How does Medicaid work with long term care?
For the sake of this website, we’re going to focus on the portion of Medicaid/MediCal that pertains to long term care expenses. Rules and services this benefit offers vary state by state. Make sure you consult with someone familiar with what benefits are available in your particular state and its requirements.
All states have a Medicaid program for individuals who need financial assistance in paying for a nursing home (sometimes called Long Term Care Medicaid). This benefit can provide funding for services including room and board, nursing care, personal care, and therapy services. Remember that Medicare covers some Skilled Nursing Facility (SNF) care under a rehab benefit, up to 100 days. If you do not meet Medicare’s requirements for the SNF benefit or you reached Medicare’s limit of covered SNF care, Medicaid may pay for this care, if you meet the assets and income requirements.
Medicare
Many people assume that Medicare covers the following services. While there are limited coverages for short-term care, Medicare does not pay for long-term care services.
Medicaid may be known by a different name in different states. Ex: CA: MediCal. TN: TennCare. MA: MassHealth. CT: HuskyHealth.
Medicare vs. Medicaid
Medicare is a federal health insurance program for almost everyone 65 or older, regardless of income, or for those under 65 who have been receiving Social Security Disability Income (SSDI) for at least two years. Medicare is made into four parts:
- Part A: Hospital insurance
- Part B: Medical insurance
- Part C: Medicare Advantage
- Part D: Prescription Drugs
Medicaid is a medical assistance program that helps people who cannot afford medical care to pay for some or all of their medical bills. Medicaid is a needs-based program administered by each state and pays medical bills with state and federal tax money. Two of the primary Medicaid programs are called Community Care Services Program (CCSP) and Nursing Home Medicaid (also called Long Term Care Medicaid).
Specific limitations under Medicare:
Medicare was not designed to pay all your health care expenses. It does not cover long term care expenses. Medicare provides limited coverage for skilled nursing care and for home health care. Medicare does not pay for personal care, such as eating, bathing, dressing or getting in and out of bed. Most nursing home care is not covered by Medicare.
Skilled nursing care limitations: Medicare pays for limited benefits in a skilled nursing facility approved by Medicare. If you need skilled nursing care as defined by Medicare.
Home health care limitations: Medicare pays for limited benefits for home health care services considered “medically necessary” by Medicare.
Considerationsin planning:
- A separate burial account, or funeral trust
- Asset protection planning
- Housing titles/deeds
- Income and asset limits vary by state
- There are many planning techniques, options, and variations, and everyone is unique. Contact us to discuss your options based on your particular circumstances.