The options for suitable long-term care and senior housing are not necessarily limited because you or a loved one is on a fixed income or disabled. With the help of government programs such as Medicaid, seniors can live in various types of care facilities without worrying who is going to foot the bill. However, it’s important to look into your state’s Medicaid program and eligibility requirements before deciding on a long-term care plan.
What Is Medicaid?
Medicaid is a federal and state health insurance program designed for certain low-income individuals and families. It is jointly funded and covers children and senior citizens, as well as those who are blind, disabled, and others who are eligible for federal assistance. It also offers benefits not typically covered by Medicare such as nursing home and personal care services.
State-specific programs called Medicaid Waivers provide support and care to seniors not living in nursing homes. Instead, they typically live at home or in assisted living facilities. Medicaid Waivers are not entitlements like nursing home care, but instead are programs that have enrollment caps and waiting lists.
Long-Term Care Eligibility
The federal requirements for Medicaid are broad, and each state has authority to design its own programs. This includes establishing eligibility standards, determining services and benefits coverage, and setting a payment rate. To be eligible for Medicaid long-term care, you must qualify financially and medically. The requirements are specific to the state in which you live, your age group, and the Medicaid waiver or program. Here are some general rules that apply:
–Financial Qualifications: Your income and assets are major factors, and although they may exceed federal or state limits, you can still qualify for Medicaid. This cap may be set at a hard income limit (three times your SSI payment) or income that is relative to the cost of your care.
–Medical Requirements: While medical qualifications may differ from state to state, Medicaid long-term care covers you if you need skilled nursing care, are afflicted with Alzheimer’s disease or other dementia, or if you cannot care for yourself at home. If skilled nursing is not needed, then Medicaid will tie its medical eligibility to the required amount of Activities of Daily Living (ADL) needed such as assistance with bathing, cooking, etc.
–Other Qualifications: Medicaid long-term care services are available to all seniors 65 years and older. If you are younger than 65 and considered disabled, you may still be eligible. Your marital status does not necessarily impact your eligibility unless it changes your income and asset limits. Veteran status also does not impact your eligibility.
Medicaid Services and Benefits
If you are eligible for Medicaid long-term care services, you may qualify for some or all the following programs depending on where you live:
–Nursing Homes/Skilled Nursing: Medicaid pays for all nursing home care no matter where you live as long as it is a Medicaid-certified facility.
–Assisted Living Communities: The number of assisted living communities covered by Medicaid is increasing. In most states, it will pay for some assisted living costs mainly with Medicaid Waivers. It will not pay for room and board or rent, but it will help with some medical assistance. Get more information about your state’s assisted living policy and learn more about other programs available to Medicaid beneficiaries.
–Adult Day Care/Adult Day Health Care: These two types of care are covered by Medicaid and Medicaid Waivers in all 50 states for some beneficiaries. Some states will only cover one and not the other. Learn more about your state’s specific policies.
–Home Health Care/Non-Medical Home Care: Through Medicaid’s personal care assistance programs and Medicaid Waivers, you can receive coverage of your home health care. These Waivers also support non-medical home care, as well as other domestic services in and around your home. Get more information about coverage in your state.
Your turn: What is your experience with using Medicaid for long-term care such as assisted living or nursing home care? What do you recommend? Share your thoughts in the comments below.
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