Medicaid's Coverage of Nursing Home Care

Author

Entrusted Legacy Law

Posted on

Feb 24, 2023

Book/Edition

Pennsylvania - Greater Pittsburgh Area

Share This

For better and for worse, Medicaid is the primary method of paying for nursing home care in the United States. But navigating the Medicaid system is complicated and confusing. Here are the basics.


Medicaid (sometimes called by other names, such as "Medi-Cal" in California, "MassHealth" in Massachusetts, and "TennCare" in Tennessee) is a joint federal-state program that provides health insurance coverage to low-income children, seniors, and people with disabilities. In addition, it covers long-term care for those who qualify. This coverage has traditionally meant care in a nursing home, although coverage of care in an assisted living facility or at home are possible (see below).


In the absence of any other public program covering long-term care (Medicare provides only limited nursing home coverage), Medicaid has become the default nursing home insurance of the middle class. Lacking access to alternatives such as paying privately or being covered by a long-term care insurance policy, most people pay out of their own pockets for long-term care until they become eligible for Medicaid.


Each state operates its own Medicaid system, but this system must conform to federal guidelines in order for the state to receive federal money, which pays for about half the state's Medicaid costs. (The state picks up the rest of the tab.) This complicates matters, since the Medicaid eligibility rules are somewhat different from state to state and they keep changing. To be certain of your rights, consult with us to guide you through the complicated rules of the different programs and help you plan ahead.


While the majority of nursing homes accept Medicaid patients, there are some that don't. Even nursing homes that accept Medicaid recipients may only have a limited number of Medicaid beds available. Nursing homes must be certified by the state in order to accept Medicaid payments. Check with the facility before applying for admittance.


To qualify for coverage, applicants must have limited assets and income. You typically cannot have more than $2,000 in assets; the figure may be slightly higher in some states. To lower your assets, you need to spend them down by paying for things that benefit the Medicaid applicant. You cannot simply give away your resources in order to qualify for Medicaid. Income limits vary by state. In some states you can keep excess income in trust; in other states you must pay your excess income to the nursing home.


In addition to the strict income and asset limits, you must meet level of care requirements in order to qualify for nursing home coverage. Each state sets its own level of care criteria and the criteria is not always clear. The state looks at an applicants’ functional, medical, and cognitive abilities to determine if they need care in a nursing home. You're usually determined to need long-term care if you need help with two or more “activities of daily living” (such as bathing, dressing, eating, moving, and going to the bathroom). But to need a nursing home level of care, you may also need frequent medical care, such as assistance with medication, injections, IVs, or other medical treatment. The state may also consider your cognitive abilities—i.e., whether you have the ability to make decisions on your own.

Once you qualify for Medicaid, the program pays for all your basic expenses, but nursing home residents may be charged extra for certain amenities, like a private room, comfort items, or specially prepared food.


In addition to nursing home care, Medicaid may cover some home care services or in limited circumstances, care in an assisted living. Home care is typically provided through home- and community-based services "waiver" programs to individuals who need a high level of care, but who would like to remain at home. States vary widely on how to qualify and what's covered. Almost all state Medicaid programs will cover at least some assisted living costs for eligible residents.


To apply for Medicaid, contact your local Medicaid office. We can help you navigate the Medicaid process.


This article is a service of Sharek Law Office, LLC. We don’t just draft documents; we ensure you make informed and empowered decisions about life and death, for yourself and the people you love. That's why we offer a Life and Legacy Planning Session, during which you will get more financially organized than you’ve ever been before, and make all the best choices for the people you love. You can begin by calling our office today to schedule a Life and Legacy Planning Session and mention this article to find out how to get this $750 session at no charge. Please note this is educational content only and is not intended to act as legal advice.

Other Articles You May Like

Why Choose A Winter Respite At A Personal Care Home

Moving to a personal care home is a big decision based on many factors. Cold winter months are drawing near, and the Farmers Almanac is forecasting a Winter Wonderland for the northeastern United States. Keeping this in mind, and to avoid winter chores, this is a great time to consider a respite stay and experience first-hand what life is like living in a personal care home.Experience an easier moveWinter weather conditions like snow and ice can complicate the move to a personal care home. Moving before bad weather conditions arrive allows seniors to avoid potential weather-related delays, accidents or other challenges during transportation and when moving belongings.Try out the personal care homeRespite care offers seniors a chance to try out a retirement community without making a long-term commitment. Country Meadows offers all-rental retirement living accommodations, so seniors are not beholden to a lengthy lease or an ownership stake. A respite stay can help older adults see for themselves whether or not the community is a good fit for a permanent move.Avoid winter weather challengesMany older adults struggle with winter chores such as shoveling snow, chipping away ice, walking on icy sidewalks, managing heating systems and driving in inclement weather. A temporary respite stay at a personal care home eliminates these responsibilities, as well as many other daily chores, removing worries. It provides seniors the opportunity to settle into their new living arrangement without the added stress of winter weather.Access daily assistance and health servicesAlong with cold weather, the winter season can also bring several challenges for older adults to maintain wellness. A major benefit to living at a personal care home is prompt, easy access to health resources and assistance. This is especially beneficial for seniors with health concerns and mobility issues. If a resident requires assistance with medications, dressing, bathing or another daily activity, simply push a call button and a personal care associate can provide needed help. And a wellness team keeps an eye on each residents overall health.Reduce lonelinessMany seniors experience loneliness and isolation while living at home. The winter months can magnify these feelings. Respite care offers opportunities for social interaction and engagement with new neighbors and friends in the same age group, reducing feelings of loneliness and providing mental stimulation.Participate in activities, enjoy entertainment and outingsSenior living communities often offer a variety of enriching activities and events. At Country Meadows, our Vibe program considers each residents physical, cognitive, social and spiritual needs and customizes activities, entertainment, outings and purposeful service opportunities. Events are organized seasonally by categories and offer opportunities for socialization and fun. When living at a personal care home, one doesnt need to brave the elements outside, because all the fun during winter is happening indoors, fostering a sense of belonging among residents.Provide relief for family caregiversA respite stay offers a break for family members and friends providing care in a seniors private home. This break is especially appreciated during winter months when private caregiving responsibilities might become more demanding due to inclement weather, illnesses or holiday-related activities.When considering respite care at a personal care home or retirement community over the winter months, its important to do some homework. Families and seniors should research and visit potential facilities to ensure the community can meet specific needs and preferences of each individual. The decision for respite care should prioritize the well-being, comfort and specific needs of each person, aiming to provide a supportive and enriching experience.  Contact Country Meadows Retirement Communities today.

What You Must Know About Your Right To Your Spouse's Retirement

If youre part of a blended family (meaning you are married with children from a prior marriage in the mix), youre no stranger to the extra considerations and planning it takes to keep your familys life running smoothly from which parent your children will be with for the holidays to figuring out the schedule for a much-needed family vacation. Youve also probably given some thought to what you want to happen to your assets and your family if something happens to you. But what you might not have realized is this: If you dont create a plan for your assets before you die, the law has its own plan for you that might not reflect your wishes for your assets, especially your retirement assets. And if youre in a blended family, this can have a significant financial impact on the ones you love and even create expensive, long-term conflict.This week, we explain how the law affects retirement distributions for married couples, and why you need to be extra careful with your retirement planning if youre in a blended family to ensure your retirement account assets go to the right people in the right amounts after youre gone.Be Aware of How ERISA Affects 401K DistributionsIf youve remarried, you and your new spouse have probably talked about updating the beneficiary designations on your retirement accounts to reflect your blended family arrangement. (If you havent talked about it, you need to talk about it ASAP). Sometimes, people who are remarried decide to leave their retirement funds to their children from a prior marriage and leave other assets like their house and savings accounts to their current spouse. You may do this to avoid future conflict between your spouse and your children over your assets.But even if you want to leave your retirement for just your children, if youre married and your retirement account is a work-sponsored account, your children wont inherit the entire account even if you name them as the sole beneficiaries. Thats because the federal Employee Retirement Income Security Act (ERISA) governs most employer-sponsored pensions and retirement accounts. Under ERISA, if youre married at the time of your death, your spouse is automatically entitled to receive 50 percent of the value of your employer-sponsored plan even if your beneficiary designations say otherwise.The only time that your surviving spouse would not inherit half of your ERISA-governed retirement account is if your spouse signs an official Spousal Waiver saying they are affirmatively waiving their right to inherit 50 percent of the account, or if the account beneficiary is a Trust of which your spouse is a primary beneficiary. IRAs Have Different Rules Than 401KsIf you want your children to inherit more than 50 percent of your work-sponsored retirement benefits, and completing a Spousal Waiver isnt an option, consider rolling the account into a personal IRA instead.In contrast to 401(k)s and similar employer-sponsored plans, IRAs are controlled by state law instead of ERISA. That means that your spouse is not automatically entitled to any part of your IRA. When you roll a 401(k) into an IRA, you gain the flexibility to name anyone you choose as the designated beneficiary, with or without your spouses consent. On the other hand, if you want to ensure your spouse receives half of your retirement savings, make sure to include them as a 50 percent beneficiary or better yet, have your individual retirement account payout to a Trust instead. With a Trust, you can:Document exactly how much of your retirement you want each of your loved ones to receiveControl when they receive the funds outrightEasily update and change the terms of your Trust without having to remember to update your financial accounts.Beneficiary Designations Always Trump Your WillWhether you have an employer-sponsored 401K or an IRA you manage yourself, there is one critical rule that everyone needs to know: beneficiary designations trump your Will.A Will is an important estate planning tool, but most people dont know that beneficiary designations override whatever your Will says about a particular asset. For example, if your Will states that you want your retirement account to be passed on to your brother, but the beneficiary designation on the account says you want it to go to your sister, your sister will inherit the account, even though your Will says otherwise.Similarly, lets imagine that you get divorced and as part of your divorce decree your ex-spouse agrees that they will not have any right to your retirement fund. However, after the divorce, you forget to take their name off of the beneficiary designation for the account. If you die before updating the beneficiary designation, your former spouse will inherit your retirement account. If you forget to update your ERISA-controlled account and have remarried, your current spouse would receive half of the account and your former spouse would receive the other half. Thats why its so important to work with an estate planning attorney who can make sure your accounts are set up with the proper beneficiary designations and ensure that your assets are passed on according to your wishes.Work With An Attorney Who Makes Sure All Your Assets Will Be Passed On How You Want Them ToUnderstanding how the law affects different types of assets is essential to creating an estate plan. But theres more to it than just having a lawyer you need an attorney who takes the time to really understand your family and your assets so they can design a custom plan that achieves your goals for your assets and your legacy. Thats why we help our clients create an inventory of all of their assets to ensure that every asset they hold is accounted for and passed on to their loved ones exactly as they want it to.Contact Entrusted Legacy Law at 412-347-1731.

How Residents Are Transitioning From Independent Living to Assisted Living: Grace Pointe of Greeleys Continuum of Care

Life is a journey filled with transitions, and one of the most significant transitions many individuals face as they age is transitioning from independent living to assisted living. This transition can be a challenging decision, but it often becomes necessary when daily tasks and self-care become more difficult to manage alone. In this blog, we will explore the steps and considerations for patients and their families when making the move from independent care to assisted living, with a special focus on the Grace Pointe Continuum of Care difference.Assessing the Need for Assisted LivingThe first step in transitioning to assisted living is recognizing the signs that indicate a need for additional support. These signs may include:Difficulty with activities of daily living (ADLs) such as bathing, dressing, grooming, and meal preparationMemory problems or cognitive decline that impact safety and well-beingFrequent falls or injuries due to mobility issuesSocial isolation and lonelinessMedication management challengesThe need for regular medical supervision and assistance Open CommunicationOnce the need for assisted living becomes apparent and the process of transitioning from independent living to assisted living begins, it is essential to have open and honest discussions with the individual who will be making the transition. This may involve a family meeting or conversations with healthcare professionals. It is crucial to listen to the concerns and preferences of the person who will be moving, as their input should be valued throughout the decision-making process. Navigating the Continuum of Care with Grace Pointe: Your Assurance of a Smooth TransitionAs weve discussed earlier, the decision to move from independent care to assisted living, marking the transition from independent living to assisted living, is a significant one, and its natural to have concerns about the future. Many individuals and families worry about whether theyll receive the care they need as their health requirements change.At Grace Pointe of Greeley, we understand these concerns and are committed to ensuring a seamless transition through our Continuum of Care. Lets explore how Grace Pointes approach is different and how we provide residents with the assurance they deserve.The Continuum of Care Approach: A Personalized PathwayOne of the key features that sets Grace Pointe apart is our Continuum of Care approach. This approach is designed to help residents and their families identify their current care needs and anticipate future requirements. Ongoing assessments are done by our care team to help create a personalized care plan that evolves with the individuals changing needs. This means that residents at Grace Pointe who are looking into transitioning from independent living to assisted living are not locked into a specific level of care, and theres no need to worry about a dishonest bait and switch scenario.Heres how the Continuum of Care approach works:Initial Assessment: When a resident joins Grace Pointe, we conduct a thorough assessment of their health, preferences, and care needs. This forms the foundation of their care plan.Regular Reassessment: We understand that health can change over time. Thats why we commit to regular reassessments of our residents. If their care needs increase or decrease, we adjust their care plan accordingly.Transparent Communication: We foster open and transparent communication with our residents and their families. If a change in care level is required, we discuss it thoroughly and collaboratively.To provide you with a deeper understanding of the exceptional care and support offered at Grace Pointe of Greeley, we invite you to read testimonials from residents and their families who have experienced our continuum of care firsthand. These heartfelt accounts will shed light on the compassionate and personalized care that sets Grace Pointe apart in the journey and benefits from independent living to assisted living.The benefits of independent living at Grace Pointe of Greeley are clear; here, residents can enjoy a worry-free life without the burden of household maintenance while maintaining a healthy level of independence. Yet, when it comes to transitioning to higher levels of care, such as assisted living or nursing care, the process can be emotionally challenging for both loved ones and their families. This shift can be accompanied by mixed feelings, as it often involves adapting to new routines, healthcare requirements, and a shift in the level of autonomy. Grace Pointes Continuum of Care approach supports each transition without the need for residents to physically relocate. Instead, they add necessary services while remaining in their current living units, tailored to each individual and their family for the ultimate peace of mind.Your Peace of Mind at Grace Pointe of GreeleyAt Grace Pointe of Greeley, we are deeply committed to our residents well-being. The transition from independent living to assisted living should not be a source of anxiety. At Grace Pointe of Greeley, we go above and beyond to ensure that residents have peace of mind about their care journey. Experience the Grace Pointe difference through our Continuum of Care approach, where we tailor each transition, ensuring that your family member moves seamlessly from one living arrangement to another with care, compassion, and a deep sense of belonging.We understand that everyones care needs are unique, and we are dedicated to providing the right level of care at the right time, tailored to you and your familys needs. With Grace Pointe, you can be confident that you or your loved one will receive the care and support needed to thrive at every stage of life.

Local Services By This Author

Entrusted Legacy Law

Elder Law 100 Pinewood Lane Suite #303, Warrendale, Pennsylvania, 15086

Our Firm Prepares You for Life What makes our firm different is that we were built with the needs of growing families in mind. We understand you are BUSY, you are growing, you are planning for a life of prosperity and you value ease, convenience and efficiency. You are raising children, and caring for elderly parents, while also working hard to build your own nest egg for a lifetime of support. You want to know youve made the best decisions for your family and that your plan will work when your loved ones need it most. You want to make sure your minor children would be raised by the people you choose, and never by anyone you wouldnt want, and that your teens and adult children are properly prepared to care for you and what you leave behind.  You want to feel confident that youve made the right choices, and handled everything so that you arent leaving behind a mess, when something happens. That is our focus as well. Weve developed unique systems to give you the same access to a Personal Family Lawyer as was previously only available to the super-wealthy, so you can have the guidance you need to build and maintain a life of prosperity and wealth. And, to keep your family out of court and out of conflict, which is the greatest risk to the people you love and all you have created, even if youve already worked with a traditional lawyer or created documents online. Our Team Is Here for You We encourage communication with our clients. In fact, weve thrown out the time clocks so you never have to be afraid to call with a quick question. Everything we do is billed on a flat-fee basis, agreed to in advance, so there are never any surprises. We have a whole team to serve you. When you call our office to ask your quick question, you wont have to wait hours or days for a phone call back. Youll get your question answered, right away. And, if you need to schedule a more in-depth legal or strategic call with your Personal Family Lawyer, a call will be scheduled when you're both available and ready for the call so we can make the very best use of your time and not waste your time by leaving voicemail after voicemail back and forth. And, we ensure the most important details of your planning are followed through on and your plan continues to work throughout your lifetime. We have a funding coordinator to ensure your assets are owned the right way throughout your lifetime and none of your assets will end up going through a long, expensive court process or being lost to the state because they were missed after your death. Weve created unique membership programs to keep your plan up to date year in and year out as well as give you access to our Trusted Team of Legal Experts for guidance on ANY legal or financial matter. One day you will need a lawyer. I dont know why and I dont know when, but when you do, you will be grateful you can call on us and well be here to advise you or get you out of a jam. We Help You Transfer Your Life and Legacy Lastly, we believe your financial wealth is only a small part of your overall Life and Legacy Planning which is made up of your far more valuable and most often lost upon incapacity or death intellectual, spiritual and human assets. These assets are what make you who you are, and sum up whats most important to you. And, a survey of inheritors has revealed that what they care about even more than inheriting your money, is inheriting these intangible assets.   Most estate plans only focus on the transfer of your financial wealth to the next generation. Most people have such great intentions of passing on the intangible, but very few ever get around to it. Its just not a priority, until its too late. How much do you know about your grandparents values? Their most prized personal possessions? How they felt about you? What they had learned during their lifetime? If you are like most people, you know very little. Thats why we build the capture and passage of these most valuable assets into every estate plan we create. Not only will we help you pass on your money, but also your values, your insights, your stories and your experience the truly valuable assets your loved ones care about the most.  Weve developed a tool that allows us to capture and pass on your whole family wealth, including your Intellectual, Spiritual and Human assets.  I cant go into all of the details here, but well definitely talk about it when you come in for your Life and Legacy Planning Session.