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What is medicaid
Medicaid is a low-income assistance program jointly funded by Federal and State taxes. Medicaid provides health care coverage for low-income people and older adults. Some people can have both Medicare and Medicaid for health care coverage. Medicaid helps pay for premiums, deductibles, medications, equipment, personal care items such as incontinence products, transportation and other services for those who can’t afford to pay.
Medicaid is administered by each state according to federal government rules. That's why Medicaid eligibility requirements vary from state to state. People eligible for Medicaid coverage must meet strict income and asset guidelines.
Long-term care and medicaid
Medicaid helps pay for long-term care in settings such as:
People must apply for Medicaid assistance. To qualify, applicants must meet low-income standards, have limited assets AND have significant daily care needs.
ELIGIBILITY: income and assets allowed
In Oregon, a single person can make up to $2,205 per month (in 2017) in gross income to qualify for Medicaid. Asset requirements are usually limited to $2,000.00
If your income is slightly more than the allowed amount, you'll need an 'income cap trust.' See an elder law attorney. HERE
Applicants cannot give away or “gift” their property or assets. There is a 5-year look-back law. The application process requires proof of income. Medicaid workers search for any hidden or undeclared income. The Medicaid application requires bank records, bills of sale and financial documents.
To understand acceptable ways to "spend-down" assets, consult an Elder-law attorney. Pre-plan long before applying for Medicaid.
eligibility: assessed care needs
Part of the application process for Medicaid includes a needs assessment. A Medicaid worker collects medical history, diagnosis’ and documentation. Applicants must prove they need help with daily activities of living (ADLs). Assistance with the following are evaluated:
Each ADL is scored based on the amount of help needed. The combined total determines a person’s level of care. The care level determines the monthly reimbursement a care home or nursing home receives. The resident usually pays a basic Room & Board fee out of their monthly Social Security or Disability income.
Medicaid continues covering long-term care if a senior continues qualifying for care.
medicaid openings in long-term care
Many care facilities do not have contracts with the State and do not accept Medicaid payments - they accept private pay only.
Communities who do contract with the state and agree to accept the significantly lower payments cannot afford a high percentage of Medicaid recipients. This means many communities are already at maximum capacity for residents on Medicaid. In order to plan their future budgets, communities may require a financial statement to assess if a prospective resident has some private funds initially - this is called a "spend down".
Many families ask if they can "make up the difference" between private pay and the amount Medicaid pays; paying the difference to the community. The answer in NO. This practice is Medicaid fraud.
Accessing Medicaid takes significant pre-planning.
Please contact an Elder Law Attorney.
medicaid resources list
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