Medicaid Long Term Care Explained

Financially limited US citizens who are no longer able to take care of themselves may be eligible for Medicaid Long Term Care. 

There are plenty of difficulties that could occur from chronic conditions and many individuals are at risk. As such Medicaid Long Term Care can be provided in assisted living facilities, nursing homes, and private homes. 

However, it’s worth noting that eligibility requirements may be unclear, which is why we’ll clarify the basics. 

What is Medicaid Long Term Care 

This is in fact a group of various programs offered under the basic Medicaid aimed at providing long-term care and support to people who are no longer able to care for themselves due to regular aging and other chronic conditions. 

Under this program, Medicaid will pay for the expenses of living in a nursing home along with all the healthcare needs. Similarly, the same services will be covered if a senior citizen wants to stay in their own home. 

Additionally, the program will cover medical bills including doctor’s appointments, along with non-medical services and goods needed to maintain a solid quality of life, such as housekeeping, personal care assistance, home modifications, etc.

What Is Considered Long Term Care?

In comparison to regular care, long term care is ongoing and may not be limited to just medical care. This helps cover for various expenses and provides the individual with the care and supervision they would receive in an institution such as a nursing home. 

Put differently, if someone requires a nursing facility level of care, they may be eligible for Medicaid long term care.

Which Medicaid Programs Provide Long Term Care

Here are the three programs that seniors with long term care needs can benefit from:

• Nursing Home Medicaid 
• Aged, Blind, Disabled Medicaid
• Home and Community-Based Services Waivers

Since all three account for different services in various settings, the nursing home requirements will be slightly different.

With Nursing Home Medicaid, eligible individuals can expect to receive full compensation for nursing home care. It’s available across the US, and while eligibility requirements are strict (applicants need a nursing home level of care), all applicants will receive these benefits instantly. 

On the other hand, Aged, Blind, and Disabled Medicaid will provide basic coverage for financially challenged seniors and long term benefits for those who have the medical need. Similar to Nursing Home Medicaid, the law guarantees eligible personas to get these benefits without wait. It’s important to stress that in some cases there might be a slight wait time for long term benefits. 

Lastly, Home and Community-Based Services Waivers will apply to similar individuals as with the first program on this list, only it will apply to those still living at home or a community instead of a nursing home. Benefits may include personal care assistance, housekeeping, or home modifications. There are a limited number of spots, and after all the spots are filled, other applicants must go to a waitlist. 

Where Can Medicaid Long Term Care Take Place?

You’ve probably noticed by now that the expression “in the community” was mentioned. What does this mean, though?

In short, it includes locations including:

• Home of the beneficiary
• Home of a caregiver
• Family member’s home
• Assisted living facilities
• Care homes or adult foster homes
• Senior living communities
• Adult day care centers
• Memory care institutions

Care In A Private Home And Other Facilities

Most programs outlined above will cover care services in the beneficiary’s home or other homes belonging to family members and caretakers.

The cost of this care mustn’t exceed the costs of residing in a nursing home. This is why most seniors receiving care at a residence receive assistance from unpaid caregivers, such as family members. 

With assisted living, Medicaid will cover support and long term care services but not boarding and room expenses. Fortunately, there are generally state-sponsored programs made available to financially limited individuals. 

The benefits will depend purely on the needs and life circumstances of the beneficiary. 

With congregate living (adult care homes) seniors can receive long term benefits if a program is available in their area. The state will have to assess the beneficiary’s medical needs first before providing them the benefits. 

Memory care is also available for those battling dementia or Alzheimer’s disease where the individuals will reside in the facility or the unit contained in a hospital. 

Lastly, with nursing home care, all the nursing home expenses will be paid for by the Medicaid Long Term Care program. Most nursing homes accept Medicaid and may only cover a shared room unless a private room is determined to be a medical necessity. 

Meeting Eligibility Requirements

Regardless of the type of program you want to apply for, Medicaid Long Term Care programs have strict eligibility criteria - they must have documentation that proves they require long term care and must have a limited amount of income. 

On the financial side, applicants need to meet income and asset limits based on the program, marital status and state of residence. These limits can change multiple times throughout the year, which makes staying informed a notable challenge.

When it comes to medical criteria, they can also vary according to the state and the program. In most cases, the applicant will require a Nursing Facility Level of Care. 

Fortunately, you can help your loved one receive the care they need with a life care plan created by a qualified professional. This set of documents is super useful as it offers a comprehensive analysis of the current and future costs of medical care. It is used to provide the necessary evidence for governmental care programs. 

If you require this service, reach out to OAS. We have been doing this since the early 70s and have helped many families receive their well-deserved benefits.

If time is of the essence, feel free to call us at 800-292-1919 or send us an email at info@oasinc.org. Don’t gamble with your loved one’s future - work with the best life care planning professionals.