The Medicaid Alphabet for Seniors

The Medicaid Alphabet for Seniors

The Medicaid Alphabet for Seniors

Medicaid is one of the most complex and confusing areas of the law, and I often think that it is intentionally set up to prevent people from qualifying or to discourage them from trying to qualify. It is a government medical program for the poor.

Medicaid is often confused with Medicare, which is the federal government’s medical program for seniors. Almost all senior citizens qualify for Medicare as long as they have contributed to the system during their working lives. For those seniors who don’t qualify, they have the option to “buy into” the system by paying premiums set by the federal government. Medicare benefits are limited; thus, seniors can purchase Medigap or Medicare supplemental insurance policies that pay benefits where Medicare leaves off.

Medicaid, on the other hand, is a joint program between the federal government and the states to provide medical care to the poor. As such, it is regulated first by Congress, then by state legislatures. These lawmakers have set the standards by which Americans and permanent residents (and only those classes of persons, not “illegal aliens,” to dispel rumors) can qualify for government-paid medical care. While qualifications may vary from state to state, there are a few concepts that apply across the board.

Although Medicaid has programs for indigent people of all ages, my law practice concentrates 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 needy seniors. Most people are aware of 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 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 know about is nursing home care, called “chronic care Medicaid” in New York and “institutional care Medicaid” in Florida. If a person becomes so infirm that they cannot perform certain activities of daily living (ADLs), it is not safe for them to live at home, and they need medical assistance, they may need constant care in a nursing home. Contrary to popular belief, Medicare (the program for the elderly) does NOT pay for nursing home care; pays only for limited “skilled nursing care,” often performed in a nursing home with rehabilitation facilities. A good Medigap policy will pick up where Medicare leaves off, paying up to 100 days in full for skilled nursing care.

However, if an elderly person needs ongoing care in a nursing home, they will either have to pay for it out of pocket, with long-term care insurance, or by qualifying for Medicaid. For those who can afford to pay for their own nursing home care, congratulations to you. For those who own or intend to purchase long-term care insurance policies, be smart shoppers: These policies typically pay a set daily rate (part of the full daily rate, especially over time) for nursing home care for a set period of time (usually only a few years) and often do not take effect until the individual has been in the nursing home for so many days. It is important that you read these policies carefully and understand them

The last option, Medicaid, is for the poor or those who have modest assets. Whether a frail senior citizen will be eligible for Medicaid to pay for nursing home care depends on whether they have done prior Medicaid planning or whether their current financial situation immediately qualifies them. Sometimes a person must “spend down” some of their assets before they qualify, although there are certain ways some assets can be protected.

If you or a loved one would like to learn more about Medicaid and proper planning for future eligibility, make an appointment with an elder law attorney who can review your financial picture and develop a strategy to help you meet your future needs.

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