Memory Care in Missouri

Table of Contents

Memory Care in Missouri

Table of Contents

• The Cost of Memory Care in Missouri
• Missouri Medicaid Programs for Memory Care
• Can You Use Medicare To Pay for Memory Care in Missouri?
• More Ways To Pay for Memory Care in Missouri
• Memory Care Laws and Regulations in Missouri
• Free and Low-Cost Resources for Seniors in Missouri
• Missouri 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.

Our cost comparisons use assisted living prices from Genworth Financial’s 2021 Cost of Care Survey and added a premium of 25% to account for memory care's additional services. On average, seniors in Missouri can expect to pay $3,750 per month for memory care, which is far below the national average of $5,625. It’s the most affordable state in the region. Seniors in Arkansas pay almost $1,000 more per month, and rates in Illinois, Kansas and Iowa are much closer to the national average.

Memory care prices vary depending on the facility's location, amenities, service package and pricing structure. Rates are very affordable in Jefferson City and Cape Girardeau. Memory care facilities in Joplin and Columbia charge around $3,500 per month. Prices are slightly higher than the state average in Springfield at $4,063, and seniors in St. Joseph can expect to pay even more at $4,844. St. Louis and Kansas City are the state’s most expensive cities at $5,125 and $5,731, respectively.

Missouri HealthNet, the state’s Medicaid program, provides limited coverage for memory care through a cash grant. Unlike many states, Missouri doesn't offer home and community-based services waivers for seniors who live in assisted living facilities or memory care units. 

Supplemental Nursing Care

However, the official Medicaid state plan includes Supplemental Nursing Care as an entitlement, so there are no waiting lists. This cash benefit is available to adults who live in assisted living facilities, intermediate care homes or residential care facilities. The benefit varies depending on the senior's living arrangement. Adults who receive memory care in an assisted living facility may be eligible for up to $292 per month. Seniors in residential care facilities receive up to $156 per month. 

• Who Is Eligible: The Supplemental Nursing Care cash grant is available to individuals aged 21 or older who are financially eligible for Medicaid for the aged, blind or disabled. Applicants must live in a licensed facility and be certified to receive that level of care.
• How To Apply: Seniors should visit the Department of Social Services at My DSS to complete a Medicaid application. Applicants who are seeking long-term care benefits must complete the Aged, Blind and Disabled Supplement form.

Medicaid Eligibility for Seniors in Missouri

Missouri allows applicants to keep $5,035 in liquid assets, and this amount doubles if both spouses require long-term care. If only one spouse requires care, the non-applicant may be entitled to generous exemptions. The state typically excludes a home, a vehicle, personal belongings and up to $137,400 in cash. Seniors may also be entitled to retain part of their spouse’s income to cover their monthly expenses. A certified Medicaid planner or elder law attorney can provide personalized advice.

2022 Medicaid Income Limits for Seniors in Missouri

Medicaid eligibility is based on state and federal guidelines. Applicants must demonstrate medical and financial need to qualify for long-term care benefits in addition to regular health care services for low-income adults. Applicants must meet the following requirements:

• Be blind, disabled or aged 65 or older
• Complete a level of care determination
• Spend most of their income on long-term care
• Provide proof of citizenship or legal residency
• Be a permanent Missouri resident

How To Get Help Applying for Medicaid in Missouri

Seniors who need help applying for Medicaid or using their benefits should contact the MO HealthNet Division for assistance. The following agencies can help seniors apply for benefits and report changes that may affect their eligibility. If needed, seniors can appoint a designated representative to handle these responsibilities.

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

In Missouri, memory care is generally provided in assisted living facilities, which are residences that accommodate three or more people and provide lodging and care services under the direction of a licensed physician. Assisted living facilities are licensed and monitored by the Missouri Department of Health and Senior Services. The facility must be inspected prior to licensing and then on an annual basis.

Facility Scope of Care

Assisted living facilities provide 24-hour care and supervision, as well as nursing services, assistance with daily living activities and recreational activities. They must also provide assistance with storage, distribution and administration of medications. Assisted living facilities are required to provide at least three meals per day. Doctor-prescribed specialty diets can be provided by the facility, but must be reviewed on a quarterly basis by a physician, registered nurse, dietitian or nutritionist. Assisted living facilities are also required to provide individualized evacuation plans for memory care residents who are unable to evacuate independently.

Admissions Requirements

Assisted living facilities that provide memory care can accommodate a wide range of residents. However, there are some restrictions regarding who may not be admitted. These are outlined in the table below.

Residents Who May Be Admitted

Those who:

• Are receiving hospice care, including those who are bedridden or require skilled nursing care
• Have physical or cognitive impairments that prevent them from safely and independently evacuating the facility in the event of an emergency

Residents Who May NOT Be Admitted

Those who:

• Are bedridden
• Have behaviors that are likely to result in injury to themselves or someone else
• Require physical or chemical restraints
• Require skilled nursing services beyond what the facility provides
• Require more than one person to provide physical assistance, outside of bathing and transferring

Care Plan Requirements

Memory care facilities are required to complete screening prior to admission to confirm that the prospective resident is eligible for admission. Within five days of admitting a resident, the facility must use an assessment tool approved by the Department of Health and Senior Services to conduct a physical exam to record the new resident’s medical status and any special orders regarding their care needs.

This assessment must be repeated on a semiannual basis and whenever the resident has a significant change in their health or abilities. Based on this assessment, the facility develops a personalized care plan that addresses the resident’s needs, goals and expectations, along with an evacuation plan if the resident requires more than minimal assistance to evacuate the building in the event of an emergency.

Medication Management Requirements

Memory care residents may only self-administer prescription and over-the-counter medication if a licensed health care provider approves. Each resident’s medication must be reviewed by a pharmacist, registered nurse or physician on a monthly basis.

Unless they are a licensed nurse, pharmacist or physician, staff members who administer medication must be certified, at the minimum, as a medication technician or a Level I medication aide. Insulin can only be administered by a licensed physician or registered nurse, or a medication technician or a Level I medication aide who has passed the state’s insulin administration course. Injections, excluding insulin, may only be administered by a licensed physician or registered nurse.

Facility Requirements

Apartment-style units and private bathrooms are not required. Rooms may be single or double occupancy, with a maximum of four residents per room. There must be at least one toilet and sink per every six residents and one tub or shower for every 20 residents. Facilities are required to be homelike, which may include living rooms or common rooms where residents can socialize, family-style kitchens and eating areas, laundry areas for resident use, private bathrooms, outdoor common areas and a place where residents can enjoy privacy and exercise control over their environment.

Staffing Requirements

Memory care facilities must have a licensed administrator, a licensed nurse and direct care staff. If the facility provides medication administration, it must have a Level I medication aide or a certified medication technician to administer medications. The facility has to be under the supervision of a physician who is kept informed of treatments and medications prescribed to residents.

Memory care facilities must have a staff-to-resident ratio of 1:15 during the day and evening and 1:20 at night. There must be enough staff members available to meet residents’ needs at all times, even if this exceeds minimum staffing ratios.

Medicaid Policy

Personal care may be covered in memory care facilities by the state’s Medicaid plan. Additionally, MO HealthNet may cover services under one of two waiver programs, including the Aged and Disabled waiver and the Supplemental Nursing Care waiver.

Reporting Abuse

Assisted living facilities are required to report abuse, neglect or exploitation to the Missouri ombudsman program. Anyone else who has concerns about the treatment or quality of care seniors receive in an assisted living facility may bring their concern or complaint to the ombudsman as well.

Seniors in Missouri have numerous resources at their disposal for long-term care planning and dementia. The following organizations provide free services to seniors and their families.

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.