The ABCs of Medicaid for the elderly

Medicaid is one of the most complicated, confusing areas of the law, and I often think it was made that way on purpose to prevent people from qualifying or discourage them from trying to qualify. It’s the government’s medical program for the poor.

Medicaid is often confused with Medicare, the federal government’s medical program for the elderly. Almost all seniors are eligible 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. Benefits under Medicare are limited; So seniors can buy “Medigap” or Medicare supplement insurance policies that pay benefits where Medicare leaves off.

Medicaid, on the other hand, is a joint program of the federal government and the states to provide medical care to the poor. As such, it is regulated first by Congress and then by the state legislatures. Those legislators 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 may vary from state to state, there are several concepts that apply across the board.

While Medicaid has programs for poor people of all ages, my law practice focuses on the elderly and those are the programs I focus on. Depending on the state, Medicaid may provide nursing home care and/or home care for seniors in need. Most people are aware of nursing home care programs, but home care programs, if they exist in your state, can provide a great alternative to nursing home care. For example, New York offers nursing home care and also has an ambitious community Medicaid program; Florida, on the other hand, provides nursing home care, leaving it to individual counties to provide whatever type of home care they can afford.

The program most people are aware of is nursing home care, referred to as “chronic care Medicaid” in New York and referred to as “institutional care Medicaid” in Florida. If a person becomes so weak that they cannot perform certain activities of daily living (ADLs), if they live in an unsafe home and require medical attention, they may require permanent nursing home care. Contrary to popular belief, Medicare (the senior citizen program) 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 picks up where Medicare leaves off and pays in full for skilled nursing care for up to 100 days.

However, if a senior needs permanent nursing home care, they will have to pay for it either out of pocket, with long-term care insurance, or through Medicaid eligibility. For those who can afford to pay for their own nursing home care, kudos to you. For those who have or are considering long-term care insurance, be a smart shopper: Those policies usually pay a flat 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 few years), and often do not take effect until the person has spent so many days in the nursing home. It is important to read and understand that policy carefully

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The last option, Medicaid, is for the poor or those of modest means. Whether an ailing senior citizen qualifies for Medicaid to pay for nursing home care depends on whether they have Medicaid planning ahead or whether their current financial status immediately qualifies them. Sometimes a person must “spend” some of their assets before they qualify, although there are certain ways some assets can be foreclosed.

If you or your loved one is interested in learning more about Medicaid and proper planning for future qualification, make an appointment with a senior attorney who can assess your financial situation and devise a strategy to help you meet your future needs.