Understanding Medicaid Coverage of Long Term Care


Understanding Medicaid Coverage of Long Term Care

Understanding Medicaid Coverage of Long Term Care

It is important to understand Medicaid coverage for long term care so that one can avail themselves of this program if needed. Medicaid is considered the country’s largest public payer of long-term care. Once a person is determined to be qualified for its coverage, this government-supported program will pay for the nursing home care and other expenditures Medicare does not cover. It certain situations, it may also aid assistance for specific LTC services provided at home.

How to qualify for Medicaid? There are several ways on how you can qualify for Medicaid coverage. Once you receive Supplemental Security Income (SSI), you are likely to qualify for Medicaid automatically. With extremely limited income and assets, you may be able to qualify as well. However, income eligibility levels for Medicaid vary by state, so check Medicaid rules where you live. Medicaid also looks at assets such as savings accounts when determining eligibility, although assets generally don’t include homes, cars, household furnishings, or burial plots.

If determined your income is higher than the state’s Medicaid eligibility level, you may still be eligible for the coverage. Through what is popularly termed as “spend down’, wherein income and assets are spent on nursing home and other health care expenses, an individual can still qualify but this is applicable in selected states only.

Also, private-pay patients can also acquire Medicaid eligibility over time once they have spent high costs for such care. Medicaid regulation procedures vary from one state to the other. If you’d like to clear things and ask for question about its coverage and limitations, it is advisable to contact the state’s Medicaid office or have a consultation with an LTC ombudsman to clear things out.

Medicaid also has its limitations which are very important to take note of. Medicaid includes nursing facility care and home and community-based services where medical providers come into the home to render the necessary services to keep a disabled individual from being institutionalized in a nursing facility or hospital. Individuals under the age of 65 requiring long term care services must meet the Social Security disability criteria either through Social Security Income (SSI) eligibility or Social Security Disability Income (SSDI) eligibility.

Keep in mind that only individual applicant income is considered in the eligibility determination. An applicant’s spouse’s income is not considered. LTC Medicaid Financial Eligibility is determined by the state’s department of social and human services. In other situations, case management agencies evaluate applicants of long term care to determine if their medical condition qualifies them to receive long term care services. This approval is necessary for eligibility.

Today, federal government and state governments have made changes to the eligibility requirements and restrictions for Medicaid eligibility. The Deficit Reduction Act of 2005 now requires that anyone seeking Medicaid must produce documents to prove that he or she is a United States citizen or resident alien. It also created a five-year “look-back period” which means that any transfers without fair market value made by the Medicaid applicant during the preceding five years are subject to penalty, dollar for dollar. The implementation of these changes continues to precede state-by-state.


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