Medicaid

Americans are living longer and longer, into their 80s and 90s, while the costs of healthcare continue to rise. And long-term care especially, whether in an assisted living facility, nursing home, or continuing care facility is extremely expensive; in 2009 the cost for a room in a private nursing home was more than $76,000 a year. While you may believe that your long-term healthcare costs will be covered by programs such as Medicare, the fact is that many seniors rely on a combination of government assistance, private insurance, and community services to get by.

Medicaid is a state and federally run program designed to help low-income individuals, and it is the country’s largest financer of long-term care services. Medicaid for the elderly helps to pay for Medicare premiums and other healthcare costs not covered by Medicare. Eligibility for Medicaid for seniors varies from state to state, but each state has the same basic requirements. Often, in order to qualify for Medicaid for assisted living, seniors have to spend or use up of their own assets. If you have sufficient income and assets to pay for your own long-term care, it might not make sense to “spend down” your assets simply to qualify for Medicaid.

To qualify for Medicaid, you must be 65 years old or older, or permanently disabled or blind, be a U.S. citizen or legal immigrant, and be a resident of the state where you apply for senior Medicaid. All or your sources of income such as bank accounts and real estate will be taken into consideration before it is determined you need of long-term care. A specialist will evaluate whether you need skilled nursing home care or if you would be better suited for home- or community-based services. The need for long-term care is usually based on whether you can manage the activities of daily living alone or if you need help. These activities include things like bathing, dressing, using the bathroom, and eating meals. If you don’t meet the criteria, even if you are poor, you cannot receive long-term care under Medicaid. If you are eligible for Medicare and Medicaid, you can use both programs. Once Medicare has paid for what it covers, the remainder of the bill will go to Medicaid.

The Program of All-Inclusive Care for the Elderly (PACE) is an optional benefit under Medicare and Medicaid developed especially for older people who meet their states’ requirements for nursing home care. Under PACE, you can receive a full range of medical and social services provided at an adult day health facility or other facilities. These services allow many patients to live at home while receiving medical care. PACE provides primary care and social services, restorative therapy, personal care and support services, nutritional counseling, meals, and recreational therapy. You can only participate in PACE voluntarily in the states that have chosen to offer the program under Medicaid. If you enroll in PACE, you may have to pay a monthly premium, depending on your eligibility for Medicare and Medicaid.