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Duane Lipham
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Duane Lipham is a Certified Long-Term Care (CLTC) consultant who writes extensively on long-term...read more

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Comments For "The Facts: What Medicaid Pays for Long-term Care"
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9 Responses to “The Facts: What Medicaid Pays for Long-term Care”
  1. ShirleyB Says:

    Duane,
    thanks for writing so clearly about such a confusing topic. My family tried to get my father onto medicaid and it never happened before his passing. It's so complicated and I think we tried to do way too much on our own. Probably should have consulted a professional.

    I think it would be unbelievably helpful to see a state by state qualification list somewhere although I imagine it might be difficult to keep something like that up to date. Aren't the rules changing frequently. Maybe gilbert guide will someday offer something like that - it would be really helpful! My dad was in Arkansas and my family lived in Virginia, which I know have different rules. I just heard that the years they look back at your assets has increased. Scary.

    look forward to reading your posts...ShirleyB

  2. Duane Lipham Says:

    ShirleyB,

    The Medicaid qualifications for long-term care assistance can differ greatly from one state to the next. Unfortunately, I am not aware of a central web site that lists the qualifications for each state all in one place. That would be a great resource, but as you observed, it could also be difficult to maintain. If you consult the CMS (Centers for Medicare and Medicaid
    Services) site at http://www.cms.hhs.gov/home/medicaid.asp, they simply direct you to call the Medicaid office in your particular state to find out about the qualification guidelines for your state.

    Generally though, to receive assistance through Medicaid it will be necessary to spend down almost all of your personal assets and essentially become impoverished. Remember, Medicaid's primary function is not to be the government's long term care provider. It's main function is to assist those who have few assets and means and so could not provide for their care on their own.

    Unfortunately, over the years many relatively wealthy folks have taken advantage of the system and have used legal tactics such as transferring of assets to family members to be able to still retain access to their assets and have their long term care costs paid for by tax dollars instead of their own. With the Deficit Reduction Act of 2005, lawmakers closed most of the loopholes that were being exploited by increasing the lookback period for transfer of assets to 5 years, with the penalty period for such a transfer starting not on the date of the transfer, but on the date of the application for Medicaid benefits.

    This is designed to send a clear message to all Americans that they need to be taking more responsibility for their own future long term care costs rather than relying on state or federal agencies to foot the bill. Toward that end, several states have begun an "Own Your Own Future" advertising campaign to help educate Americans about the challenges of financing long term care and encouraging them to start planning ahead as soon as possible.

  3. Sue Z Bell Says:

    Unfortunately I fear that long term health insurance will only, as other insurance benefits, insure the healthly and not the sick!

  4. Duane Lipham Says:

    Sue,

    You are correct Sue in assuming that long-term care insurers will require applicants to have reasonably good health when seeking to invest in a LTCI policy. However, it is often surprising just how much leeway some companies will alow in their underwriting.

    I always encourage folks not to procrastinate on getting LTCI just because their health is good at the present though. We all know that in general our health tends to deteriorate as we age, so why wait until major health issues arise before trying get insured? Remember, you can't get home insurance while your house is on fire and burning down, and it is the same with any other kind of insurance product. The only way that insurance companies can keep their rates affordable for those who do invest in LTCI is to do their best to screen out those who will present an unreasonably high risk of future claims.

    So the lesson is, be wise and apply for LTCI long before you actually need it. You'll be glad you did!

    Duane

  5. Lynsey Says:

    husband and I have power of attorney for his grandmother, who is 97 and been living in an assisted living community for four years. The costs at this facility have increased by 50% in the last year, and soon her savings, combined with her monthly income from pension and social security, will not be enough to cover it. We have considered pulling from our own savings to pay, so that she can stay in this nice community, but want to know what our options are. Would Medicare or Medicaid be able to assist?

  6. Duane Lipham, CLTC Says:

    Lynsey,

    Medicare will most likely not be able to help at all since they only contribute toward long-term care costs for at most 100 days after the care begins. Even then there are several restrictions on the kind of care and the care setting that will qualify for their assistance. From your description it does not sound as if your husband's grandmother will meet that criteria.

    Medicaid may be able to assist financially but only after almost all of her assets are drained away by the cost of her care. Since Medicaid requirements can often differ from state to state it would be best to contact the Medicaid agency of your state and discuss the situation with them. They will most likely be able to give you a clear picture of what kind of assistance, if any, would be available.

  7. Mel Says:

    Hi my mother-in-law in Wheeling, WV is 85 and has this past year developed serious health issues, such as severe depression, possible dementia has been diagnosed, and needs help bathing herself and doing certain activities. Just the other day she fell and hit her head and has a severe contusion over her right eye. She has called 911 seven times in the last 3 weeks and they have taken her to the ER and said they can't find anything wrong with her so they give her a sedative and send her home. She takes Zoloft and other meds along with Zanax for sleep and depression. She cries alot and her health seems to be growing worse by the day. Her weight has drop off considerably and her appetite is sporadic. She is a widow and is on very limited funds which sometimes there is little left for sufficient food in the house after her bills. Her house is 80 years old or so and is worth very little. No assets at all. My question is with your expertise does this sound like Medicaid would consider this as a qualified situation. We have checked into a assisted living/nursing home and they have accepted her. We live in Arizona so the youngest daughter of 55 years yound lives with her but can't take care of her and keep her job. This daughter has no assets either and barely gets by paycheck to paycheck. Any advise would be helpful.

  8. Duane Lipham Says:

    Mel,

    The administrator at the Nursing Home/ALF should be able to let you know if your mother-in-law can qualify for Medicaid. From your post, it sounds like she should qualify both financially and by level of care.

    You can learn more about WV's Medicaid program at this website:

    http://www.wvdhhr.org/bcf/family_assistance/medicaid.asp

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