Medicaid Long-Term Care Services

Medicaid long-term care options are available to all qualified Medicaid recipients who pass the functional assessment and are deemed eligible to receive Medicaid assistance.

Long term Medicaid differs from Medicare in that Medicaid will pay for custodial care in nursing homes and at home. Nursing facility services and home health services are both mandatory Medicaid benefits that the Centers for Medicare and Medicaid Services require all states to offer.

The Medicaid long-term care eligibility factors include the general Medicaid eligibility requirements you should know, plus what are called functional assessments to determine your need for long term care. You will have to apply for Medicaid, if you do not already have coverage, and then also prove your need for such services. Medicaid and long term care go hand-in-hand these days, with over 20 percent of total annual Medicaid spending going toward long-term services and support in 2015. The facilities and the programs are there for you if and when you need them.

About Long Term Medicaid

Medicaid long term care services help millions of citizens of all ages who need assistance due to disability or chronic illness. Whether you require at-home care, community-based care or institutional facilities, Medicaid long term care facilities and funding can help ensure you receive the solutions you need and deserve. Children and adults who require assistance due to disability or illness have options through Medicaid services, as do aging adults who need more full-time care and assistance with daily tasks.

Long-term Medicaid services include both medical and non-medical assistance to meet health and daily life needs. These are called Activities of Daily Living (ADL), which are used as a baseline to determine an individual applicant’s need for long-term services. These ADL tasks can include the following:

  • Bathing
  • Dressing
  • Using the toilet
  • Transferring to or from a bed or chair
  • Caring for incontinence
  • Eating

In determining your need for long term Medicaid service, you will be evaluated on those ADL functions. You can find out more about that testing in the eligibility section below. More and more Citizens who require long-term assistance want to receive that type of care at home for as long as possible. Medicaid does offer at-home services coverage, but that option is also based on your functional eligibility and abilities.

Medicaid Long Term Care Eligibility

Your eligibility for long-term Medicaid services starts with your overall eligibility for the Medicaid program. Your eligibility is primarily based upon your total household income and assets, with other factors like your citizenship, state residency, age and family status also considered. After you are deemed eligible for Medicaid in general, you can also request an eligibility determination for your long-term care.

For Medicaid eligibility for long-term services, your level of care required must be equivalent to that received at a nursing facility. That is the baseline judgment made against which your functional assessment will be evaluated. A local medical specialist, such as a nurse or a social worker will evaluate your needs and decide if you do require long-term care services. If you need assistance performing certain ADL functions, then the specialist will usually base a determination based on that fact.

If you do not meet the Medicaid functional eligibility criteria for long-term care services, then you will not receive any assistance, regardless of your financial eligibility. If you do meet the general requirements for Medicaid, then you can still receive assistance with other medical needs.

Related Article: Medicaid Eligibility

Note that different states will have different eligibility factors for long-term Medicaid care. The only way to confirm your state Medicaid agency’s exact eligibility requirements and application requirements is to contact them directly or review their specialized information online, if your state has those details available. In addition to differing eligibility and application criteria, what your state actually covers for long-term care can differ from other states, too. For example, only some states offer coverage for assisted living. Be sure to confirm your options with your local agency before making any commitments.

Medicaid Long Term Care Application

Getting Medicaid long term care requires you to apply for Medicaid according to your state’s requirements first, and then your state can evaluate your disability status after confirming that you are eligible for the program. That is the functional assessment part of your Medicaid long term care application and eligibility determination. Whether you submit your application for assistance on your own or you have someone help you, an in-person interview will likely be required to confirm all of your details. If the Medicaid agency determines that you are eligible, you will receive a letter with your date of eligibility and the amount you must pay toward the cost of your care.

If you find that you need long-term care with Medicaid, you should apply as soon as possible because it can take up to 90 days to make a determination for your eligibility and disability status. For the most part, the date you become eligible is based on the date you apply for Medicaid, assuming you meet all of the eligibility requirements when you apply.

Medicaid Long Term Care Facilities

The Medicaid long term care facility and home care options include a variety of services and levels of care, depending on your current and future needs. Most long-term care is provided at home for as long as possible. This might mean that a family member or friend provides unpaid care or that a professional nurse or home care aide comes to your home to offer assistance.

Beyond the home-based long-term Medicaid services, you could also take advantage of community-based care, including adult day care service centers, specialized transportation services and home care agencies that provide services on a daily basis or as needed. These types of community-based services are often designed to supplement your at-home care provided by family or friends.

Nursing homes are a long-term Medicaid facility option that can provide the most comprehensive care with 24-hour nurse availability and constant supervision. Assisted living and continuing care retirement communities are other facility options offering long-term care services at various levels that you may need over time.

For official purposes in Medicaid long-term care documentation, the word “institutional” refers to the benefits provided via the Social Security Act. These institutions can include the following:

  • Hospital services
  • Intermediate Care Facilities for People with Intellectual Disability (ICF/ID)
  • Nursing Facility (NF)
  • Preadmission Screening & Resident Review (PASRR)
  • Inpatient psychiatric services for individuals under age 21 years old
  • Services for individuals age 65 or older in an institution for mental diseases

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