for long-term care. It allows family members to become paid caregivers and provides benefits proportional to the individual's needs. It can also cover the cost of admitting a family member into a nursing facility with memory care services.

• Who Is Eligible: In order to apply, you must remain under an income threshold of $2,349 per month and have medical documentation that shows you need assistance with at least two types of basic activities, such as cooking meals and personal grooming. 
• How To Apply: The first step is to apply for Medicaid and then work with your local Area Agency on Aging to enroll in the Community First Choice program.

Community Options Waiver

This waiver is for people who require long-term care but choose to receive it at home or through a group living center. Some assisted living and memory care facilities may qualify for this waiver.

• Who Is Eligible: Anyone over the age of 65 and in need of nursing care may apply as long as they remain under the income threshold for Medicaid. Adults under 65 may qualify if they suffer from a disability.
• How To Apply: You can apply through Maryland Access Point, your local Agency on Aging or a social worker who's working with your care facility.

Medicaid Eligibility for Seniors in Maryland

Income limits are used to determine whether you're eligible for financial aid. In order to be approved for Medicaid, you can't earn more than the specified limits or hold countable assets that could be sold to pay for care. 

2022 Medicaid Income Limits for Seniors in Maryland

In addition to the above financial limitations, if you're applying for Medicaid in the state, you must:

• Reside in Maryland full-time
• Be a U.S. citizen or legal immigrant
• Have or apply for a Social Security number
• Meet the medical eligibility requirements of the programs you're applying for

How To Get Help Applying for Medicaid in Maryland

Maryland offers several ways to get enrolled in Medicaid. You can use the MDThink website to access all these programs. 

Unfortunately, Medicare does not generally cover the cost of Memory Care. Most Memory Care Facilities are considered to be "social settings," so Medicare does not cover the cost incurred in these facilities. The only exception to that is if you are receiving memory care services in a Nursing Home. While this situation is much less common, Medicare would sometimes cover the cost, depending on a number of circumstances.

That being said, Medicare does still cover qualified doctor visits, medications, etc., as it would if you were still at home, but it will not cover the cost of care received at the Memory Care Facility.

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

• Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. It's best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
• Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
• Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs such as memory care. More information about these programs can be found on the VA website.

Memory Care Regulation

Assisted living facilities in Maryland that are licensed to care for individuals with memory impairment are considered assisted living programs (ALPs) and are regulated by the Department of Health. There are three types of licenses available based on the level of care provided. The department or their delegates conduct facility inspections every 15 months, or more often if required.

ALPs must complete an assisted living disclosure form, and facilities with an Alzheimer’s special care unit must include details regarding the unique design features and activities provided to meet the needs of residents with dementia.

Facility Scope of Care

All ALPs must provide three nutritious meals daily and snacks throughout the day. They must also aid in coordinating health services, provide assistance with two or more ADLs and offer occasional assistance in accessing recreational services. Programs can provide minor interventions to manage disruptive behavior and occasional psychological episodes.

Facilities with level two licenses provide a higher level of support with ADLs and can assist with frequent disruptive behaviors or psychological episodes. Level three programs also provide ongoing access to comprehensive health services, frequent assistance with ADLs and intensive supervision to manage behaviors that may disrupt or harm the resident or others. They must also monitor and manage psychological episodes that may require immediate intervention.

Admissions Requirements

There is a wide range of residents who can be admitted to ALPs, but facilities must meet certain restrictions as well. This table gives an overview of who may or may not be admitted.

Residents Who May Be Admitted

Older adults and people with:

• Dementia
• Mental health conditions
• Developmental disabilities
• Physical disabilities

Residents Who May NOT Be Admitted

Those who require:

• More than intermittent nursing care
• Treatment of certain skin ulcers
• Ventilator treatments
• Skilled monitoring, testing and close monitoring and adjustment of medications
• Monitoring of a chronic condition that is not easily controllable
• Treatment for certain communicable diseases

And those who:

• Are a danger to self or others
• Are at risk for health or safety complications that cannot be adequately managed

Care Plan Requirements

Individuals must be assessed to identify the level of care they require to meet their medical, cognitive and psychiatric needs. The assessment also determines their treatment requirements, ability to self-administer medication and their ADL and risk factor management needs. Any problematic behaviors are noted. The assessment must be reviewed every 6 months, and a full assessment must be performed after a non-routine hospitalization or significant change in condition.

Medication Management Requirements

Level one programs can assist with self-administration of medications, while level two and three programs can administer medication and monitor the effects of medications and treatments. Each resident’s ability to self-administer must be reviewed by a licensed health care professional at least quarterly. Health professionals must also review individual’s regimes within 14 days of admission, and a licensed pharmacist must conduct an on-site review at least every six months for any resident receiving nine or more medications.

Facility Requirements

ALPs can have a maximum of two residents per unit, although this limit may be waived if programs have previously received a waiver. There must be at least one toilet for every four residents. A minimum of one bathtub or shower is required for every four residents in facilities with eight or fewer residents. Larger facilities must have one for every eight residents.

Staffing Requirements

Facilities must have enough staff available to make sure residents’ scheduled and unscheduled needs can be met. A waiver to use electronic monitoring instead of awake overnight staff can be granted when a physician or nurse determines residents don’t require overnight assistance.

Each facility must have a manager to direct daily operations and an alternate nominated for periods when the manager is unavailable. There must be a registered nurse available to provide nursing services, and medication technicians and direct care staff must also be available. Initial training is required and individuals who perform personal care must demonstrate competence to the delegating nurse. Managers must complete 20 hours of continuing education every 2 years.

Medicaid Policy

Room and board in ALPs is not covered by standard Maryland Medicaid. Waiver programs, including the Community Options Waiver, do assist with the cost of some care services provided by level two and three ALPs. Services in level one programs are not covered by any Medicaid waivers.

Reporting Abuse

Maryland has a range of reporting options for anyone with concerns or complaints about the treatment of residents in ALPs. Both Adult Protective Services and the Office of Health Care Quality investigate complaints. Residents with Medicaid insurance can report concerns to the Medicaid Fraud Control Unit of the Maryland Attorney General’s office. In addition, the Maryland Department of Aging, Long-Term Care Ombudsman Program investigates and attempts to resolve complaints made by residents of assisted living facilities.

While Maryland does provide financial aid to those who require memory care through state-funded programs, you can also obtain additional assistance through charitable organizations and community programs. Whether you're looking for the best possible care, caregiver support or financial aid, these organizations can offer you additional resources at little or no cost. 

Note: The following information was compiled and most recently updated on 2/8/2022. Since COVID-19 is a rapidly evolving crisis, be sure to contact your Memory Care Facility or local Area Agency on Aging for the most up-to-date information.