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Medicaid…..Yesterday and Today

Medicaid is a joint federal and state system of health insurance for those requiring financial assistance within the U.S. It is the government’s version of long-term care insurance and is a safety net for those who can’t pay for healthcare. It was originally established by the federal government and is administered by individual states for their own programs, according to federal requirements in order to help needy families. It provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, elderly adults and people with disabilities. The federal government covers approximately 50 percent of those individuals needing long-term care. History Medicaid was created in 1965 under Title XIX of the Social Security Act, and was enacted at the same time the Medicare program was passed, Since its inception, the Medicaid program went from originally providing health insurance only to welfare recipients, to a safety net program for around 74 million people today who are in need of healthcare assistance.


As of this year, Medicaid covers 1 in 5 Americans, including many with complex and costly needs for care. A large percentage of Medicaid enrollees lack access to other affordable health insurance. It covers a broad array of health services. It also limits enrollees and out-of-pocket costs. It also provides about one-fifth of all personal health care spending in the U.S. It covers financing for hospitals, community health centers, physicians, and nursing homes.

Medicaid Eligibility

The program rules for who can be eligible for Medicaid, including the services that are covered, are based on federal guidelines. However, states are given some flexibility in what is offered in Medicaid coverage with their programs. Since states are required to cover certain groups of individuals, they do have the option to cover additional services due to the allowance of eligibility rules and services varying state to state. Those who meet eligibility must meet certain requirements, among which is having income that does not exceed the levels issues by the particular state they live in. Once the state determines if someone is eligible for Medicaid, a determination will also be made if that person is also eligible for Long-Term Care (LTC) services.

Long-Term Care Coverage

Medicaid covers Long-Term Care (LTC), which entails services and supports necessary to meet health or personal care needs over an extended period of time. A long-term facility, also referred to as a Nursing Home or Convalescent Care Facility, provides general nursing care to those who are chronically ill or unable to take care of daily living needs. Most long-term care services assist people with Activities of Daily Living, such as dressing, bathing and using the bathroom. It can be provided at home, in the community, or in a facility. LTC helps meet health or personal needs services, which include medical and non-medical care for people with a chronic illness and disability. Payment for LTC services are for those who meet Medicaid eligibility because they require a level of care equivalent to that received in a nursing facility. LTC insurance is designed to offer financial support to pay for those services. Applying for LTC services There is a look pack period, which entails a five-year period, to a person’s application for Medicaid payment for LTC services. A Medicaid state agency will determine if any transfers of assets of have taken place during that period of time that would disqualify the applicant from receiving Medicaid benefits for a period of time, referred to as “the penalty period.”

Care in Your Home

When you live at home and not at a facility, the Medicaid program refers to you as living “In the community, and Medicaid will still cover certain services if you qualify. There are many states which provide a program entitled “Home and Community Based Services.” Prior to 2007, a state that provided coverage for those living outside of a nursing home needed to apply for a specific “waiver” of the usual Medicaid rules. Since then, the states are authorized to provide the program without having to obtain a waiver. Those seeking coverage still would need to verify with their state’s HCBS programs, which can be limited to certain kinds of disabilities and location they reside in. State may also cover those who currently reside in a nursing home with the option of living in the community. They would have the same level of care, as well as be covered be covered by Medicaid.

Assisted Living

Under an HCBS program in most states, there Medicaid coverage can pay for certain services even if you live in an assisted living facility. The facility must be “Medicaid certified,” so you it’s important to make sure of that requirement when looking to move into a facility. Also, it’s important to note that the facility’s cost of basic room and board will not be covered by Medicaid as it would be in a nursing home.

Nursing Homes

Medicaid typically will cover the full nursing home bill. This includes room, board and all nursing care costs. Even though 58 percent of all nursing home beds in the U.S. are filled by patients on Medicaid programs, not every nursing home accepts Medicaid payments. It’s very important to know if a nursing home accepts Medicaid patients before choosing one. It is against the law to for a nursing home too evict a patient if they run out of money and m us transition from private pay to Medicaid. However, this would not apply for a nursing home that does not accept Medicaid. It becomes difficult for a nursing home resident to switch to another facility once they have become adjusted to a nursing home for good. They have made friends and have become accustomed to routines and the nurses who give them care. Another important factor to note is that a specific federal regulation requires nursing homes to offer the same exact policies an provide equal services to all residents regardless of how the bill get paid. Staff members typically will not have any knowledge of which patients pay the facility through Medicaid and which ones pay privately. *The Medicaid office in your state will provide information about qualifying and applying for Medicaid, including qualifying for long-term care services.

Cited Sources:

How to Protect Your Family’s Assets from Devastating Nursing Home Costs: Medicaid Secrets 2016 Edition (K. Gabriel Heiser, Attorney). 10 Things to Know about Medicaid: Setting the Facts Straight; (Henry J. Kaiser Family Foundation (KFF) - Robin Rodowitz, Rachel Garfield and Elizabth Hinton);