The ABC’s of Medicaid For the Elderly

Medicaid is one of the most complicated, confusing areas of the law, and I often think it is deliberately made so in order to keep people from qualifying or to discourage them from attempting to qualify. It is the government medical program for the poor.

Medicaid is often confused with Medicare, which is the federal government medical program for the elderly. Almost all senior citizens qualify for Medicare, so long as they have contributed to the system over their working lives. For those seniors who do not qualify, they have an opportunity to “buy into” the system by paying premiums set by the federal government.

Benefits under Medicare are limited; thus, seniors may purchase “Medigap” or Medicare supplement 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 for the poor.

As such, it is regulated first by Congress, 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 medical 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 law practice concentrates on the elderly and those are the programs upon which I focus. Depending on the state, Medicaid can offer nursing home care and/or at-home care for seniors in need.

Most people are aware of nursing home care programs, but at-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 at-home, Medicaid program; Florida, on the other hand, offers nursing home care and leaves it to the individual counties to provide whatever type of at-home care they can afford.

The program most people are aware of is nursing home care, referred to in New York as “chronic care Medicaid” and referred to in Florida as “institutional care Medicaid”. If a person becomes so infirm that they cannot perform certain Activities of Daily Living (ADLs), they are unsafe living at home, and they need medical assistance, they may need permanent nursing home care.

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 up to 100 days in full for skilled nursing care.

If a senior needs permanent nursing home care, however, they are either going to have to pay for it out of their own pocket, with long-term care insurance, or by qualifying for Medicaid. For those who can afford to pay for their own nursing home care, kudos to you.

For those who own or are contemplating purchasing long-term care insurance policies, be a smart shopper: Those policies usually pay a set daily rate (a fraction of the full daily rate, especially over time) for nursing home care for a set period of time (usually only a couple of years), and frequently do not go into effect until the individual is in the nursing home for so many days. It is important to read those policies carefully and understand them

The last option, Medicaid, is for the poor or those who have modest assets. Whether an infirm senior citizen 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 an individual has to “spend down” some of their assets before they qualify, although there are certain ways in which some assets can be shielded.

If you or your loved one is interested in learning more about Medicaid and proper planning for future qualification, make an appointment to see an elder lawyer who can review your financial picture and devise a strategy to help you meet your future needs.

 

Medicaid for the Elderly: A Comprehensive Insurance Policy

Introduction:

As individuals age, the need for comprehensive healthcare coverage becomes increasingly important. Medicaid for the Elderly is a government insurance program designed to provide essential medical services to low-income seniors. This comprehensive policy offers coverage for a range of healthcare needs, ensuring that elderly individuals can access the care they require without facing financial hardship. In this article, we will explore the key features, eligibility requirements, and benefits of Medicaid for the Elderly.

I. Understanding Medicaid for the Elderly:

a. Definition: Medicaid is a joint federal and state program that offers health coverage to eligible individuals, including the elderly. Medicaid for the Elderly specifically focuses on providing healthcare services to seniors who meet specific income and asset criteria.

b. Coverage: Medicaid for the Elderly covers a wide range of healthcare services, including hospitalization, doctor visits, prescription drugs, long-term care, nursing home care, home health services, and preventive care.

II. Eligibility for Medicaid for the Elderly:

a. Age Requirement: Generally, individuals must be 65 years or older to qualify for Medicaid for the Elderly. However, some states have expanded eligibility to include individuals below the age of 65 who meet certain disability criteria.

b. Financial Eligibility: Eligibility for Medicaid is primarily based on income and assets. The specific income and asset limits vary by state, and individuals must meet these criteria to qualify. Some assets, such as a primary residence and personal belongings, may be exempt from consideration.

c. Medicaid Spend-Down: If an individual’s income exceeds the eligibility threshold, they may still qualify by using a “spend-down” provision. This allows individuals to deduct certain medical expenses from their income to meet the income requirements.

d. Look-Back Period: Medicaid has a look-back period during which they review an applicant’s financial transactions. Any improper transfers or gifts of assets made within a specific timeframe before applying for Medicaid may result in a penalty period of ineligibility.

III. Benefits of Medicaid for the Elderly:

a. Comprehensive Medical Coverage: Medicaid for the Elderly provides coverage for a wide range of healthcare services, ensuring that seniors can access essential medical care, including doctor visits, hospitalization, prescription medications, and preventive services.

b. Long-Term Care Services: Medicaid offers coverage for long-term care, including nursing home care, assisted living facilities, and home health services. This is particularly beneficial for seniors who require ongoing assistance with daily activities or have chronic health conditions.

c. Prescription Drugs: Medicaid for the Elderly includes coverage for prescription medications, helping seniors afford necessary medications to manage their health conditions.

d. Coordination with Medicare: Medicaid can work in conjunction with Medicare to provide additional coverage and fill gaps in Medicare benefits. This coordination is known as “Medicaid dual eligibility.”

IV. Application and Enrollment:

a. State Medicaid Offices: Medicaid programs are administered by individual states, and applications must be submitted to the respective state Medicaid office. The application process typically requires documentation of income, assets, residency, and age.

b. Medicaid Planning: Due to the complex nature of Medicaid eligibility, individuals may seek assistance from Medicaid planning professionals or elder law attorneys who can help navigate the application process and ensure compliance with regulations.

c. Open Enrollment: Unlike private health insurance plans, Medicaid enrollment is open year-round. Eligible individuals can apply for Medicaid at any time.

Conclusion:

Medicaid for the Elderly plays a critical role in providing comprehensive healthcare coverage to low-income seniors. This insurance policy offers a wide range of benefits, including medical services, long-term care, prescription drugs, and coordination with Medicare.

Understanding the eligibility criteria, benefits, and application process is crucial for elderly individuals and their families to access the healthcare they need and deserve. If you or a loved one is an elderly individual with limited financial resources, exploring Medicaid for the Elderly may provide the necessary support to ensure quality healthcare in the later stages of life.