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Long Term Care and Medicaid


Medicaid is a government program that pays for certain health care services and nursing home care for older people with low incomes.

Medicaid Coverage and Medicaid Benefits for Nursing Homes and Community Services

Medicaid coverage includes physician fees, hospital and long term care costs. Additional coverages include drugs, equipment and transportation.

Medicaid benefits for nursing homes includes room and board and long term care health services. In most states, Medicaid coverage also extends to some community and home based long term care services. Medicaid benefits for community services usually only covers health care services. Rent, food, utilities and taxes have to be paid by the recipient out-of-pocket. Medicaid in some state may leave allowances that are too small and many recipient are forced to go to a nursing home instead.

Medicaid Eligibility for Nursing Home Expenses

Both federal and state guidelines for income and personal assets must be met for Medicaid eligibility. If you have substantial income and assets and still qualify for the program, Medicaid law usually requires you to spend down your assets on health care each month before Medicaid pays.

Financial Medicaid eligibility for nursing home and community waiver may require recipients to be receiving Supplemental Security Income (SSI) payments. If the recipient is qualifying under alternate income rules and receive no SSI payment, the recipient can have no more than $2,000 in resources.

Resources are defined as any asset that can be used to produce income. Some states may not count your home and a car when determining Medicaid eligibility. However, Medicaid may subject these non-income producing assets to estate recovery upon the death of the recipient.

Recipients that gift away their assets are subject to a lookback period usually within 36 months of a community waiver or nursing home stay and will be counted as resource. Irrevocable trust assets created 60 months prior to the nursing home stay will also be counted as an asset or resource and may be subjected to the spend down requirements.

Each state has different laws about how much money and assets you can keep and still be eligible for Medicaid benefits. Contact your state Medicaid office, department on aging or state department of social services for more specific Medicaid information, Medicaid requirements and for Medicaid application.

To get an idea how much long term care insurance costs, get a free long term care insurance quote online.

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