Medicaid Long-Term Care Guide

NIH Approved Resource Helps You Navigate Benefits Nationwide

Every state has different rules around Medicaid eligibility. We have a resource that can help you navigate benefits nationwide. Getty Images

If you’ve begun your search for Medicaid long-term care benefits then you’ve undoubtedly discovered how complicated the whole process is. Of course, there are state offices you can call, but half the time they’ll redirect you to another office that will then give you another phone number. And don’t even get me started on the headache you’ll have if you’ve sent in an application without all the necessary forms and qualifications.

All is not lost, however, because the team at Senior Planning has put together a nationwide Medicaid long-term care guide. We’re listed on the National Institute if Health's (NIH) list of resources so you can rest assured the information is accurate.

After receiving numerous calls to our office from out-of-state clients, we were surprised to find out that a nationwide Medicaid guide does not exist anywhere on the web. Furthermore, states fail to update their Medicaid pages and even when they do, it is nearly impossible for someone to find what they are looking for if they are inexperienced in the matter. We found the information by digging into state legislation, calling state ombudsman offices repeatedly, and digging deep into government sites.

Each state has individual financial and medical requirements and although there are federal minimums they have to meet, depending upon where you live, there may be extra rules.

Our aim in making this guide was to lay the groundwork for you before you begin your application process. Armed with some knowledge, your application will hopefully be expedited and you’ll be more aware of whether you can qualify in the first place, before fruitlessly wasting your time.

First off, we need to clarify what is meant by “Medicaid long-term care benefits.” Medicaid’s long-term care services differ from general Medicaid because long-term care benefits are only given to people who need care at the nursing home level.

Many people believe they need long-term care, but unless they qualify under Medicaid’s strict medical requirements, they may not be able to receive benefits. Before qualifying medically, the state will send someone out to do a medical examination.

Some states grade applicants on a point scale while other states simply check whether or not a person can perform necessary activities of daily living (ADLs). No matter which state you are applying in, dementia, Alzheimer’s disease, and other forms of memory degeneration are given extra weight in determining eligibility. The ADLs that are considered most imperative are: bathing, transferring, eating, toileting, and dressing. Sometimes states include medication management and meal preparation, which are considered instrumental activities of daily living (IADLs). The medical examination serves two purposes, determining eligibility and devising a service plan. If a person meets enough functional impairments or needs they will be given medical eligibility.

Next, and equally as important as the medical portion, is financial qualification. Before taking any steps towards applying you should organize your financial records. Each state has unique monthly income limits so you’ll have to see the guide to be sure, but usually the limit is around $2000/month. For married couples there is more flexibility in both income and asset levels because generally, one spouse will remain out of long-term care (community spouse) and there is something called community spouse impoverishment protection.

Beyond income, Medicaid is concerned with assets as well. Medicaid divides assets into two categories: exempt and available. Each state has unique assets that are exempt and they are specifically designated under the state’s rules. Ownership of an exempt asset does not disqualify an applicant from receiving benefits. It should be noted, however, that all fifty states have a look-back period of sixty months, which means the state can see if you’ve transferred assets in order to meet their qualifications. Gifting assets, putting them into someone else’s name, selling them below fair market price, or transferring them to others will disqualify an applicant. What an applicant can do though, is liquidate their assets and use that cash to fund long-term care. Once that money runs out the state will step in and begin paying for care. Basically, all money and property, and any item that can be valued and turned into cash, is an available asset unless it is specifically listed as exempt. Each state has different exempt assets, trusts, property allowances, and long-term care insurance rules so again; you’ll need to see your state’s page on our Medicaid guide for specifics.

Describing each state’s individual qualification processes is beyond the scope of this blog post so please use our Medicaid guide as an assistive tool to determine the kinds of care and programs that may be available in your state.  Also, it’s worth mentioning that not all homes or facilities accept Medicaid long-term care so you’ll have to do some extra research before deciding on where to relocate. There are many agencies and local elder care experts that will work with you for free to help you decide on a location that is most appropriate for your needs.

Max Gottlieb is the content manager for Senior Planning. Senior Planning provides free assistance to seniors or the disabled and specializes in long term care; which includes finding and arranging care services, transitioning people into new living situations, and applying for state and federal benefits.

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