Medicaid Long-Term Care

Medicaid provides health care coverage to many low-income Americans, and long-term care is part of that care made available from Medicaid. Nursing homes, assisted living, hospice and home health care are all available to individuals who qualify for services.

Eric Estevez, Independent Licensed Life Insurance Agent
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    Eric Estevez

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    Lamia Chowdhury, editor for RetireGuide.com

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    Michael Jones

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  • Published: August 9, 2023
  • Updated: October 24, 2023
  • 5 min read time
  • This page features 5 Cited Research Articles
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How to Cite RetireGuide.com's Article

APA Estevez, E. (2023, October 24). Medicaid Long-Term Care. RetireGuide.com. Retrieved May 22, 2024, from https://www.retireguide.com/retirement-life-leisure/healthy-aging/costs/medicaid/

MLA Estevez, Eric. "Medicaid Long-Term Care." RetireGuide.com, 24 Oct 2023, https://www.retireguide.com/retirement-life-leisure/healthy-aging/costs/medicaid/.

Chicago Estevez, Eric. "Medicaid Long-Term Care." RetireGuide.com. Last modified October 24, 2023. https://www.retireguide.com/retirement-life-leisure/healthy-aging/costs/medicaid/.

Key Takeaways
  • Medicaid offers long-term care services to those who qualify.
  • To qualify, you must meet certain financial requirements and reside in the state you’re applying in.
  • Although Medicaid is a state-by-state issue, there are some federal commonalities.
  • The application process is available online.

Does Medicaid Cover Long-Term Care Expenses?

Medicaid covers long-term care services among qualifying children, adults and seniors. Medicaid long-term care services, as described by their website, aims at achieving inclusiveness, accountability, transparency, sustainability and competency.

The program is aimed at providing health coverage to those individuals or groups who, by definition and qualification, cannot provide health care for themselves. Medicaid offers comprehensive long-term care to both seniors and low-income families.

However, there are still low-income individuals who require long-term care but don’t immediately qualify for Medicaid due to income or asset limits. So, it’s important to note there are asset planning strategies that can generate Medicaid eligibility if properly planned for and executed.

Be as accurate and truthful as you can on your application for Medicaid. In most states, Medicaid will look back up to five years to see any assets you have transferred when determining your eligibility. If Medicaid determines that you have done this fraudulently they can penalize you by not paying for your long-term care.

Eligibility Requirements for Medicaid Coverage

Medicaid eligibility varies from state to state, but there are certain eligibility requirements that are common across most states. Federal law requires certain demographics that include low-income families, qualified women in pregnancy, medically needy individuals and children, according to the list of Medicaid Eligibility Groups.

To be eligible (no matter what state you’re in), you’ll need to meet both financial and nonfinancial requirements.  Financial eligibility will be based on ones modified adjusted gross income. This method considers taxable income and tax-filing relationships. Those who are blind, disabled or over 65 are exempt from these requirements.

Nonfinancial eligibility requires the individual to reside in the state they choose to apply in. They must also be citizens of the USA or be a qualified noncitizen. An example of a qualified noncitizen would be permanent residents.

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What Types of Long-Term Care Are Covered?

Be sure to research your specific state’s coverage and limitations. Whether you’re sure or unsure of your research, it is good practice to call your state Medicaid office or consult with an industry expert, starting with your state Department of Insurance.

Your local insurance broker or financial advisor may be an industry professional, though make sure they practice in the long-term care area, so you can leverage the experience they have with past or present clientele.

Medicaid offers institutional long-term care, which includes but is not limited to hospital services, intermediate care facilities, nursing facilities and inpatient psychiatric services for individuals under 21.

The institutions include residential facilities and comprehensive care with room and board. The program also provides home- and community-based care. These provide the opportunities for beneficiaries to receive care in their own living settings. Medicaid offers an extensive list of mandatory benefits on their website.

Common Types of Long-Term Covered by Medicaid
Nursing Home Care
Covers nursing care, 24-hour supervision, meals and assistance with activities of daily living.
Home Health Care
Health services provided in the beneficiary’s residence, typically provided by certified nursing assistants.
Assisted Living Facilities
A facility where health professionals assist beneficiaries with their daily care. Typically, this comes at a lesser capacity than the skilled nursing home care.
Hospice Care
Defined as nursing, social services, physician services and counseling services for the terminally ill.

How To Apply for Medicaid

To apply for Medicaid, you’ll have to visit Medicaid.gov and click on the Medicaid tab from the menu on the top of the page. You’ll see an icon that is titled “Learn How To Apply for Coverage.” This page will direct you to your eligibility requirements, how to get your Medicaid cards, how to contact your state, and how to check on the status of your Medicaid application.

The first link on the page will say “Apply Now.” Follow that link and it will prompt you to choose your state of residence. Remember, you can only apply in the state you reside in. Each state will have a link labeled “Enrollment.” This will take you to your state portal where you can start a new application.

Before you apply, you should have your personal details in order, such as your Social Security number. Also, gather your employer and income information for everyone in your household. This should include your paystubs and tax forms.

Sometimes, the state agency can come back and request more information such as proof of income or citizenship verification. After processing the application, be sure to understand you will receive a decision in writing.

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FAQs About Medicaid and Long-Term Care

How much do you have to pay before Medicaid takes over?
According to Medicare.org, Medicaid will require beneficiaries to incur debt equal to the deductible before benefit payments begin. That amount will vary by state, as many parts of the program can. Medicaid will then cover all qualified expenses above your deductible, as long as treatment is provided by an approved medical professional.
How does Medicaid define a need for long-term care?
According to Medicaid.gov, the need for long-term care is defined as disabling conditions and chronic illnesses.
Is there an age requirement to sign up for Medicaid?
One must be 65 years old to apply for Medicaid, unless your situation falls into a covered group such as low income, qualified pregnant women, or children. A full list can be found on the official Medicaid website.
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Last Modified: October 24, 2023

5 Cited Research Articles

  1. Senior Planning.org. (n.d). South Carolina Medicaid Long Term Care Eligibility for 2023 Retrieved from https://www.seniorplanning.org/long-term-care-medicaid-eligibility/south-carolina/
  2. Medicaid (n.d). Medicaid. https://www.medicaid.gov/medicaid/index.html
  3. Medicaid (n.d). Long Term Services & Supports. Retrieved from https://www.medicaid.gov/medicaid/long-term-services-supports/index.html
  4. National Institute on Aging (n.d). Residential Facilities, Assisted Living, and Nursing Homes. Retrieved from https://www.nia.nih.gov/health/residential-facilities-assisted-living-and-nursing-homes
  5. Medicaid (n.d). Mandatory & Optional Medicaid Benefits. Retrieved from https://www.medicaid.gov/medicaid/benefits/mandatory-optional-medicaid-benefits/index.html