How And When Medicaid Can Pay For A Nursing Home
Thomas J Catalano is a CFP and Registered Investment Adviser with the state of South Carolina, where he launched his own financial advisory firm in 2018. Thomas’ experience gives him expertise in a variety of areas including investments, retirement, insurance, and financial planning.
Medicaid was created in 1965 as a social healthcare program to help people with low incomes receive medical attention. Many seniors rely on Medicaid to pay for long-term nursing home care.
Most people pay out of their own pockets for long-term care until they become eligible for Medicaid. Though Medicare is an entitlement program, Medicaid is a form of welfareor at least thats how it began. So to be eligible, you must become impoverished under the programs guidelines, says Laura M. Krohn, a Rhode Island-based elder law attorney.
Let’s look at how the economics work, and how Medicaid can be used to pay for a nursing home.
What We Like About Pay Out Of Pocket
- No insurance premiums
- Might be hard to find a facility you can afford
- Could run out of money
Before choosing to pay out-of-pocket, check with your state to see if you’re eligible for Medicaid and if that would help with coverage. You should also carefully review your finances, talk to your family, and create a budget. You’ll want to choose service providers that you can afford long-term if you think you’ll need ongoing care.
Medicaid’s Benefits For Assisted Living Facility Residents
Assisted living facilities are a housing option for people who can still live independently but who need some assistance. Costs can range from $2,000 to more than $6,000 a month, depending on location. Medicare wont pay for this type of care, but Medicaid might. Almost all state Medicaid programs will cover at least some assisted living costs for eligible residents.
Unlike with nursing home stays, there is no requirement that Medicaid pay for assisted living, and no state Medicaid program can pay directly for a Medicaid recipients room and board in an assisted living facility. But with assisted living costs roughly half those of a semi-private nursing home room, state officials understand that they can save money by offering financial assistance to elderly individuals who are trying to stay out of nursing homes.
Local Elder Law Attorneys in Your City
City, State
As of 2019, 44 states and the District of Columbia provided some level of financial assistance to individuals in assisted living, according to the website Paying for Senior Care, which features a State by State Guide to Medicaid Coverage for Assisted Living Benefits that gives details on each states programs. According to the website, the Medicaid programs of Alabama, Kentucky, Louisiana, Maine, Pennsylvania, and Virginia are the only ones that provide no coverage of assisted living, although non-Medicaid assistance may be available.
For more about assisted living communities, .
Recommended Reading: What Is A Medicaid Advantage Plan
Impact Of Pet Therapy On Seniors’ Quality Of Life
The advantages of pet-therapy can be life-changing. For instance, if a senior decides to walk their pet, they enjoy cardiovascular exercise that is good for their health. Other simple acts of caring for their furry friends that include brushing, petting and feeding offer light activity and an avenue for staying engaged with the rest of the universe.
Because cats, dogs and other pets provide unconditional support, elderly citizens also feel like they are still needed while looking after their precious animals, which can translate to a greater sense of self-worth and purpose in their senior years.
The pets can also help with increased socialization, which is a huge plus during the post-retirement years, because this time can be quite a lonely time for many. Seniors can make strong friendship bonds with people who keep the same pets in the assisted living facilities.
The animals are also excellent icebreakers for people who may want to start conversations, but they do not know where to start. Some employees in the senior care homes agree that responsibility of caring for pets among retirees helps to build self-esteem.
Federal Requirements Specify That Each Nf Must Provide At Least:
- Nursing and related services
- Specialized rehabilitative services
- Medically-related social services
- Pharmaceutical services
- Dietary services individualized to the needs of each resident
- Professionally directed program of activities to meet the interests and needs for well being of each resident
- Emergency dental services
- Room and bed maintenance services
- Routine personal hygiene items and services
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Medicare Coverage Of Assisted Living
Medicare is not a free full-service medical plan, but rather a subsidized form of medical insurance for citizens who are at least 65 years old. In most cases, it will cover medical care, however most long-term living costs such as retirement homes, independent living communities and assisted care facilities will not be eligible. What Medicare will cover is any short term stay by a senior in a skilled nursing home, a rehabilitation community and even home-based care provided by a licensed therapist or nurse. There are also some HMOs that will cover additional senior services such as vision and dental care as well as cover the cost of their prescription medications.
Free Assisted Living Resources In Missouri
Missouri Association of Area Agencies on Aging
Missouri Association of Area Agencies on Aging, commonly shortened to MA4, serves seniors by implementing and endorsing programs that promote seniors physical, social and economic independence. Through MA4, seniors can receive important informational and educational resources and knowledge of local services, including meal delivery and transportation services, vaccine clinics and new legislation that may affect them.
Region 1
1078 Wolverine Lane, Suite J, Cape Girardeau, MO 63701 335-3331
106 West Young Street, PO Box 1078, Warrensburg, MO 64093 747-3107
809 North 13th St. P.O. Box 265, Albany, MO 64402 726-3800
815 North Osteopathy Street, Kirksville, MO 63501 665-4682
1121 Business Loop 70 East, Suite 2A, Columbia, MO 65201 443-5823
600 Broadway, Suite 200, Kansas City, MO 64105 474-4240
14535 Manchester Road, Ballwin, MO 63011 207-0847
1520 Market St. Room 4086, Saint Louis, MO 63103 612-5918
531 East 15th Street, P.O. Box 3990 , Joplin, MO 64804 781-7562
Through the states Veterans Service Program, accredited Veterans Service Officers provide support to seniors who served in the military and their family members. Seniors can consult their local office to find out if they qualify for income-based benefits and health care benefits that can help them cover the cost of assisted living.
4040 Rangeline Street, Suite 105, Columbia, MO 65202573-814-6206
Read Also: What Is The Difference Between Medicare & Medicaid
Recommended Reading: Medicaid Funded Home Care Services
Missouri Aged & Disabled Waiver
TheAged and Disabled Waiver offers in-home services to individuals aged 63 or over who have been assessed with certain impairments and unmet needs to the extent that they would require nursing home care in the absence of these services. The Department of Health and Senior Services, Division of Senior and Disability Services administers this program through an interagency agreement with the MO HealthNet Division.
Services
Services include: homemaker, chore, respite, home delivered meals and adult day care.
Eligibility
Practical Considerations
The Aged & Disabled waiver is available to seniors 63 and older, which is unusual for Medicaid waiver programs which usually have an age limit of 65. Further, the unique individual asset limit because of the status as a 209 state makes it harder for people to qualify because the income limit is lower than usual. Also, while the allowances and asset limits for the spouse are the same as Medicaid for nursing homes, the asset limit can be increased through the legal system, which is a unique feature to Missouris A& D Waiver.
Medicare Vs Medicaid Roles In Nursing Home Care
Medicare does cover nursing home careup to a point. If you are sent to a skilled nursing facility for care after a three-day inpatient hospital stay, Medicare will pay the full cost for the first 20 days. For the next 100 days, Medicare covers most of the charges, but patients must pay $185.50 per day unless they have a supplemental insurance policy. For day 101 and beyond, the patient pays all costs.
These rules apply to traditional Medicare. People on Medicare Advantage plans likely have different benefits
Some nursing homes wont accept Medicaid patients outright, but the law forbids them from throwing you out if you become dependent on Medicaid when you are in their care.
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Assisted Living Medicaid Policy
Unlike many states, Missouri does not allow Medicaid waiver coverage to be used in long-term care facilities for people with greater medical needs. However, for eligible Medicaid recipients who need a greater level of care than their facility is able to provide, the state does reimburse for personal care services, and also for advanced personal care services to aid residents with medical maintenance tasks. For people in need of skilled nursing care who have an income that is less than the monthly charge of their facility, the state may offer a cash grant to cover the difference.
Financial Eligibility For Medicaid
States have different rules regarding who qualifies for Medicaid, but usually you must have both very low income and very few assets . Even within a state, the financial eligibility guidelines may differ depending on whether you are covering nursing facility care or at-home care. Below, we discuss typical income limits and asset limits, but some states can veer drastically from the norm. For example, California is beginning to phase out asset limits entirely, and New York also has a much higher asset limit than most other states.
Read Also: What’s The Difference Between Medicaid And Medi Cal
Senior Services Of America: Find An Assisted Living Facility That Accepts Your Benefits And Adds To Your Quality Of Life
If youre seriously considering an assisted living facility as your next home, its important to find the right facility for you. Not only that, you need to find a facility that accepts your financial benefits.
That’s because some facilities accept Medicaid but can only offer so many rooms to Medicaid recipients, while others do not accept it at all.
Thats where Senior Service of America comes in.
Senior Services of America specializes in the management and operation of senior housing communities, including:
-
Independent living
Which Services Will Medicaid Cover
The types of services covered by Medicaid will vary based on state programs. But the typical services paid for by Medicaid for those in assisted living include:
- Personal care assistance, which includes help with dressing, bathing, toileting and eating
- Specialized home care services, including house cleaning, laundry, shopping for groceries and other essentials, and meal preparation
Read Also: Different Medicaid Plans In Texas
How To Sign Up For Home Health Care In Missouri
Step 1: Before you can sign up for CDS, you have to be eligible for Medicaid . If you are not currently on Medicaid in Missouri, call 855-835-3505 for information about how to enroll.
To be eligible for MO HealthNet, you must meet certain income, age, and asset requirements listed below:
â Own less than $4000 in assets if youâre married
â Have a total income less than $1198 per month if youâre married .
Note that some of your assets may not count toward your eligibility requirements. For example, the home that you live in permanently does not count as an asset if it is worth less than $585,000. And your vehicle and other personal items also donât count toward the total amount you own in assets.
Step 2: After you have enrolled in MO HealthNet, you can apply for at-home services through the Missouri Division of Health and Senior Services. This process will involve a pre-screening along with a home assessment to determine level of care and any other requirements that must be met in order for you to receive high-quality care.
â Bathing and personal hygiene
â Toileting
â Assistance with moving from place-to-place inside the home
â Laundry
â Taking medications at the appropriate time
â Cooking
â You must be above 18 years of age
â You must be a Missouri resident
When A State Can Recoup Benefits
After the Medicaid recipient dies, the state can try to recoup whatever benefits it has paid out. The home is usually the only major claimable asset. Currently, the state can only put a lien on it if it is part of the deceased’s probate estate. If the asset is jointly owned with a spouse or in a life estate or trust, then it can escape recovery.
In most states, the government can place a lien on the home after the death of both spouses, unless a dependent child resides on the property.
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Future Medicaid Claims Against Your Estate
Medicaid has the right to collect the entire amount it has spent on the long-term care of anyone age 55 or overwhether that care is home care or care in a long-term care facility. It most often recoups this money out of any assets in the Medicaid recipient’s estate at death. If assets have been lawfully transferred out of the Medicaid recipient’s name before death, without violating Medicaid’s transfer rules, those assets usually cannot be taken for Medicaid reimbursement. And if the recipient dies without any property left, that’s usually the end of the story the state will not ask the recipient’s heirs to repay the costs.
However, estate recovery practices and rules vary by state. For example, in some states, only assets in a Medicaid recipient’s “probate estate” can be used to reimburse the costs of care. And whether you might qualify for an exception from estate recovery will also vary by state. To find out the particulars of your state’s estate recovery procedures, find an experienced estate planning lawyer who has experience with Medicaid planning.
What Assisted Living Services Does Medicaid Cover
Not all states offer financial assistance for assisted living, and those that do rarely cover the full costs associated with it. States pick and choose what services they will cover for enrollees. That said, there are a few common services that Medicaid will typically pay for, at least in part. These include:
-
Case management
-
Registered nurses or health aides
While fees for room and board arent covered through Medicaid directly, some programs might cover the cost of food preparation and dining services, though not the food itself. In some states, like Ohio, Medicaid might also pay for recreational activities and housekeeping, as well as help families transition from rehabilitation facilities to assisted living facilities. Those who are eligible to receive Medicaid benefits might still need to pay a co-pay or some subset of the costs, even for services covered under the states program, says Tyler White, an elder law attorney at JacksonWhite Attorneys at Law in Mesa, Arizona.
As a rule of thumb, single Medicaid members are entitled to keep a personal needs allowance of about $115.00, White says.
The rest of their income goes toward covering their share of assisted living costs.
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Do Medicare Advantage Plans Help With Assisted Living Facilities
As mentioned above, Medicare Advantage plans typically dont cover custodial care in an assisted living facility, but they often offer additional benefits. For example, Medicare Advantage plans usually offer prescription drug coverage, and might offer coverage for routine vision, dental, and hearing services. Some plans even include membership in Silver Sneakers fitness programs. Please keep in mind that you are still responsible for your Part B premium if you choose to enroll in a Medicare Advantage plan.
If you need help understanding Medicare coverage and your assisted living options, Im available to answer your questions. Click one of the links below to schedule a phone call or request an email with information prepared just for you. You can check out plans in your area by clicking the Compare Plans button.
New To Medicare?
Becoming eligible for Medicare can be daunting. But don’t worry, we’re here to help you understand Medicare in 15 minutes or less.
Long Term Care 1915 Waiver Training Requirements
Long term care waiver providers are required by Administrative Code to ensure all staff meet training requirements as defined by the Division of Medicaid. The provider type specific memorandums linked below define the current training requirements for all direct care staff.
In an effort to streamline and standardize procedures across waiver platforms, along with reducing the burden on Medicaid providers, the Division of Medicaid would like to confirm the removal of the forty hour training requirement for Assisted Living Waiver direct care staff. The list of the required training topics to be covered in training can be located on the Medicaid website at Training Requirements for AL Waiver Direct Staff. The Division of Medicaid is in the process of updating the Administrative Code to reflect removal of the forty hour requirement.
Medicaid has partnered with the Person Centered Planning Institute and is excited to offer training on Person Centered Planning/Person Centered Thinking. If they have not already done so, PCPI will be reaching out to your agency with a schedule of courses offered and dates they are available. All AL case managers have attended this training and PCPI does an outstanding job presenting the material. You are strongly encouraged to avail yourself of this outstanding resource.
Thank you for all you do to serve our Medicaid population.
Recommended Reading: How To Tell If You Have Medicaid
How Do I Pay For Long
Many people think that Medicare will pay for their long-term care expenses, but this usually is not true. Instead, people have to rely on their savings, long-term care insurance or Medicaid to cover the costs.
And while Medicaid pays for the largest share of long-term care services, to qualify your income and assets must be below a certain level and you must meet the minimum state eligibility requirements. To find out if you might be eligible for Medicaid or to apply for benefits, visit the Your Texas Benefits website.
Note: Texas is required by federal law to have a Medicaid Estate Recovery Program. This means that if you received Medicaid long-term care services, the state of Texas has the right to ask for money back from your estate after you die. In some cases, the state may not ask for anything back, and the state will never ask for more money back than it paid for your services.
