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The ABC’s of Medicaid For the Elderly

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.