Medicaid is a government-run health insurance program that provides coverage to more than 4.6 million low income seniors in the United States. There are many facets to Medicaid coverage, one of which provides for long term care.
If eligible, Medicaid’s provision for long term care could pay for some or all of seniors’ long term care expenses, such as nursing home costs. The eligibility requirements can be difficult to navigate because they vary from state to state, but there are some general guidelines to be aware of. An elder law attorney in your state will be able to walk you through the more specific details and requirements to be eligible for this program.
As a general rule, to be eligible for Medicaid, one must be financially qualified and have a medical need for care.
To determine if an individual is financially qualified for Medicaid’s long term care provision, states use one of two approaches. Some states use what is called a “categorically needy” Medicaid approach. This means that these states have an income cap, and as long as an individual doesn’t exceed that income cap and meets one of the other categories such as being age 65 or older, they will be eligible for Medicaid long term care coverage. The income cap limit is three times the Supplemental Security Income payment amount, otherwise known as the Federal Benefit Rate. In 2018, the limit for an eligible individual is $2,250 a month.
The other approach states use to determine if an individual is eligible is known as “medically needy” or “spend-down” Medicaid. These states determine eligibility based on an applicant’s ability to afford their care. It is important to mention; however, the state and the individual often disagree over whether the care is affordable. Generally, if an applicant has less than $500-$1,000 left per month after deducting their care expenses, the state will grant them eligibility. If an applicant is not eligible, it may be required they “spend down,” or pay their care costs out of pocket, to get their income down to the level deemed eligible.
Assets are also an important factor in determining eligibility. The majority of states have an asset limit of $2,000 or less to be eligible. Asset transfers of up to five years preceding the application, known as the “Look Back Period,” are also considered. This may look bleak, but not all assets are countable towards the eligibility requirements. For example, the applicant’s home, vehicle, clothing, furniture, and jewelry are all exempt.
Along with financial eligibility requirements, an applicant must also meet certain medical requirements. Even more so than the financial requirements, medical requirements differ significantly from state to state. Usually, if an applicant is diagnosed with Alzheimer’s or dementia, requires skilled nursing care, or is unable to care for themselves they will qualify. States may also consider the number of activities of daily living (ADLs) the applicant requires assistance with. ADLs may include dressing, toileting, cooking etc.
The long-term care provision within Medicaid can be difficult to navigate and understand. It can also provide much needed financial security during a time where the only thing you should be concerned with is ensuring you get the care you need. Elder law attorneys are well-versed in Medicaid and will be able to determine your eligibility in your state and help give you the peace of mind you deserve. Please do not hesitate to contact our office if you think you may be eligible, or know someone who may be.