What is long-term care Medicaid?

Long-term care Medicaid is the largest payer of long-term care, and it is used as a payment source for long-term care in a facility or at home.  Long-term care costs increase yearly, and an average stay at a skilled nursing facility is $8,515 a month.  Is it a wonder that Medicaid is the largest payer of this type of care.  The average person would not be able to sustain this high payment for long before depleting their assets.

Long-term care Medicaid is for those that meet the eligibility requirements. To qualify for long-term care Medicaid, you must meet the state income and asset limits to qualify for Medicaid and additional functional requirements to specifically qualify for long-term care services. If you or a loved one anticipates needing long-term care from Medicaid now or in the future, it may be worth your while to talk with a Medicaid planner sooner rather than later. This ensures you have the best chance of qualifying for long-term care Medicaid and not having to wait for a penalty period before services are covered.

To qualify for Medicaid long-term care services, an assessment is completed to determine your ability to perform activities of daily living (ADLs) on your own. The six ADLs are:

  • Eating
  • Bathing Dressing
  • Continence
  • Toileting
  • Transferring/mobility

The criteria used to determine impairment in cognitive abilities are often more challenging to define and quantify than the assessment of ADLs. They usually will look at how the cognitive impairment affects the six ADLs listed above.

To meet the eligibility criteria to receive Medicaid for long-term care, you will need to meet all requirements below.

  • Meet the physical criteria based on the assessment outlined above
  • Be 65 or older, have a permanent disability, or be blind
  • Be a US citizen or (qualified non-citizen)
  • Meet residency rules in your state
  • Meet the income and asset limits

If you meet all of the criteria, you will become eligible for long-term care services. Long-term care services include non-medical and medical care for those with either a chronic illness or disability. Medicaid long-term care services can be provided in various settings, including in an institutional facility. If institutional care is required, Medicaid beneficiaries must reside in a Medicaid-certified nursing facility.  You may also choose to receive services at home under one of the Medicaid waiver programs.   


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