Medicaid Long Term Care Eligibility

Established in 1965 as an amendment to Social security Act, Medicaid is a program of health insurance that is designed for people having low-income including those with children; or those of retired age; pregnant women or children with no income; and those people with medical bills that they cannot afford. This also includes people with disabilities who rely on supplementary income such as security income.

Managed and financed through a state-federal partnership, Medicaid has a wide range of federal requirements. In designing their program, states may have an extensive scale of flexibility. The authority to instigate eligibility standards, situate payment rates, and establish what kinds benefits to offer, including services, rest among the states.

It is a program originally designed to sponsor health care for the income-challenged families or individual. Today, Medicaid has developed into the primary long-term care services public payer for those who are not poor on conservative standards but cannot afford such treatments or care due to their ever increasing costs.

Certain categorical requirements must be met in order to qualify for Medicaid long term care eligibility.

Requirements for general Medicaid Eligibility – a general Medicaid recipient must be a certified state resident where they are applying, must be 65 years or older, must meet the United States citizenship or immigration rules and finally, must be disabled permanently.

Requirements for Functional Eligibility – through Medicaid, getting long term care services means that evaluation through a specialist is needed in order to determine if a patient is in need of long-term care. It is done together with your application with a different staff than those evaluating your financial qualification. It is also here where they determine if a patient would require nursing home care or if they are eligible for community- or home-based services.

Medical long term care eligibility in general, is verified upon knowing whether daily activities or tasks can be performed by the patient on their own or if support from someone else is considered necessary. Simple tasks such as getting around, eating, taking a bath and getting dressed, as well as getting undressed, and more, if still achievable on their own, Medicaid may not grant you their functional eligibility criteria. Thus meaning you would not be granted no matter what your financial status may be.

Requirements for Financial Eligibility—a person’s income and their assets will both be evaluated in order to be eligible for Medicaid. Although some assets are disqualified, some are still considered. Even though your income’s assessment is clear-cut, your assets’ assessment is reasonably much more complicated. Although every state has different levels for assets, they have the alternative to raise the least amount. In some places, a person may only be able to retain about $2,000 countable assets, while married couples may only have about $3,000. On the other hand, if a spouse is in a foundation or institution while the other is still residing in the community, he or she is allowed by the federal state law to maintain more assets.