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Choose Dementia Care Facilities Accepting Medicaid

E Editorial Team Content Writer Sep 26, 2026 13 min read

Table of Contents

Last Updated: September 25, 2026

Understanding Medicaid Coverage for Dementia Care Facilities

Medicaid pays for dementia care facilities Medicaid when specific conditions are met. Your loved one must qualify medically and financially. The coverage depends on the type of facility and the level of care needed.

Medicaid is a federal and state program. Each state runs its own version. In Tennessee, the program is called TennCare. It covers long-term services and supports for seniors who meet income and asset limits.

Dementia care facilities include nursing homes, assisted living communities, and memory care units. Not all facilities accept Medicaid. Those that do must meet state certification standards. They must have trained staff and proper equipment for dementia residents.

The key difference between Medicare and Medicaid coverage is important to understand. Medicare covers short-term skilled nursing care after a hospital stay (Skilled Nursing Facility Services). Medicaid covers long-term custodial care for residents who cannot afford private pay. Most dementia residents need custodial care, which is why Medicaid is often the right option.

At Emory Mills, we help families navigate these distinctions. Our team understands how dementia care needs change over time.

TennCare CHOICES Eligibility Requirements for Memory Care

TennCare CHOICES is Tennessee's Medicaid waiver program. It covers long-term services and supports for seniors. The program allows people to receive care in community-based settings instead of nursing facilities.

To qualify for TennCare CHOICES, you must meet three basic requirements:

  • Age 65 or older
  • Need a nursing facility level of care (determined by medical assessment)
  • Meet income and asset limits set by the state

Income limits change yearly. Asset limits also vary based on marital status and other factors. You should check the current limits with the Tennessee Department of Human Services or your Area Agency on Aging.

The pre-admission evaluation (PAE) determines whether someone needs a nursing facility level of care. A nurse or social worker conducts this assessment. They review medical history, daily functioning, and care needs. The PAE is the critical document that opens the door to Medicaid coverage.

Understanding TennCare CHOICES Waitlists and Planning Ahead

Approval for TennCare CHOICES does not guarantee immediate placement. This is the gap most families don't anticipate. Tennessee's TennCare CHOICES program operates under a capped enrollment model, meaning the state limits how many people can receive benefits at any given time. When enrollment reaches capacity, new applicants are placed on a waitlist.

Waitlist length varies by region and changes seasonally.

Key planning strategies:

  1. Start the application process before crisis. If your loved one is still at home or in assisted living, initiate the TennCare CHOICES application now, even if placement isn't needed for months. Approval happens faster than placement. Once approved, you move to the waitlist, and your position is secured.

  2. Understand the difference between approval and placement. Approval means you qualify medically and financially. Placement means a Medicaid bed is available at a facility you choose. These are two separate timelines. Approved applicants wait on a state-managed waitlist for an available bed.

  3. Ask about waitlist priority categories. The state prioritizes certain applicants, for example, those in hospitals or nursing homes on private pay may move faster than those at home. Ask your Area Agency on Aging if your loved one qualifies for priority status.

  4. Maintain private-pay options during the wait. If your loved one needs care immediately but TennCare approval is pending, assisted living or temporary skilled nursing may bridge the gap. Some families use this time to explore facilities and build relationships with staff before Medicaid takes over payment.

  5. Confirm Medicaid bed availability at your chosen facility. Not all certified facilities have available Medicaid beds. A facility may be certified to accept TennCare but have no openings. Ask directly: "How many Medicaid beds do you have available right now?" and "What is your typical wait time for a Medicaid opening?" Some facilities maintain a waitlist of their own.

  6. Document your waitlist position. Once approved and on the state waitlist, request written confirmation of your position and expected timeline. This documentation helps you plan and follow up if delays occur.

Medical Necessity and Level of Care Assessment

Medical necessity means a doctor confirms the person needs care that only a facility can provide. The assessment looks at whether the person can safely stay at home with help.

  • Ability to manage medications
  • Need for help with bathing, dressing, eating
  • Risk of falls or wandering
  • Behavioral issues related to dementia
  • 24-hour supervision needs

How to Apply for TennCare Long-Term Services

The application process has several steps. Start by contacting your Area Agency on Aging. They can explain the process and answer questions about eligibility.

Here's what to expect:

  1. Contact your Area Agency on Aging, Find the office serving your area. They provide guidance on TennCare CHOICES and other programs.

  2. Request a pre-admission evaluation, This assessment determines if you need nursing facility level of care. The evaluator visits you at home or in the hospital.

  3. Gather financial documents, Collect bank statements, property deeds, and income records. You'll need these to prove you meet income and asset limits.

  4. Submit the TennCare application, Your Area Agency on Aging helps with this. The application includes medical and financial information.

  5. Wait for approval, The state reviews your application. Approval typically takes 30-60 days, but waitlists may apply in some areas.

  6. Choose a Medicaid-certified facility, Once approved, you can select a facility that accepts TennCare. Not all facilities participate.

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Memory Care Costs in Tennessee and Financial Planning

Medicaid doesn't cover all costs at every facility. Understanding what's included and what isn't prevents surprises. (Source: National Institute on Aging's information on dementia care)

  • Personal items like clothing or toiletries
  • Haircuts or beauty services
  • Telephone or cable
  • Activities or outings beyond basic programming
  • Specialized therapies not ordered by a doctor

Evaluating Dementia Care Facilities: What to Look For

Choosing the right dementia care facilities Medicaid means looking beyond cost. Safety, staff training, and programming matter most for dementia residents.

Caregiver engaging a senior in a memory care facility Medicaid-approved home setting
Caregiver engaging a senior in a memory care facility Medicaid-approved home setting

Start with these evaluation criteria:

  • Safety features, Locked units, fall prevention, secure outdoor areas
  • Staff training, Dementia certification, behavioral management training
  • Staffing ratios, Adequate staff for the number of residents, especially at night
  • Activity programming, Meaningful activities based on residents' abilities
  • Family involvement, Open visiting, communication about changes
  • Medical services, On-site nursing, medication management, doctor visits

Verify Medicaid Certification and Compliance

All facilities accepting Medicaid must be state-certified. Certification means they meet minimum standards for staffing, safety, and care quality.

Ask the facility directly:

  • "Are you currently certified to accept TennCare?"
  • "When was your last state inspection?"
  • "What deficiencies were found, and how did you fix them?"
  • "Do you have any pending complaints?"

Assess Memory Care Programming and Staff Training

Memory care programming should be based on residents' remaining abilities, not just keeping them busy. Activities should be meaningful and match their interests.

Ask about staff training:

  • How many staff members have dementia certification?
  • What training do new staff receive?
  • How is behavioral management handled?
  • What happens if a resident becomes agitated or confused?

Review Facility Quality and Safety Records

State inspection reports are public records. They show what state surveyors found during their visit. Look for patterns, not isolated incidents.

Check for:

  • Staffing violations, Not enough staff on duty

  • Medication errors, Wrong dose or medication given

  • Resident abuse or neglect, Any reports of mistreatment

  • Infection control, Outbreaks of illness

  • Nutrition issues, Residents not being fed properly

  • Fall rates and prevention measures

  • Infection rates

  • Resident and family satisfaction

  • Staff turnover rates

Steps to Schedule Tours and Make Your Final Decision

Visiting the facility is essential. A tour lets you see the environment, meet staff, and observe how residents are treated.

During the tour, ask to see:

  • Memory care units and common areas
  • A sample resident room
  • Dining areas and kitchens
  • Activity spaces
  • Outdoor areas

Talk to current residents' families if possible. Ask:

  • Are you happy with the care?
  • How does the staff respond to problems?
  • What surprised you (good or bad)?
  • Would you choose this facility again?

After touring, compare your options. Create a simple comparison:

Facility Medicaid Accepted Staff Training Safety Record Dementia Programming Your Impression
Facility A Yes Strong Good Excellent High
Facility B Yes Adequate Fair Good Medium
Facility C Yes Weak Poor Basic Low

Make a decision based on:

  1. Medical appropriateness, Does it meet your loved one's care needs?
  2. Medicaid acceptance, Will it accept TennCare?
  3. Quality and safety, Does it have good inspection records and staff training?
  4. Fit and comfort, Does your loved one feel at home there?

Frequently Asked Questions

Does Medicaid pay for dementia care facilities?

Yes, Medicaid covers skilled nursing care and assisted living services for eligible individuals with dementia through programs like TennCare CHOICES. Coverage depends on meeting financial and medical necessity requirements. Medicaid-certified facilities must accept the program's reimbursement rates. Not all private pay facilities accept Medicaid, so verification during your search is essential. Contact the facility directly to confirm they participate in TennCare.

What are the TennCare CHOICES eligibility requirements for memory care?

TennCare CHOICES serves individuals aged 65 and older who need long-term services and supports. Eligibility requires a pre-admission evaluation confirming medical necessity for nursing facility level of care, plus financial qualification based on income and asset limits. The program emphasizes community-based services first, so you may be offered home or assisted living options before facility placement. Contact your Area Agency on Aging for a detailed eligibility assessment.

How do I know if a facility provides quality dementia care?

Review state inspection reports and deficiency records through the Tennessee Department of Health. Ask about staff-to-resident ratios, dementia care training certifications, and how the facility handles behavioral episodes and medical emergencies. Request references from families currently using the memory care program. Visit during different times of day to observe daily routines, meal quality, and staff interactions. Look for person-centered care approaches that honor residents' life histories and remaining abilities.

What should I expect to pay for memory care in Tennessee?

Request a detailed cost breakdown from each facility showing what's included (meals, activities, medications, incontinence supplies) versus what costs extra. Ask about Medicaid spend-down planning and whether the facility assists with financial applications. Getting quotes from multiple Medicaid-accepting facilities helps you understand the local market.

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