The ABC’s of Medicaid for Seniors
Medicaid is one of the most complicated and confusing areas of the law, and I often think it’s done deliberately to keep people from qualifying or to discourage them from trying to qualify. It’s the government’s medical program for the poor.
Medicaid is often confused with Medicare, which is the federal government’s medical program for seniors. Almost all seniors qualify for Medicare, as long as they have contributed to the system during their working lives. Those seniors who do not qualify have the opportunity to “buy” the system by paying premiums set by the federal government. Medicare benefits are limited; therefore, seniors can buy “Medigap” or Medicare supplement insurance policies that pay benefits where Medicare ends.
Medicaid, on the other hand, is a joint program between the federal government and the states to provide health care to the poor. As such, it is regulated first by Congress and then by state legislatures. Those lawmakers have set the standards by which Americans and permanent residents (and only those classes of individuals, not “illegal aliens,” to dispel a rumor) can qualify for government-paid health care. While qualifications can vary from state to state, there are several concepts that apply across the board.
Although Medicaid has programs for poor people of all ages, my legal practice focuses on the elderly and those are the programs I focus on. Depending on the state, Medicaid may offer nursing home care and/or home care for seniors in need. Most people are familiar with nursing home care programs, but home care programs, if they exist in your state, can offer a great alternative to nursing home care. New York, for example, offers nursing home care and also has an ambitious “community” or in-home Medicaid program; Florida, on the other hand, offers nursing home care and leaves it up to individual counties to provide whatever type of home care they can afford.
The program most people are familiar with is nursing home care, known in New York as “Chronic Care Medicaid” and in Florida as “Institutional Care Medicaid.” If a person becomes so sick that they can’t do certain activities of daily living (ADLs), it’s not safe to live at home, and they need medical help, they may need ongoing care in a nursing home. Contrary to popular belief, Medicare (the program for seniors) does NOT pay for nursing home care; It only pays for limited “skilled nursing care,” which often takes place in a nursing home with rehabilitation facilities. A good “Medigap” policy will pick up where Medicare leaves off, paying for up to 100 days total for skilled nursing care.
However, if a senior needs permanent nursing home care, they will have to pay for it out of pocket, with long-term care insurance, or by qualifying for Medicaid. For those who can afford their own nursing home care, congratulations to you. For those who own or are contemplating buying long-term care insurance policies, be smart shoppers: Those policies generally pay a fixed daily rate (a fraction of the full daily rate, especially over time) for nursing home care. nursing home for a set period of time (usually just a couple of years) and often don’t take effect until the person has been in the nursing home for that many days. It is important to read those policies carefully and understand them.
The last option, Medicaid, is for the poor or those with modest assets. Whether a sick senior will qualify for Medicaid to pay for nursing home care depends on whether they did advance Medicaid planning or whether their current financial status immediately qualifies them. Sometimes a person has to “spend” some of their assets before qualifying, although there are certain ways that some assets can be protected.
If you or your loved one are interested in learning more about Medicaid and proper planning for future qualification, make an appointment to see a senior attorney who can review your financial situation and strategize to help meet your needs. future.