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Everything You Need to Know About LTC Medicaid

Expenses haunt the minds of everyone while providing long-term care (LTC) regardless of the type of care. Medicaid is a health insurance program for people of all age groups with low incomes to handle the financial crisis conveniently. Medicaid offers medical care like in-home personal assistance, physician visits, nursing care, and medical and non-medical support services. Medicaid enrollment for long term care pays almost the entire long-term cost, or a majority of it in a situation where a senior citizen of the USA is medically and financially qualified.

Medicaid Enrollment for Long Term Care- Eligibility Requirements

The Medicaid enrollment for long term care has requirements dependent on the individual’s age, Medicaid program, and state of residence. Though numerous eligibility rules apply in the USA for Medicaid long-term care service, you must know the basic rules to reap its benefits. To be more specific, the eligibility criteria are:

  • Financial qualification
  • Medical & functional needs
  • Being 65 years old or older
  • Permanent disability
  • Blindness
  • Citizenship

Financial Need Eligibility Requirements

Various states in the USA calculate the financial status differently when determining the eligibility for Medicaid’s long-term care. But as a base rule, an elderly individual’s assets and income are the common considerations. However, they have a few limitations regarding the qualification. An applicant will be able to qualify for Medicaid with careful planning when their asset or income exceeds the limits.

A. Medicaid Income Limits

There are two approaches in the USA to find out if a person meets Medicaid income limits. They are:

  1. Income cap states called categorically needy
  2. Non-income cap states called medically needy

People generally have a low-income limit when applying for personal long-term care or support. However, this differs depending on the state where the person is residing. According to income cap states, when a person is over the income limit, they can still opt for Medicaid enrollment for long term care. Whereas non-income cap states always permit people to qualify for Medicaid even when their income is beyond the limit. If their medical bills are high, they can spend their income over the Medicaid limit on medical care, assistance, or bills. By doing so, i.e., once they use their income to the MNIL or medically needy income limit, they become eligible for Medicaid for the remaining spend-down phase. This period usually ranges between one to six months and varies for different states in the USA.

B. Medicaid Asset Limits

Financial resources play a significant role in determining eligibility. Resources are categorized into:

  • Countable assets
  • Non-countable or exempt assets

When determining the countable assets, there are several exclusions. The applicant’s primary home, jewelry, furniture, vehicle, and clothing fall under non-countable assets. A senior person is considered experiencing a “Medicaid Gap” when their financial assets exceed the Medicaid eligibility requirement and their income fails to cover the long-term care charges. A few individuals may “spend down” their assets onto long-term care during such circumstances to become eligible. An important fact to bear in mind here is that it is not advisable to sell or give away the assets to meet Medicaid’s asset limit below the current market value. When the look-back period (past asset transfers for five years before the application date) is violated, it might lead to Medicaid ineligibility. The norm is that married couples can have a higher asset limit when one of the partners is not making Medicaid enrollment for long term care. It is an added value beyond the asset which the applicant partner can have. The non-applying partner is known as “community spouse”.

Medical & Functional Need Eligibility Requirements

The Medicaid enrollment for long term care process has eligibility requirements with a medical need, which varies from one state to another in the USA. An individual must have home nursing care to gain an institutional LTC service charge from Medicaid. Usually, medical specialists in every state conduct an assessment to determine the applicant’s medical needs. The assessment finds out if the patient requires an assisted living facility, nursing home, or home & community-based service (HCBS). The HCBS is more like an adult daycare or in-home service.

The eligibility requirement for the functional needs of an applicant is analyzed with a similar assessment. This assessment identifies the applicant’s ability to perform the day-to-day activities in life called ADLs. The daily activities include bathing, eating, using the toilet, dressing, and moving from one place to another. But it is always difficult to identify and quantify cognitive abilities. Eventually, by evaluating the patient or applicant, the specialists calculate the level of assistance required for them. In most cases, special allowance is given for senior citizens with long-term care needs in their nursing care requirements. Some of the conditions which befall the special category with the Medicaid enrollment for long term care are:

  • Alzheimer’s disease
  • Parkinson’s disease
  • Dementia
  • Other neurodegenerative conditions

Benefits & Services of Medicaid Enrollment for Long Term Care

Medicaid long-term care benefits are not affected by the Affordable Care Act, while the Medicaid enrollment for long term care differs between several programs and various states of the USA. A few of the benefits are stated below.

  1. In all states of the USA, Medicaid pays for nursing long-term home care if the facility is certified by Medicaid.
  2. The Medicaid programs are increasing in number with assisted living care. It is believed that it will grow until assisted living becomes available nationwide. However, Medicaid does not bear the expense of room in assisted living communities.
  3. Medicaid enrollment for long term care covers programs like adult foster care or nursing home care which are open to its beneficiaries. These include programs similar to assisted living but not exactly assisted living. It offers an identical experience and is often considered an alternative to the assisted living option.
  4. Medicaid operating in all the states of the USA with HCBS Medicaid waivers or through other regular programs of Medicaid cover adult day care and adult day health care. A few states do not cover adult day health care but cover adult day care and vice versa. However, certain states prefer to cover both.
  5. Medicaid and HCBS Medicaid waivers and a few personal care assistance programs cover home health care. Some waivers pay for non-medical home care and several chore services too.

How to Apply and Enroll for Medicaid Long Term Care?

If you are looking to apply for Medicaid long-term care for yourself or a beloved one, you must contact the Area Agency on Aging in your state. Seeking help for Medicaid enrollment for long term care from a reputed and knowledgeable law attorney will give you a better insight into enrolling and applying without any hiccups. If you want to know Medicaid policies specifically for a state in the USA, you must visit or contact any local Medicaid agency.

Last But Not Least

Medicaid applications are processed within 45 days after receipt and in 90 days, when determining disabilities in applicants. The initial paperwork for the application process will take some time, and so it is recommended to add a buffer time to the standard time limit while applying for Medicaid. You should be aware of the point that Medicaid will not transfer its policy from one state to another. Thus, re-applying procedures are always complicated. Reach out to CoverMe, the best front-end RCM solution provider that guides you through the Medicaid application process.

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