Medicaid Long Term Home Health Care Program


Your Options For Home Care And Other Longterm Care Services

Medicaid and Long Term Care Overview

Medicaid Managed Long Term Care

Managed Long Term Care Plans help provide services and support to people with a longlasting health problem or disability. These Plans are approved by the New York State Department of Health to provide Medicaid managed long term care.

A Plan can provide your Medicaid home care and other longterm care benefits. To get these services, you may be required to join a Plan.

This Guide tells you who must join a Plan, how the different Plans work, and other important things you should know. The Guide can also help you select a Plan.

New York Medicaid Choice We can help

New York Medicaid Choice is a State program. Counselors will answer your questions and assist you over the phone or TTY. If you have trouble reading or understanding this Guide, we can help. We speak all languages.

New York Medicaid Choice 18884016582 or TTY: 18883291541 Monday to Friday, 8:30 am 8:00 pm Saturday, 10:00 am 6:00 pm

This Guide is available on CD and in Braille

Eligibility Criteria For Colorado Medicaids Long Term Care Programs

To be eligible for Health First Colorado , a person has to meet certain financial and functional requirements. The financial requirements vary by the applicants marital status, if their spouse is also applying for Medicaid, and what program they are applying for Nursing Home / Institutional Medicaid, Home and Community Based Service Waivers or Aged Blind and Disabled Medicaid / Regular Medicaid.

Colorado Nursing Home Medicaid Eligibility Criteria

For married applicants with both spouses applying, the 2022 asset limit for nursing home coverage through Health First Colorado is $3,000 combined if the couple will live in separate rooms, and $4,000 combined if they will live in a shared room. And the income limit for married applicants with both spouses applying for nursing home coverage is $5,046 / month combined. For a married applicant with just one spouse applying, the 2022 asset limit is $2,000 for the applicant spouse and $137,400 for the non-applicant spouse, and the income limit is $2,523 / month for the applicant. The income of the non-applicant spouse is not counted.

Health First Colorado applicants are not allowed to give away their assets in order to get under the asset limit. To make sure they dont, Colorado has a look-back period of five years. This means the state will look back into the previous five years of the applicants financial records to make sure they have not given away assets.

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.

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What Does Medicaid Cover Regarding Long

Medicaid certified nursing homes deliver specific medically indicated care, known as Nursing Facility Services, including:

  • Skilled medical care/skilled nursing/related services
  • Rehabilitation for injury/disability/illness
  • Long-term health-related services needed due to a mental/physical condition

Medicaid coverage for Nursing Facility Services only applies to services provided in a nursing home licensed and certified as a Medicaid Nursing Facility . Availability is additionally limited to Medicaid-eligible persons who have no other payment options.

What Types Of Long

MassHealth Medicaid Exemption

Long-term care includes care provided at:

  • a nursing facility
  • an assisted living facility, and
  • home .

If you require long-term care and both your income and your assets fall below certain levels established by your state, then federal law requires your state’s Medicaid program to pay for nursing home care. In the past, this was the only type of long-term care covered by Medicaid. But in more recent years, states have also begun to cover at-home care and assisted living care through new pathways. Most commonly, coverage for HCBS is provided through a state “waiver” programso called because the program waives certain federal requirements that restrict states, and allows states to operate more freely.

All states now offer some level of benefits for use in home settings, but the breadth of coverage varies widely. For example, state waiver programs for home care do cover nursing care and home health aide services in your home, as well as physical, occupational, and speech therapy, but only some states will cover personal caremeaning assistance with bathing, dressing, eating, and using the bathroom.

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Determining Eligibility For Medicaid Long Term Care

Medicaid Eligibility Requirements FinderStart here

Regardless of the type of Medicaid program or the state in which a beneficiary receives it, there are two consistent eligibility criteria for Medicaid long term care. The individual must have limited financial resources and a documented need for care.

From a financial perspective, typically there are limits on monthly income, total countable assets and home ownership. These limits vary based on age, marital status, number of applicants in the family, state of residence and the specific type of Medicaid program. In addition, these limits change annually and, in some cases, twice annually.

Medical or functional eligibility criteria also vary by state and by type of Medicaid program. In all cases, the individual must be determined by Medicaid to require the type of care they are seeking.

Income Retained By A Nursing Home Resident

Once a long-term care facility resident qualifies for Medicaid and begins to receive benefits, that resident must contribute nearly all of their income to the facility. Medicaid will pay the balance of the bill for the costs of care. However, the resident can retain a small amount of income in the following forms:

  • a monthly personal needs allowance to spend on personal items such as books and magazines, clothing, vending machine snacks, and toiletriesusually ranging from $30 to $100 a month, though a few states allow more
  • out-of-pocket medical expenses not covered by Medicare or Medicaid, including income the resident spends directly on Medicare premiums, deductibles, and copayments,
  • a monthly home maintenance allowance during short-term stays in a facility , in which a resident can keep a certain amount each month for home maintenance expensessuch as repairs, mortgage payments, and property tax payments on the resident’s private homefor up to six months this allowance requires a doctor to determine that the resident will likely be able to return home within six months after entering the facility, and
  • a spousal allowance, if you’re married and your spouse would otherwise become impoverished .

Recommended Reading: How To Qualify For Medicaid In Nebraska

Ways To Become Medicaid Eligible When Exceeding The Limits

If you meet Medicaids medical criteria, but your income and / or assets exceed Medicaids financial limits, there may be other ways you can qualify for Medicaid LTC.

For those with high medical costs that exceed their income, you may be deemed Medicaid-eligible if your state offers a Medically Needy Pathway. About 60% of states offer this program. If you spend a lot of your income on LTC, Medicaid can deduct those costs from your income. If the remaining income is at or below your states income limit, youre considered financially eligible, regardless of your income.

A Qualified Income Trust allows an applicant to directly deposit into a QIT the portion of their income that exceeds Medicaids income limit. Excess income will no longer count toward Medicaids income limit. The money in the QIT must be controlled by a trustee, not the Medicaid applicant. QIT funds can only be spent for medical expenses, Medicare premiums, or LTC that are not covered by Medicaid.

Spending Down Assets, for persons who are over the asset limit can make you financially eligible eventually if you dont violate any of Medicaids spend-down rules. For example, its not permitted to give away assets. Its very important to get professional advice before you spend down your assets to avoid violating state rules. You will be denied Medicaid for an extended period if you violate the rules.

How Do I Pay For Long

Medicare & You: Nursing Home / Long-Term Care

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.

Also Check: What Kind Of Insurance Is Medicaid

How Does Pace Work

PACE covers all Medicare- and Medicaid-covered care and services, and other services that the PACE team of health care professionals decides are necessary to improve and maintain your health. This includes drugs, as well as any other medically necessary care, like doctor or health care provider visits, transportation, home care, hospital visits, and even nursing home stays when necessary.

If you have Medicaid, you wont have to pay a monthly premium for the longterm care portion of the PACE benefit. If you have Medicare but not Medicaid, youll be charged a monthly premium to cover the longterm care portion of the PACE benefit and a premium for Medicare drug coverage . However, in PACE, theres never a deductible or copayment for any drug, service, or care approved by the PACE team of health care professionals.

Aged Blind And Disabled Medicaid

Where Nursing Home Medicaid offers full-time care in an appropriate facility, and HCBS waivers allow you to receive that level of care outside of a nursing home, ABD Medicaid can best be thought of as an expansion of regular Medicaid. Think Medicaid health insurance expanded for aged, blind of disabled persons. One qualifies for each service and support separately as opposed to the suite of services one receives in a nursing home.

ABD Medicaid is not referred to by the same name in every state, but states typically use a variation on that state such as Aged or Disabled , the ABD Pathway, Elderly, Blind and Disabled, or EBD.

Typically, ABD Medicaid programs do not offer the same wide range of services and supports that are provided under nursing homes or waivers. In most states, care is limited to home health care and personal care assistance or attendant care.

Every states ABD Medicaid program is an entitlement, so just like with the Nursing Home Medicaid, if you meet the eligibility requirements, the state must pay for the benefits. Its not like waiver programs that have a cap on the number of participants. More on ABD Medicaid eligibility.

Recommended Reading: Medicaid Long Term Care Virginia

Homemaker And Personal Care Services

Home health agencies offer homemaker and personal care services that can be purchased without a physician’s order. Homemaker services include help with meal preparation and household chores. Personal care includes help with bathing and dressing. Agencies do not have to be approved by Medicare to provide these kinds of services.

Find a Medicare-certified home health agency in your area.

Choices For Care Program

Medicaidâs Coverage of Nursing Home Care

Choices for Care provides a package of long-term services and supports to Vermonters who are age 18 years and over and need nursing home level of care. People who need nursing home level of care typically require extensive or total assistance on a daily basis with personal care. Eligible people choose where to receive their services: in their home, in their familys home, an Adult Family Care home, Enhanced Residential Care or nursing facility. People must meet a clinical and financial eligibility for long-term care Medicaid in Vermont.

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What Is Long Term Care

The Centers for Medicare and Medicaid Services says LTC is for Americans who need long-term care services because of disabling conditions and chronic illnesses. Meaning the need for assistance can be due to normal aging or illness and disability.

Long term care differs from regular care in that 1) the need is ongoing and 2) the care is not necessarily medical care. Long term care includes medical care but also includes non-medical care such as assistance with activities of daily living. Activities of Daily Living are the things we do throughout a typical day: eat, bathe, brush our teeth, walk from one room to another, go to the bathroom, get dressed, etc. Someone who cannot perform these activities of daily living is unfortunately unable to live independently.

Another term critical to understanding Long Term Care is Nursing Facility Level of Care . This is the level of care typically provided in a nursing home. For comparison purposes, this is a lower level of care than is provided in hospitals. Because Medicaid programs are provided through state offices, each state has its own definition of Nursing Facility Level of Care. In most states there is an NFLOC score that measures the following: ability to perform activities of daily living like eating and bathing cognition or thinking ability mobility continence

What Does Florida Long Term Care Medicaid Cover

Older Floridians usually come to me because they need help paying for home-health care, assisted living facility care, or skilled nursing home care . As a quick reminder, my elder law firm focuses on helping its clients in South Miami, Kendall, North Miami, Aventura, Hallandale, Hollywood, Davie, Plantation, Pembroke Pines, Brandon, and Tampa get the government to pay for about15-40 hours a week of home health care or approximately $1,400.00 – $1,500 toward an ALF bill or the lions share of a semi-private room in a nursing home.

After I’m done protecting their assets and qualifying my clients for Medicaid’s long-term care benefits, they begin to realize and appreciate the additional bonus services that come with being qualified for Medicaid . For example, it’s nice when my clients, who are seeking home health care or ALF care, realize that they get a little extra cash in their bank account each month .

My elder law attorney / medicaid planning clients are further pleasantly surprised when they are enrolled in a Medicaid long-term care plan and find out that Florida LTC Medicaid covers so much more. The Florida Medicaid program that helps pay for home health care and ALF care is often referred to as the Florida “Medicaid Waiver” Program.

Read Also: How Much Can You Make To Be Eligible For Medicaid

What Are The Different Types Of Home

Home-based long-term care includes health, personal, and support services to help people stay at home and live as independently as possible. Most long-term care is provided either in the home of the person receiving services or at a family member’s home. In-home services may be short-termfor someone who is recovering from an operation, for exampleor long-term, for people who need ongoing help.

Most home-based services involve personal care, such as help with bathing, dressing, and taking medications, and supervision to make sure a person is safe. Unpaid family members, partners, friends, and neighbors provide most of this type of care.

Are you a long-distance caregiver? See When It’s Time to Leave Home.

Home-based long-term care services can also be provided by paid caregivers, including caregivers found informally, and healthcare professionals such as nurses, home health care aides, therapists, and homemakers, who are hired through home health care agencies. These services include: home health care, homemaker services, friendly visitor/companion services, and emergency response systems.

Asset Transfers And The 5

Program aims to keep seniors out of nursing homes

If you’re spending down your assets to qualify for Medicaid, you can’t just give away all of your money to your family to qualify for Medicaid faster. Beware of a major Medicaid rule limiting your ability to transfer assets: Any asset transferred out of your name during the “look-back period” can result in a penalty period during which you are not eligible for Medicaid.

The look-back period is usually 60 months , counting back from the date of your Medicaid application. The exception is California, whose look-back period is halved: 30 months . Some states also have more lenient look-back periods for HCBS coverage as opposed to nursing facility coverage for example, New York historically did not have a look-back period for HCBS, though in 2022 it began phasing in a look-back period of 30 months .

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Medicaid Benefits And Requirements

Unlike Medicare, which is largely a federal program, Medicaid is primarily state-run, resulting in varying degrees and types of long-term care coverage. Generally speaking, for qualifying people, Medicaid covers custodial care in a nursing home in all states. Custodial care is for when you can’t perform some or all of the activities of daily living without assistance:

  • Eating
  • Mobility
  • Continence

Medicaid evolved during what was called the war on poverty in the 1960s as a program for the truly poor the indigent population surviving on less than about 125% of the official poverty level.

Medicaid generally requires you to be unable to perform at least two of these six ADLs independently, much like long-term care insurance policies. If you qualify for Medicaid by meeting the ADL requirement and your state’s income and asset requirements, you can probably use Medicaid to pay the entire cost of care in a nursing home.


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