Medicaid Long Term Care Coverage

Medicaid is a health insurance program intended for individuals and families of low income and limited financial resources, including low income families with children; aged, 65 and older, blind or disabled individuals on Supplementary Security Income (SSI); low income pregnant women and children; and people with especially high medical bills. It is administered and funded through a state-federal partnership; wherein the broad federal requirements for Medicaid still leave room for flexibility for each state to plan and execute their program with regards to establishing eligibility guidelines, benefits and the services they cover and payment rates.

Eligibility for Medicaid varies from one state to another but generally, once a person receives Supplementary Security Income, he or she is likely to qualify for Medicaid. If, on the other hand, you are not receiving SSI but have extremely low income, you may still be able to qualify for Medicaid.

All states are required to cover inpatient and outpatient hospital care, laboratory and x-ray services, doctor’s services, routine check-ups, diagnosis and treatment of children, family planning and skilled nursing and home health services.

Nearly all recipients of Medicaid long-term care come from the aged, blind and disabled group of people; these are the individuals who need assistance with life’s daily activities. Medicaid long term care coverage includes institutional or nursing facility care, and home and community-based services. This is where medical providers give the needed care and assistance to a disabled or aged individual in his or her own home or that of a relative’s, instead of in a nursing home or hospital. While many people opt to be cared for in their own home, those who have more extensive conditions and medical needs are best cared for in nursing homes. On the other hand, spending for home and community-based Medicaid services has been growing. In April 2009, a report by insurance company Genworth showed that a private nursing home room costs $74,208 per year or $203 a day.

If Medicaid covers in-home care for a patient, Medicaid-licensed home care agency personnel are assigned to visit the Medicaid beneficiary to assist with non-medical needs and perform medical tasks. Depending on the patient’s needs and medical condition, the frequency and length of the visits and the type of care and assistance provided would vary. In some states and in some cases, Medicaid can pay the beneficiary directly for the required in-home care, and he or she can then pay whoever he or she wants to provide the care needed; this may include family members if the beneficiary and the family member have agreed on this arrangement. This kind of program is called Cash and Counseling.

The amount that a beneficiary receives with Cash and Counseling depends on an assessment made by Medicaid of a person’s needs and the pay-rate for in-home care aides in their state. The recipients can then use the money to purchase items for their homes that would provide comfort for their daily living activities, such as safety equipments or even modify homes to accommodate wheelchairs and the like. Sometimes, the money may also be used to pay for cleaning services, meal deliveries and transportation.

Cash and Counseling is considered a better option for most than in-home care through an agency, as many in-home care agencies are overextended with high worker turnovers. This can sometimes mean that in-home care visits become inconsistent, with caregivers changing almost every time.