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Medicaid Benefits And Long Term Care

What is Medicaid?

Medicaid is a state administered insurance program that helps people with low income pay for their medical costs. This may include help with Medicare premiums, copays, and deductibles. Medicaid can also pay for some services not covered by Medicare, including long term care services.

Specific eligibility criteria will vary by state. The information provided is a general guide to eligibility. Speak with your VA social worker or state Medicaid office to determine your eligibility.

The Medicaid website provides information about:

  • Eligibility and how to apply
  • How to locate a Medicaid office
  • How to use Medicare and Medicaid at the same time (dual enrollment)

Speak with your VA social worker or state Medicaid office to determine your eligibility.

Medicaid Eligibility for Long-Term Care Benefits

Long-Term Care Benefits

State Medicaid covers Nursing Home Services for all eligible people age 21 and older. Medicaid may also cover Home and Community Based Services for eligible persons IF their condition would require a nursing home without those services. Covered Home and Community Based Services vary by state. For example, some states cover Assisted Living Facility costs, while other states do not. Many states cover services to help you remain in your home, such as help with personal care needs or some chores (laundry, cleaning). Specific services should be discussed with your state Medicaid office or your VA social worker.

You must meet the eligibility requirements listed below to qualify for Medicaid Coverage for Long Term Care services:

  • General Eligibility:
    • Be 65 or older, OR under 65 with a permanent disability, OR blind
    • Be a U.S. citizen or meet certain immigration rules, and be a resident of the state where you apply
  • Financial Eligibility: Your income and items of value you may have (your assets except for the home where you live, one motor vehicle and personal belongings) determine whether you are eligible for Medicaid. Income levels and allowable assets vary by state. The income level is set on average (see a state-by-state comparison) at about 100% to 138% of the federal poverty level (varies by state), and the assets level is usually set at about $2,000 per person. Many people must pay for long term care services with their own resources until they spend enough so that they become eligible for Medicaid. This is also known as “spending down.”
  • Functional Eligibility: An assessment of your need for assistance with activities of daily living (also known as ADLs) will be completed by a health care professional. This assessment will review your functional eligibility for long term care and whether that care should be provided in a home and community based setting or a nursing home, as determined by your state. Examples of ADLs include:
    • Eating
    • Bathing
    • Dressing
    • Transferring to a bed or chair
    • Using the toilet
    • Caring for incontinence

States have different levels of coverage and eligibility for nursing home care and other home and community based services such as home health, personal care services and adult day programs.

Your Costs Under Medicaid

Your state may also require you to pay for some of your Medicaid covered services, if you have enough income to do so. This varies by state. Talk with your local Medicaid office to find out how this works in your state.

Helpful Websites

The Administration for Community Living provides details about:

  • Average costs of long term care services in each state
  • Options to help pay for long term care services

The Medicaid website provides details on how to apply for Medicaid benefits in your state. Contact your local Medicaid office for specifics on the application process.

Program of All-Inclusive Care for the Elderly (PACE)

PACE provides comprehensive medical and social services to certain frail, elderly people still living in the community. Most of the participants who are in PACE are dually eligible for both Medicare and Medicaid. The National PACE Association can assist in determining whether a PACE program exists in your area.

How do I enroll?

How do I enroll in Medicaid benefits?

To apply for Medicaid benefits in any state you need to:

  • Complete an application
  • Provide documentation of general and financial eligibility requirements

How do I enroll in Medicaid Long Term Care benefits?

  • Complete an application for Medicaid benefits
  • Complete a functional eligibility assessment as required by your state’s Medicaid program

Where do I get an application?

  • The application can be found at your local Medicaid office. Many states also provide Medicaid applications at aging/disability assistance agencies throughout the community.