There are many seniors today who have seen the benefits that can come with Medicare and their assisted living costs, but for many they still have a lot of questions about Medicaid. There are some complicated eligibility rules with Medicaid and senior care, but in many situations, Medicaid can actually step in and help seniors in need cover their care.
Medicaid isn't just a federal program, it is a joint federal and state program, meaning some states have flexibility when it comes to benefits and what they are able to offer. Some states may vary when it comes to eligibility criteria as well. Understanding what Medicaid may and may not cover can go a long way in helping seniors and their families make smart decisions about their future care plans.
Medicaid considers nursing homes and assisted living communities to be types of long-term care that can include both medical services and personal care for people with an illness or disability.
What Medicaid Can Pay For
In most states in the U.S., it is possible to have Medicaid pay for certain services related to a senior's long-term care. The most important thing to remember about Medicaid is that in order to qualify for benefits, seniors need to be "Medicaid certified" which means they are medically cleared to need certain benefits. This will be one of the major differences in what is covered and what is not covered by Medicaid.
In general, to qualify for Medicaid, a senior needs to meet the following requirements:
- They must meet general Medicaid eligibility requirement. This means being age 65 or older, or permanently blind and disabled. All Medicaid eligible seniors must also be U.S. citizens or qualify under immigration rules and be a resident of the state that they are applying in.
- The must meet functional requirements. This means having a medically-proven need for long-term care. A medical expert in the state the senior is living in must give them an assessment and evaluate what type of care the individual needs before they can qualify.
- The must meet certain financial requirements. Medicaid is need-based not only in terms of medical need but in financial need as well. Before qualifying, the state will assess a person's available income and their available assets to determine whether or not they qualify.
For example, Medicaid may cover some additional assisted living services for qualifying residents, but it won't cover room and board. This is because room and board for assisted living is considered a housing expense, not a medical expense. However, Medicaid may cover room and board for a nursing home. In fact, nursing homes are the most likely place where seniors will be able to get Medicaid support.
Before qualifying for any of these coverage options, all residents must have some type of medical proof from a doctor that they need this assistance. Medicaid patient will also have to meet certain financial eligibility markers as well. For example, some state have the option to offer Medicaid coverage to seniors with income up to 100 percent of the federal poverty level, which last year was around $11,770 per year per individual. However, that doesn't mean that all low-income seniors are guaranteed to be covered.
Medicaid and Dementia
One area where some seniors are seeing Medicaid help is when it comes to dementia care. Approximately 25% of seniors in America with dementia have Medicaid coverage. This is a stark contract to Medicare benefits, which provide services to most adults with dementia.
One of the biggest reasons that so many dementia patients do not have Medicaid coverage, is because the early stages of dementia care falls under what is known as custodial care, not medical care. This is personal care that can be provided by a non-medically trained staff member. It can including bathing assistance, supervision, help with day-to-day activities and even medication administration, but many times dementia patients do not need the help of a medically-trained professional to get the quality care they need.
In some situations, dementia patients can get assistance if they are receiving in-home care from a professional as a way to avoid moving into a nursing home or medically-based care facility. Dementia patients who go to adult day care programs while their family members or loved ones are at work during the day can often get Medicaid assistance as well as these day care centers are typically medically based and designed to help dementia patients keep their minds sharp and active longer.
Dementia patients that go to nursing homes will often get Medicaid coverage for their expenses, this is one area where seniors can often rely on Medicaid coming through to cover their costs. However, seniors who decide to go specifically to a memory care unit, will typically not get Medicaid support.
How to Determine Medicaid Coverage
Medicaid can be very confusing, and it is important to remember that in different states Medicaid can actually have a different name, such as MaineCare or MassHealth. This is not the only way that Medicaid varies from state-to-state. Each state also has its own Medicaid Waivers, which are specialty programs designed to help seniors who are not living in nursing homes. Many times, these programs come with waiting lists and enrollment caps, so while some people may qualify for extra Medicaid coverage while they are living in an assisted living facility, they may not receive these benefits right way.
So, how do seniors determine if they qualify for Medicaid in their state? They need to visit their local office. Medicaid differs so much, coverage almost always depends on a mixture of state-rules, a person's medical condition and their financial qualifications. All three of these things must align for someone to get approved for Medicaid. A person’s marital status does not impact their eligibility, neither does their status as a veteran.
Long-term senior care is expensive for all parties involved, and while the expenses can still be dramatic for many seniors and their families, there are some older adults that can ease this financial burden with Medicaid assistance. While Medicaid does not help all seniors, there are many who may feel they have no other options who can find Medicaid is just what they have been looking for to get the assistance that they need.