An assisted living facility (ALF) provides room and board, therapy and nursing services, and supervision. ALFs are generally less expensive and less medically intensive than nursing homes. Some ALFs are specially licensed by the state to accept Medicaid residents, and those are known as Assisted Living Programs (ALPs). You can find profiles of New York ALPs and identify one near you on the Department of Health's website.
None of the Medicaid managed long-term care programs in New York will cover assisted living facility fees, though they might pay for some home health services while they're in assisted living.
Although Medicaid won't cover the cost of room and board at ALPs, Supplemental Security Income (SSI) may be available to supplement a resident's income and help cover costs.
So if you're a New York resident and you want Medicaid to cover your stay in an assisted living facility, then you must qualify for ALP. ALP has limited enrollment, so it's not available to everyone who wants it.
To qualify for ALP, you must need a nursing home level of care. Furthermore, you must show that, if it weren't for the ALP, you would have to be placed in a nursing home because you don't have a home or a suitable home environment. At the same time, you can't need 24-hour nursing care, be bedridden, or be a danger to other ALP residents.
ALP has a higher income limit than regular Medicaid—you must have a monthly income lower than $1,732 in 2024 to qualify for an ALP. If both spouses are applying, their income is limited to $3,464 per month.
Most assisted living facilities aren't licensed to be ALPs, and they generally accept only private-pay residents. However, residents in ALFs can qualify for Medicaid home health services that can be provided to them while they live in the ALF.
ALPs are regulated by the New York State Department of Health. For more information, contact your Local Department of Social Services (LDSS) or call the Department of Health Medicaid Helpline at 1-800-541-2831.
Home health care can include:
New York's managed care programs Program for All-Inclusive Care for the Elderly (PACE) and Managed Long-Term Care (MLTC) both offer home health services as part of their benefit package, so if you're a participant in those programs, you can receive assistance from skilled nurses, home health aides, or personal care attendants in your home, as long as your doctor or care coordinator has authorized those services for you according to the requirements in your particular managed care plan.
In addition, New York offers personal care assistance to Medicaid beneficiaries through its Personal Care Services Program (PCSP). PCSP covers assistance with in-home activities like housekeeping, bathing, using the toilet, and preparing meals. Your doctor must send a physician’s order to your local social services district, and then a nurse assessor will visit your home and interview you about your activities of daily living and your need for assistance. The assessor will decide what kind and how much assistance you need. Generally, your local social services district selects the agency that will provide services to you.
Another way to get personal care assistance is through New York’s Consumer Directed Personal Assistance Program (CDPAP). Like for the PCSP, you need a physician’s order and a nurse’s evaluation to qualify for help. However, in CDPAP, you get to select, train, supervise, and fire (if necessary) your own service providers. That means CDPAP recipients have flexibility and control over their choice and management of caregivers. In addition, CDPAP will cover skilled nursing services in your home, not just personal care services.
Finally, New York has the Long-Term Home Health Care Program (LTHHCP). LTHHCP provides a wide range of services, coordinated by registered nurses, with the goal of allowing individuals who would otherwise be institutionalized to stay in their homes. To qualify for LTHHCP, you must be a Medicaid beneficiary, and you must meet the nursing home level of care. You can get medical and therapy services, home-delivered meals, modifications to your home or assistance moving to a more suitable home, plus social services.
To apply for Medicaid or any of these programs, contact your New York State LDSS.
Updated March 22, 2024
]]>For California residents needing long-term care services, Medicaid is the most common source of funding. Medicaid pays for the nursing home expenses of about two-thirds of the residents in California nursing homes.
Medi-Cal, the name of California’s state Medicaid program, is funded by both federal and state funds, and it provides health insurance to one-third of California’s population. There are many different ways to become eligible for Medi-Cal, and there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services. The California Department of Health Care Services (DHCS) administers long-term care programs in California.
Skilled nursing facilities are residential facilities that offer round-the-clock skilled nursing care in addition to other supportive services. These nursing homes are expensive, averaging approximately $11,500 per month in California. Most people can't afford to pay their own nursing home expenses.
Medi-Cal, however, will pay for a nursing home only when it's "medically necessary." California defines medically necessary as "when it is reasonable and necessary to protect life, to prevent significant illness or significant disability, or to alleviate severe pain." For Medi-Cal to pay for a nursing home stay, your treating physician must prescribe a nursing home for you because you either need the continual, round-the-clock availability of skilled nursing care or what's called "intermediate care."
Skilled nursing care includes things like giving injections, inserting or replacing catheters, changing wound dressings, feeding through a gastric tube, and treating bedsores.
Intermediate care means a protective and supportive environment with "observation on an ongoing intermittent basis to abate health deterioration."
To determine whether you need at least an intermediate "level of care" (LOC), Medi-Cal will do an LOC assessment that looks at your limitations in your activities of daily living (ADLs), cognitive function, and physical function and your need for help with medication and treatments.
If you need a health care aide or nurse only for one or two things a day, then Medi-Cal may find that a nursing home stay is not medically necessary, because you could get these services on an outpatient basis or by a home health provider. In essence, your doctor must find that your health is at risk if you don't have access to skilled nursing or intermediate care.
If you already qualify for Medi-Cal, then your Medicaid coverage includes nursing home care if you need it. Groups of people who automatically qualify for Medi-Cal include SSI recipients, participants in the CalWORKs (California’s Temporary Assistance to Needy Families) program, individuals enrolled in California’s refugee programs, and children in its foster care system.
If you don't already qualify for Medi-Cal, you could be eligible for Medi-Cal long-term care if you have little income. Due to the Affordable Care Act (ACA), the income limit for Medi-Cal now works out to 138% of the federal poverty level (FPL) in California. In 2024, that's $20,783 for an individual (about $1,730 per month) and $28,207 for a couple (about $2,350 per month).
Starting in 2024, California has eliminated its asset limit for Medi-Cal recipients, so people who need long-term care no longer need to “spend down” or transfer their assets to qualify for Medi-Cal. And because there's no asset limit, Medi-Cal no longer has a look-back period from the date that you apply for Medicaid-paid long-term care to examine any asset transfers to see if they were legitimate.
If you are "over-income" for Medi-Cal but have high health care expenses like nursing home fees, then you might qualify for a program called Share of Cost (SOC) Medi-Cal. SOC Medi-Cal allows recipients to pay a certain portion of their income every month towards their medical expenses, and Medi-Cal pays all of the expenses incurred afterward. The portion that the Medi-Cal recipient pays is called his or her share of cost.
SOC Medi-Cal is an important resource for individuals who might have higher incomes but who find that they can't afford the cost of long-term care. However, Medi-Cal only lets long-term care residents keep a very small personal needs allowance ($35-$50/month) when they have nursing home fees paid by SOC Medi-Cal.
Any non-exempt income above that personal needs allowance has to be paid to the long-term care facility before Medi-Cal will cover additional costs each month. In essence, Medi-Cal pays the difference between the monthly cost of the nursing home and the monthly income of the Medicaid recipient (minus $35).
Assisted living facilities (ALFs) offer a wide range of supportive services like housekeeping, medication management, meal preparation, and assistance with dressing and bathing, but they don't offer skilled nursing care. (In 2023, the average cost of an assisted living facility in California was $6,500 per month.)
In general, Medicaid pays for room and board only when they're offered in an institution that provides skilled care (like a nursing home), and it doesn't pay for room and board expenses in assisted living facilities. However, in California, to assist with the costs of assisted living facilities, the state has created a Medi-Cal program called the Assisted Living Waiver (ALW) that pays for ALFs in some counties.
The assisted living waiver program is a Home and Community-Based Services (HCBS) waiver program that offers care coordination services and can pay for expenses associated with some assisted living facilities and also with some home health services. Most recipients of ALW services still have to pay most of their income to the assisted living facility for room and board charges.
To be eligible for the assisted living waiver program in California, you must be eligible for Medi-Cal (without the Share of Cost program) and require an intermediate level of care. You meet that level of care if, without the ALW services, you would need to live in a nursing home.
Because ALW is a Medicaid waiver program, it doesn't need to be equally available to everyone in the state who is eligible for it. At this time, California has opted to make the services available to some seniors and people with disabilities living in Alameda, Contra Costa, Fresno, Kern, Los Angeles, Orange, Riverside, Sacramento, San Bernardino, San Diego, San Joaquin, San Francisco, Santa Clara, San Mateo, and Sonoma counties.
If you qualify for the assisted living waiver, you must use one of the assisted living facilities that have been approved by the state to participate in the program. The state licenses and regulates assisted living facilities that wish to receive Medi-Cal payments. Those approved facilities are called Residential Care Facilities for the Elderly (RCFE). RCFEs can have as few as six beds or as many as 100 beds.
California's SSI/SSP program also pays for some custodial long-term care (called "non-medical out-of-home care," or NMOHC). (Many people who are eligible for Medi-Cal are also eligible for SSI.)
SSI is paid for by the federal government, but California pays an extra supplement to its residents called the "state supplementary payment" (SSP). The SSP amount is higher for those living in a non-medical out-of-home care situation (at a board and care facility, RCFE, or ALF).
Someone who receives SSI/SSP in California and lives in an assisted living facility or RCFE can receive $1,575.07 monthly ($943 from SSI and $632.07 from SSP). Of that, the facility can charge up to $683.07 for room and board and up to $715 for "care and supervision," for a total of $1,398.07.
Because an assisted living or long-term care facility can charge no more than $1,398.07 total, this leaves a small personal needs allowance (PNA) for the recipient ($177).
A couple living in the same facility and both receiving SSI/SSP would get $3,150.14 monthly, and the long-term care facility could charge no more than $2,796.14, leaving a PNA for the couple of $354.
California covers home health services as part of its state Medicaid plan. Medi-Cal covers home health services that are medically necessary, like skilled nursing care and medical equipment. For individuals who need ongoing, non-skilled care like assistance with bathing, cooking, and chores, California has the In-Home Supportive Services (IHSS) Program.
The IHSS program pays for home care services that aren't necessarily medical in nature. The types of services covered by IHSS include housecleaning, meal preparation, laundry, grocery shopping, bathing, bowel and bladder care, accompaniment to medical appointments, and protective supervision for the mentally impaired.
To be eligible for IHSS, you must be 65 or older, disabled, or blind, and you must be living in a home, not an institution. In addition, you must meet the financial eligibility criteria for Medi-Cal, and you must be unable to live at home safely without IHSS services.
When you apply for IHSS, your county will send a social worker to interview you about your needs and review your medical records. The county will use the results of the needs assessment to decide how many hours of in-home services it will pay for each month.
Non-severely impaired applicants can receive up to 195 hours each month, and severely impaired applicants can receive up to 283 hours. The average hourly rate of a home health aide in California was $37 per hour in 2023.
The IHSS program is available with a share of cost for those whose income is above the Medi-Cal limit.
You apply for IHSS through the Department of Social Services, using this Application for Social Services form.
After a Medi-Cal recipient passes away, California's Medi-Cal program will attempt to recover the costs for nursing home, assisted living, and Home and Community Based Services (HCBS) that were paid for by Medi-Cal. This is called "estate recovery." The changes to California's asset limit in 2024 did not affect estate recovery in the state.
The state, however, can only try to seek repayment from assets that pass through probate, so houses that are put in a living trust, or mobile or manufactured homes, are not subject to liens for recovery.
The state might waive its claim to payment if it would cause "substantial hardship." You must apply for a hardship waiver within 60 days of the date on the estate recovery claim letter.
For more information, see the Estate Recovery in California brochure put out by California Advocates for Nursing Home Reform (CANHR).
Updated March 18, 2024
]]>When people can't afford to pay for long-term care, they often turn to Medicaid, which has become a very common source of funding for long-term care. In 2023, over 60% of nursing home residents in Pennsylvania used Medicaid to pay for their nursing home care.
There are many different ways to become eligible for Medicaid in Pennsylvania, and there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services.
If you receive SSI, you are already eligible for Medicaid. People who don't receive SSI but are 65 or older, disabled, or blind can qualify for Medicaid if they meet certain income and asset limits.
Pennsylvania’s Medicaid benefit for elderly, disabled, and blind individuals is called Non-Money Payment (NMP) Medicaid. You may be eligible for NMP Medicaid if your income is equal to or less than 300% of the monthly SSI benefit amount (also known as the federal benefit rate, or FBR). In 2024, the FBR is $943, and the individual NMP income limit is $2,829 per month.
If your income is above the 300% FBR limit, you may still be able to qualify for Medicaid. First, you can put your extra income each month into a special bank account that is set up under the terms of a special needs trust or qualified income trust. For help with an income trust, consult an estate planning attorney.
You may also qualify for Medicaid through Pennsylvania’s Medically Needy Program. In the Medically Needy Program, you can use medical bills, including nursing facility bills, that you incur each month to “spend down” your income and qualify for Medically Needy Only (MNO) Medicaid.
The MNO income limit is $425 per month, meaning that you must show that you have incurred medical expenses each month that would leave you with no more than $425. When you apply, your county assistance office will estimate your income and expenses for six months and see whether your adjusted income is less than $2,550 ($425/month for six months). The actual or anticipated cost of a long-term care facility for a six-month period is an allowable expense to qualify for MNO Medicaid.
For example, Mrs. Smith is 70 years old. Her income is $3,500/month, but she lives in a nursing home that charges $7,500/month. She is not eligible for NMP Medicaid because she is over the income limit of $2,250/month, but she is eligible for MNO Medicaid because her medical expenses exceed her income. She will be allowed to keep a monthly personal needs allowance of $45, but she will have to contribute all of her other income to the cost of the nursing home. Medicaid will pay the remaining balance. If she has a dependent or a spouse remaining in the community, the state will allow her to set aside some income for their support.
You can apply for Medicaid using Pennsylvania’s online application system, called COMPASS. You can also complete a paper application and turn it in to your local county assistance office.
To qualify for Medicaid in Pennsylvania, you must also have few resources, or assets. The resource limit for individuals whose income is below 300% of the FBR is $2,000 for an individual, but the program also “disregards” $6,000 in assets, so you can actually have up to $8,000 in resources and still qualify. The resource limit for an individual whose income is above 300% of the FBR is $2,400.
Some property doesn't count toward the resource limit. In Pennsylvania, your home is exempt up to an equity value of $713,000 (in 2024), so long as you live in it, intend to return to it, or your spouse or dependent lives in it. One vehicle is also excluded from the resource calculation.
Medicaid will pay for a nursing home only when it is medically necessary, meaning that a doctor has said you need a nursing home because you have a condition that requires more care than just room and board. This is called meeting the "nursing home level of care." In Pennsylvania, to meet the nursing home level of care, you must show that either you need skilled nursing or rehabilitation services or that you need some kind of health-related care to be provided to you on a regular basis. You must show that you can't provide the care yourself and that you need some type of licensed staff to provide services for you.
In Pennsylvania, before you're admitted to a nursing home, you'll get a Pre-Admission Screening and Resident Review (PASRR). PASRR screening is intended to assess whether you meet the nursing home level of care and also whether a particular facility can meet your needs.
Assisted living facilities, called “personal care homes” (PCHs) in Pennsylvania, are generally less expensive and less medically intensive than nursing homes. PCHs are licensed by the state, but in general, Pennsylvania’s Medicaid programs don't cover the costs of PCHs/assisted living.
But if you receive SSI and need to live in a PCH, the state can pay a supplement to the facility to help you afford the cost with your SSI benefit. In addition, Medicaid might pay for some services you receive while you are living in a PCH, even though it won't pay your room or board fees.
Home health care can include skilled nursing or therapy services, home health aide services like medication management or bathing assistance, and personal care aide services like meal preparation or cleaning. Pennsylvania has several programs that offer payment for home care services.
If you receive Medicaid, the program will pay for some limited home care services. The services must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you.
Pennsylvania also operates several Medicaid Home and Community-Based Services (HCBS) waiver programs that provide home health care services to low-income Pennsylvanians.
To qualify for any of Pennsylvania’s waiver programs, you must meet the nursing home level of care. In addition, you must have income less than $2,829/month and fewer than $8,000 in resources. To apply for waiver programs and for more information, contact the state's Long-Term Care Helpline at 800-753-8827 or visit the Pennsylvania Department of Human Services (DHS) website.
If you're 60 or older, you might qualify for Pennsylvania’s Community HealthChoices (CHC) Program (incorporating the former DHS Aging Waiver). The program offers home-delivered meals, home health services, transportation, personal assistance, emergency response systems, accessibility modifications to your home, and other services. For more information, contact the Office of Long-Term Living Bureau of Participant Operations at 800-753-8827.
If you're younger than 60 and have a physical disability, you may qualify for Pennsylvania’s Attendant Care/Act 150 Waiver. Depending on your income, you may be required to contribute to the cost of your services. If you qualify, this program can provide you with personal support, home health services, emergency response services, and specialized equipment and supplies to help you live independently. Pennsylvania has similar waiver programs for other specific populations, like people with developmental disabilities, people with AIDS, and people with traumatic brain injuries.
Pennsylvania also has a program for individuals who are 55 or older called Living Independence for the Elderly (LIFE). LIFE is not a Medicaid waiver program; it operates under a Medicaid provision called Programs of All-Inclusive Care for the Elderly (PACE). PACE programs provide a system of comprehensive "wrap-around" services to allow seniors who are at risk of institutionalization to remain in their homes. Pennsylvania’s LIFE programs are managed care programs that are operated by private entities. LIFE is not available in all areas of the state. To see whether there's a LIFE provider near you, check this Pennsylvania DHS provider reference or call the Pennsylvania CHC Helpline at 844-824-3655.
If you don't qualify for Medicaid and don't meet the nursing home level of care requirement, you might still qualify for some home health services if you're at least 60 years old. Pennsylvania’s Area Agencies on Aging operate a program called Help at Home (OPTIONS) that provides a variety of services like personal care services, home-delivered meals, transportation, medical equipment, accessibility modifications, and home health services. You may be required to make a co-payment, depending on your income. To apply, contact your local Area Agency on Aging or call the Pennsylvania Department of Aging at 717-783-1550.
Updated February 23, 2023
]]>Florida Medicaid plans cover a range of long-term care services, including certain costs of nursing facility care and assisted living facility care, homemaker and chore services, nursing care, medical equipment and supplies, and other services, for those who qualify.
There are two parts to qualifying for Florida nursing home Medicaid or SMMC-LTC coverage: needing a nursing home level of care and financial eligibility.
To qualify for Florida's nursing home Medicaid and SMMC-LTC programs, you must require a nursing home "level of care." That means that you must be able to show that your condition is serious enough that you either:
Although SMMC-LTC coverage may be available for certain limited long-term care services like personal care assistance or adult day care, you must require a nursing home level of care to be eligible for institutional nursing home or home and community-based services (HCBS).
Comprehensive Assessment and Review for Long-Term Care Services (CARES) is Florida’s screening program for long-term care applicants. CARES assessments are administered by the Department of Elder Affairs (DEA). Someone from DEA will personally interview you and ask you many questions about your ability to function, the help you need, and your medical conditions. You will need a CARES assessment to show that you meet the nursing home level of care necessary to qualify for Florida’s managed long-term care programs.
Once you show that you require a nursing home level of care and you enroll in a Medicaid plan, you'll need to establish that the service you want is "medically necessary" (for instance, necessary to prevent serious disability). Nursing home Medicaid and SMMC-LTC plans will pay only for services that are medically necessary.
The CARES assessment, along with input from your treatment providers, will help your plan determine whether the particular long-term care service that you want is medically necessary.
Even if you meet the nursing home level of care (and are 18 or over), you can qualify for Florida’s nursing home Medicaid or SMMC-LTC programs only if you meet the Florida Medicaid income limits for long-term care, as well as the Medicaid resource limits for long-term care. Different limits apply for MEDS-AD eligibility.
If you qualify for SSI, you're already eligible for long-term care through Medicaid in Florida. If not, your monthly income (in 2024) must be no more than $2,829, or $5,658 for spouses who are both trying to qualify for Medicaid-paid long-term care.
If you are or will be moving to a nursing home, you'll be required to contribute most of your income to your care. However, you're allowed to keep a small amount of money, called a “personal needs allowance” (PNA). In 2024, Florida’s personal needs allowance for nursing home residents is $160 per month. (There is a separate maintenance allowance for spouses who remain at home.)
Florida does have a Medically Needy program, which assists individuals who have too much income to qualify for Medicaid. The Medically Needy, or “share of cost,” program lets enrolled participants contribute part of their monthly income towards allowable medical expenses, similar to meeting an insurance deductible, to gain Medicaid eligibility for the month. Once participating individuals “spend down” their income through their sharing of medical costs, Medicaid can cover medical expenses during the monthly period.
Florida also allows individuals to establish special trusts, called Qualified Income Trusts, Qualified Disabled Trusts, or Qualified Pooled Trusts for the Disabled, to set aside excess income and still qualify for Medicaid. You can learn more about these trusts in Nolo's article on Medicaid special needs trusts (for specific information about trusts, consult an attorney).
In addition, to qualify for the nursing home Medicaid or SMMC-LTC programs in Florida, you must have few assets, like money in the bank, retirement accounts, land, or personal property like cars. The resource (asset) limit for a single person to qualify for Medicaid in Florida in 2024 is $2,000, and it's $3,000 for a married couple. Some property doesn't count toward the resource limit, like the value of your home (up to $713,000 in 2024) if your spouse lives there or if you intend to return there. There are other excluded resources, like the value of one car.
There is a separate "community spouse resource allowance" (CSRA), an amount that a spouse who does not need Medicaid long-term care services can retain. In 2024, the community spouse resource allowance in Florida is $154,140 in assets.
A Florida assisted living facility (ALF) provides room, board, and personal care services, such as help with dressing, moving, bathing, taking medication, and general care of your physical and mental wellbeing. Another kind of ALF is an adult family care home (AFCH). AFCHs have no more than five residents, and the operator of the home must live in the home.
Assisted living facilities and adult family care homes can be covered by Florida’s SMMC-LTC plans. Each plan will contract with its own providers, so not every ALF or AFCH will be covered under every plan. It is important to choose the plan that covers the facility you're in or that you want to enter.
The average cost of assisted living in Florida was about $4,000 a month in 2021. While Florida's Medicaid program won't pay for all of an assisted living facility's cost, it might reduce the amount significantly.
Florida also has a non-Medicaid program called Optional State Supplementation (OSS) that helps low-income qualified individuals pay for room and board at ALFs and AFCHs. For more information, visit the website of Florida’s Department of Children and Families.
Home health care can include:
SMMC-LTC plans offer home health services as part of their benefit packages, so if you're a participant in such a plan you can receive assistance from skilled nurses, home health aides, or personal care attendants in your home, as long as your doctor or care coordinator has authorized those services for you and they're medically necessary for the treatment of a specific impairment.
Coverage through MEDS-AD may also be available for assistance with activities of daily living even if a nursing facility level of care is not required.
Because long-term care is so expensive and accounts for a large proportion of Florida's Medicaid expenditures, the state transitioned long-term care recipients into a managed care system consisting of eleven regions and various SMMC plans that serve them. As a result of a more recent 2022 legislative change, Florida counties will be consolidated into a reduced nine regions, effective 2025.
Not every SMMC-LTC plan is available in every part of the state. All of the plans must cover certain core services, including:
You can compare and choose Florida SMMC-LTC plans at the Florida Agency for Health Care Administration site. You can also get help from Medicaid Choice Counselors by calling (877) 711-3662.
Updated January 26, 2024
]]>Private health insurance policies generally don't cover long-term care (LTC), and Medicare coverage for LTC services is limited. LTC insurance policies can help pick up some of the tab, but few people purchase it. This leaves Medicaid, which has become a very common source of funding for long-term care.
Medicaid, however, has strict eligibility rules for long-term care in Illinois. Besides qualifying financially, you also need to qualify medically for Medicaid to pay for any LTC service like a nursing home, assisted living facility, or home health care.
In Illinois, people who are 65 or older, disabled, or blind can qualify for Medicaid through the Aid to the Aged, Blind and Disabled (AABD Medical) program, if they also meet income and asset limits.
Medical Assistance (Illinois' name for Medicaid) and the AABD program, administered through the Illinois Department of Healthcare and Family Services (HFS), also provide cash benefits.
Because different types of Illinois Medicaid programs provide LTC coverage—including AABD Medical, Home and Community Based Services (HCBS) waivers, and nursing home Medicaid (for persons living in nursing homes)—it's important to note the services offered and financial and other eligibility requirements of each.
If you already receive Medical Assistance in Illinois, then your Medicaid coverage includes nursing home care if you need it. Nursing homes are residential facilities that offer around-the-clock skilled nursing care in addition to other supportive services. You can search from a list of licensed nursing homes in Illinois here.
Income limits for Medical Assistance may be different depending on whether you live in the community or in a nursing home or assisted living facility.
AABD Medical covers elderly, blind, and disabled residents living in the community (at home or with friends or relatives) with income up to 100% of the federal poverty level (FPL). In 2023, that's $1,215 per month for a household of one or $1,643 per month for a household of two.
If your income is more than the FPL, you can still qualify for AABD Medical by "spending down" your excess income every month on certain medical expenses. The state determines your spend-down amount based on your income. You qualify for Medicaid every month you can show the state that you have incurred the associated expenses, even if you have not yet actually paid them.
For example, Mrs. Brown has excess income above the AABD Medical income standard. Illinois tells Mrs. Brown her spend-down amount is $120 per month. She has a doctor's appointment that will cost her $250 out of pocket. She has met her spend-down and qualifies for AABD Medical that month.
Enrollment in "Pay-In Spenddown" gives AABD Medical recipients the option of paying their spend-down amount to HFS. That means that they don't need to bring in proof of their medical expenses each month. They can just pay the spend-down amount to the state and qualify for AABD Medical that month. So in the example above, Mrs. Brown could just pay the state $120 each month and be sure that she would get her medical benefits.
Pay-In Spenddown isn't available for residents of nursing or supportive living facilities.
If you are living in a nursing facility, you can have more income than 100% of the federal poverty level, but you'll be required to pay almost all of your monthly income toward your care. Illinois Medicaid allows single recipients in nursing homes to keep only $30 per month for themselves. The state does have rules that allow a "community spouse" (the spouse not entering a nursing home) to keep more income.
If your monthly income exceeds the cost of the nursing or supportive living facility, you can still qualify for Medicaid benefits if you spend down your excess income every month on other eligible expenses.
To qualify for Medical Assistance, you must have less than $17,500 in "non-exempt" resources. Resources are assets like money and property. For married couples with one spouse applying, the non-applicant spouse can retain $120,780 (as of 2023).
Some property doesn't count toward the resource limit (the property is called "exempt"). Your home isn't counted as an asset for Medicaid in Illinois (up to a home equity limit of $713,000 in 2024). And your personal belongings and household goods of reasonable value are exempt.
One car is also exempt if:
If you have resources that exceed the limit but need Medical Assistance in order to move into a nursing home, you can spend down your assets and qualify. If you have a spouse who is remaining at home, then you'll be allowed to keep some assets to help support that person.
Medicaid will pay for a nursing home only when it's medically necessary. Medicaid won't pay for nursing home care that's just custodial, meaning non-medical care such as help with transferring to and from a wheelchair, bathing, or eating.
Before Medicaid will pay for nursing home care, you must have a needs screening. If you're in a hospital, the hospital will arrange the needs screening for you. If you're in your home, you should contact the state to arrange for a screening. Here's who to call:
Medicaid uses the information in your needs screening to decide whether you qualify for a nursing home and, if so, what kind of nursing home is appropriate for you. In general, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of skilled nursing care that is available in an institution.
Supportive living facilities (SLFs, also known as assisted living facilities) provide apartment-style room and board, therapy and nursing services, and supervision. SLFs are generally less expensive and less medically intensive than nursing homes. In Illinois, SLFs are specially licensed and monitored.
Illinois operates a Medicaid waiver program called the Supportive Living Program (SLP) to pay for some of the costs of supportive living facilities.
To qualify for SLP, you must be 65 or over or an adult with a physical disability. If you have a primary or secondary diagnosis of developmental disability or serious and persistent mental illness, then you won't qualify for SLP. You must require the nursing home level of care.
If you qualify, SLP will pay for many of the services that you can receive in an SLF, like personal care services, housekeeping, meals, exercise programs, medication supervision, and temporary nursing care. You must pay the room and board fee for the living facility. You must have monthly income that's equal to or greater than the SSI amount to qualify for this program. In 2024, that's $943 per month for a single person ($1,415 for a couple).
If you're eligible for SLP, you'll need to pay almost all of your monthly income to the facility. SLF residents are allowed to keep $90 per month as a personal needs allowance.
To apply for SLP, contact a participating facility directly, and the facility will help you get the appropriate assessments and paperwork done. For more information or if you have questions about an SLP provider, contact the HFS Bureau of Long Term Care by calling 844-528-8444 or review the HFS SLP resident fact sheet web page.
Home health care can include:
Illinois has several programs that offer payment for home health care services.
First, if you receive AABD Medical, the program will pay for some limited home care services. The services must be prescribed by your doctor as part of a plan of care for a particular condition, and the services must be directed at curing or rehabilitating your condition.
AABD Medical won't pay for services that you might need on a long-term basis like housekeeping, but it will pay for services provided by:
Illinois has a number of active Home and Community Based Services (HCBS) waiver programs. These programs provide services that allow individuals to live in their own homes or community settings instead of institutions. Individuals who meet certain Medicaid financial and medical needs eligibility criteria, as well as any other particular requirements specified in each waiver, may be eligible to participate in one of these programs.
For example, the Persons who are Elderly waiver provides services and individualized support to elderly persons who would otherwise require nursing facility care. This waiver is a component of the Community Care Program (CCP) provided through the Illinois Department on Aging (DoA).
Generally speaking, if you qualify for CCP, you can receive homemaker services, adult daycare services, and emergency home response services. To qualify, you must be 65 or over, or 60-64 and physically disabled. You must have an assessment that shows you are at risk of being placed in a nursing facility and have less than $17,500 in non-exempt assets. If you have enough monthly income, you may be required to contribute to the cost of the services. To apply, contact the Department on Aging Senior Help Line at 800-252-8966.
Another example of an Illinois HCBS waiver is the Persons with Disabilities (PD) waiver. If you're a disabled individual under 60 at risk of placement in a nursing facility, then you might qualify for this program. The PD program pays for home health services like a personal assistant, therapy or nursing in your home, delivered meals, and housekeeping. To qualify, you must have a needs assessment that shows that you're at risk of being placed in a nursing home without these services.
Illinois operates a similar program for adults suffering from brain injuries, called the Persons with Brain Injury waiver.
You can obtain more information about the services available, and apply for the programs online, on the Home Services Program page of the Illinois Department of Human Services.
]]>Medicaid (along with its related Children’s Health Insurance Plan, or CHIP) is funded by both federal and state resources, and it provides health coverage to around five million Texans.
There are many different ways to become eligible for Medicaid in Texas, and Texas has specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services.
In 2021, the average monthly cost of a private room in a nursing home in Texas was approximately $7,100, or over $85,000 per year. Thus, most people can't afford to pay their own nursing home expenses. Nursing homes are residential facilities that offer 24-hour skilled nursing care in addition to other supportive services.
If you already qualify for Texas Medicaid, then your Medicaid coverage includes nursing home care if you need it. Groups of people who can automatically qualify for Medicaid include SSI recipients, participants in the TANF (Texas’ Temporary Assistance to Needy Families) program, and children in its foster care system.
In addition, people who are 65 or older, disabled, or blind can qualify for Medicaid if they also meet income and resource limits.
To be able to get Texas's Medicaid program to pay for long-term care in 2024, a single person’s monthly income cannot be higher than $2,829. If both spouses of a married couple need nursing home care, the couple’s monthly income can't be higher than $5,658. The applicable income and resource limits, discussed below, may change each year.
Some people who have excess income, which would otherwise keep them from qualifying for Medicaid, can still qualify by “spending down” their income on qualifying medical expenses until they reach Medicaid income limits. Professional advice from a financial advisor or lawyer can help guide you in spending down your income or assets, or using other ways to reduce the income or assets that count against Medicaid caps.
For instance, Texas allows you to place some extra monthly income into a trust to allow you to qualify financially for Medicaid. These trusts are called “Medicaid Trusts,” “Miller Trusts,” or "Qualified Income Trusts" (QITs); you can read more about them in Nolo's article on Medicaid income trusts.
If you meet the non-financial criteria for Medicaid but have been told that you're over-income for the program, you should consult a professional to see whether a trust can help you qualify.
To qualify for Medicaid, you must have few resources. Resources are assets, like money in the bank, retirement accounts, land, and personal property like cars.
The resource limit for a single person to qualify for Texas Medicaid is $2,000, and for a married couple who both want to qualify for Medicaid, it is $3,000.
Some property does not count toward the resource limit. In Texas, the home you live in (or intend to return to, if you are in a nursing home) is excluded from the resource calculation as long as it is worth less than $713,000 (in 2024). Medicaid excludes some other resources as well, including personal belongings and one car.
Most Medicaid recipients in Texas receive medical services through a managed care system. The most common system is called the State of Texas Access Reform (STAR) Managed Care. In managed care, Medicaid recipients pick a medical plan from a list of plans available in their area and choose a primary physician who works under that plan. The plans are operated by private companies that contract with Texas to provide Medicaid services.
STAR+PLUS is Texas’ Medicaid managed care program for adults who have disabilities or who are 65 and over. Through STAR+PLUS, enrolled individuals receive Medicaid healthcare and long-term care support and services through their chosen managed care plan. Previously limited to elderly and disabled individuals who didn't need nursing home care, since 2014, STAR+PLUS plans cover nursing home and in-home care.
If you have a problem getting your managed care plan to pay for services that you need, you can appeal the written denial notice you receive. In addition, you can follow the separate complaint procedure for your plan.
If you still have a problem with your Medicaid managed care program, you can file a complaint with Texas’ Health and Human Services Commission Ombudsman, reachable at 877-787-8999 or 866-566-8989. Find out more about the Ombudsman here.
Medicaid will pay for a nursing home only when it is "medically necessary." In Texas, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care available only in an institution.
Your doctor must document your medical condition and must prescribe skilled nursing services to be provided on a regular basis in an institutional setting. Nursing care includes things like giving shots, inserting a feeding tube or catheter, treating bed sores, and changing wound dressings.
For Medicaid to keep paying for your nursing home stay, a doctor has to certify at least every six months that you meet the standard for medical necessity.
If you need only custodial care (someone to watch over you), for instance, because you fall often or because you have dementia and tend to wander, then Medicaid may find that a nursing home stay is not medically necessary because you do not need a skilled nurse.
Assisted living facilities (ALFs) provide food, personal care services like help with bathing or dressing, and medication administration. Historically, Medicaid didn't pay for ALFs. However, Texas has programs offering Medicaid payment for assisted living facilities, if you meet specific criteria.
If you're otherwise eligible for Medicaid and you can show that a nursing home is medically necessary for you (also called “meeting the nursing home level of care”), then you could qualify for STAR+PLUS Waiver services. This program pays for home- and community-based services, including assisted living facilities, for people who would otherwise have to be institutionalized in a nursing home.
The STAR+PLUS Waiver program has limited enrollment and there may be a waiting list for certain services. For more information, visit the STAR+PLUS web page of Texas Health and Human Services.
Texas also offers continuing care retirement communities (CCRCs), which combine independent living, assisted living, and nursing home care in one residential setting. CCRCs, which are regulated by the Texas Department of Insurance (TDI), typically charge entrance and monthly fees.
Once in a CCRC, you can use long-term care insurance, private insurance, Medicare, or Medicaid to pay for some of your health care, depending on your coverage options and the types of services you require. If you have questions, call the TDI at 800-252-3439 or visit their CCRC web page.
Texas covers home health services under its Medicaid program. If your doctor prescribes home health services like nursing or therapy services in your plan of care for a particular medical condition, Medicaid will cover them. Medicaid reviews your need for home health care every 60 days.
You don't need to meet the nursing home level of care to qualify for home health services. However, because these Medicaid-funded home health services need to be related to a doctor’s plan of care for a particular medical condition, they're generally offered on a short-term basis.
If you otherwise qualify for Medicaid and your doctor says that you have a medical condition that causes you to need assistance with one or more activities of daily living (ADLS), you might qualify for Primary Home Care (PHC), a Texas program providing long-term care services at home.
In PHC, an attendant provides medically related personal care service (PCS) to people who need assistance with ADLs. Activities of daily living are tasks like bathing, getting dressed, doing routine hair and skin care, preparing meals and eating, getting exercise, using the toilet, walking, and getting in or out of a bed, chair, or wheelchair. For more information and to apply, visit the Texas Health and Human Services PHC program web page.
Other associated Texas Medicaid home health and PCS programs include:
For general information about PCS Medicaid benefits, visit the Texas Health and Human Services PCS web page.
Updated December 13, 2023
]]>There are several different ways to become eligible for Medicaid in Georgia, and there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services.
People who are sixty-five or older, disabled, or blind, can qualify for Medicaid if they also meet income and asset limits. Georgia’s Medicaid program for elderly, blind, and disabled residents is called aged, blind, and disabled (ABD) Medicaid. If you receive Supplemental Security Income (SSI), then you automatically qualify for ABD Medicaid. If you are elderly, blind, or disabled and need long-term care in a nursing home or in the community but are not receiving SSI, then your monthly income must be less than $2,250 (in 2018) to qualify for ABD Medicaid.
If your income is above the limit, you can still qualify for Medicaid in two other ways. First, you can put your extra income each month into a special bank account that is set up under the terms of a Qualified Income Trust (also known as a Miller Trust). For help with a Qualified Income Trust, consult an attorney.
The second way to qualify for Medicaid if you are over the income limit is through Georgia’s Medically Needy Program. In the Medically Needy Program, you can use medical bills that you incur each month to “spend down” your income and qualify for Medicaid. The program is available to pregnant women, children, the elderly, and blind or disabled adults.
In 2018, the income limit for the ABD Medically Needy Program is $317 per month, meaning that you must show that you have incurred medical expenses each month that would leave you with no more than $317. Once you show that you have those expenses, you qualify for Medicaid coverage for the rest of that month.
To apply for ABD Medicaid or the Medically Needy Program, contact your local office of the Georgia Division of Family and Children Services.
To qualify for Medicaid in Georgia, you must have less than $2,000 in resources. The resource limit is the same regardless of whether you are in a nursing home, receiving community care, or living independently. Resources are assets like money and property. A couple can have $3,000 in resources and still qualify, unless they are qualifying under the Medically Needy Program, under which they can have $4,000 in resources.
There are special "community spouse" rules that allow a spouse who is remaining in the community (at home or with relatives rather than in a long-term care setting) to keep more assets and income when the other spouse is in a long-term care institution.
Some property does not count toward the resource limit. As of 2018, in Georgia, your home is exempt unless you have more than $572,000 in equity in it. Your household goods are also exempt. In addition, Georgia will not count one car as part of your resources, regardless of its value.
Medicaid will pay for a nursing home only when it is medically necessary. You must show that you have a physical or mental impairment, or a combination of the two, that requires continued nursing care under the supervision of a doctor. This is called needing a “nursing home level of care.” You must show that you cannot care for yourself.
The severity of your impairment will determine what type of facility you need. For example, if you require round-the-clock nursing care, then you will need a skilled nursing facility. On the other hand, if you need only intermittent nursing services, but you have an impairment that prevents you from taking care of yourself, then you may need an intermediate care facility. You must meet at least the intermediate level of care for Georgia Medicaid to pay for a nursing home.
In Georgia, before you are admitted to a nursing home, you will get a Pre-Admission Screening and Resident Review (PASRR). PASRR screening is intended to assess whether you meet the nursing home level of care and also whether a particular facility can meet your needs.
Many elderly and disabled Georgians may be eligible for nursing home placement but would prefer to live in a less restrictive setting, like an assisted living facility (ALF), or to remain in their own homes with some services like home health care. Assisted living facilities are generally less expensive and less medically intensive than nursing homes. Home health care includes a wide variety of services like skilled nursing, therapy, medication management, help with bathing or getting around, and personal care aide services like meal preparation or cleaning.
If you receive ABD Medicaid, the program will pay for some limited home care services. The services must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you. The number of home health visits you can receive in one year is limited.
Georgia operates several Medicaid waiver programs that offer payment for assisted living facilities and home health care services to low-income Georgians. To qualify for any of the waiver programs that Georgia offers to cover long-term care costs, you must meet the intermediate nursing home level of care. That is, you must be able to show that you qualify for placement in a nursing home and that, without the services provided by the waiver program, you would need to move into a nursing home.
Georgia’s Community Care Services Program (CCSP) offers services like emergency response systems, skilled nursing and therapy services, home-delivered meals, housekeeping and chore help, and personal care assistance like help bathing or getting around. To qualify, you must be elderly or disabled, and you must have a functional impairment that is caused by physical, not mental, limitations. If you qualify, you will receive a needs assessment and a care plan outlining what type of services you will get. The CCSP also can pay for Alternative Living Services, which include the provision of 24-hour supervision, personal care, nursing supervision, and health-related support services in state-licensed personal care homes. To apply, contact your local Area Agency on Aging.
Georgia also operates a waiver program called Service Options Using Resources in a Community Environment (SOURCE). SOURCE offers case management services with primary care physicians, payments for services offered in an assisted living home, home health, personal care, delivered meals, and emergency response services. To qualify for SOURCE, you must be an elderly and disabled Georgian and be eligible for SSI. To apply, contact your local office of the Georgia Aging and Disability Resource Connection (ADRC).
Finally, Georgia’s Independent Care Waiver Program offers personal support, home health services, specialized medical equipment and supplies, counseling, emergency response systems, and home modifications to adults between 21 and 64 years old who have a severe physical impairment or a traumatic brain injury. To apply, call the Georgia Medical Care Foundation (GMCF) at 888-669-7195 or 800-982-0411, or contact GMCF at www.gmcf.org.
Georgia has a Money Follows the Person (MFP) grant from the Centers for Medicare and Medicaid Services that helps people move out of institutions and into less restrictive settings. If you are elderly or have a physical or developmental disability and live in a hospital, nursing home, or other long-term care facility, but want to live in your home or in a community-based setting, then you might qualify for assistance from the MFP program.
MFP provides funding for things like moving expenses, transportation costs, modifications to your home or vehicle, medical supplies, and other services intended to help you live more independently.
You can apply for MFP by contacting the state MFP office at gamfp@dch.ga.gov or by calling 404-651-9961.
If you do not qualify for Medicaid or do not meet the nursing home level of care, you may still qualify for some home health services if you are elderly. Georgia's Area Agencies on Aging operate the Non-Medicaid Home and Community Based Services program, which offers a wide variety of services like meal delivery, chore help, and personal care assistance. To apply, contact your local Area Agency on Aging.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for long-term care.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet the income and resource qualifications of Nevada's Medicaid program.
There are also some limited services for people who still live at home but would otherwise require a nursing home. These are called home-based waiver programs. Similar income and asset rules apply for these programs.
Nevada's Medicaid program uses a Pre-Admission Screening Resident Review (PASRR) test to determine whether a person needs a nursing home and a Level of Care (LOC) Assessment Form to determine the level of care a person needs. The nursing home staff usually does this screening, which includes a review of the person’s medical diagnoses and abilities. The LOC form asks about the level of assistance you need with various activities of daily living (ADLs), such as moving about, dressing, eating, hygiene, and using the bathroom, and whether you have any special needs such as durable medical equipment.
In general, you must require a level of care that cannot be met anywhere but in a nursing home. Nevada Division of Welfare and Supportive Services (DWSS) makes the final decision on eligibility for institutional Medicaid.
Typically, your care facility can assist you with the Medicaid application process or you can apply directly with the DWSS. Before you apply, make sure that to the best of your knowledge you meet the eligibility criteria.
In Nevada, a single person can have a monthly income of only up to $2,313 in 2019 and qualify for Medicaid-paid long-term care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,626 per month in 2019. These long-term care income limits are higher than the income limit for those applying for other health care benefits from Medicaid.
If you have income over the monthly amount and are in need of a nursing home, Nevada allows you to establish a Qualified Income Trust to meet the Medicaid income limits. A Qualified Income Trust is a special account used only for Medicaid purposes. You set up your income to go into a Qualified Income Trust and it is then used to pay a portion of the cost of the nursing home. The trust can also pay for Medicare premiums and premiums for supplemental health plans. If you are a single person in a nursing facility, you can keep only $35 a month from the trust, and the rest goes to your nursing home costs or allowable medical expenses.
Medicaid for long-term care has different resource rules than for other Medicaid programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash on hand. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can only have up to $2,000 in resources with a few allowable exclusions such as a car and your home (up to a value of $585,000 in 2019). If you are married, your spouse at home can keep up to $25,284 worth of resources. In Nevada, the at-home spouse can also request a court order to keep a higher amount of up to $126,420.
Medicaid "waivers" will pay for some services to individuals who can appropriately be cared for at home or in an adult group care facility. These waivers can help individuals maintain their independence, sometimes in their own homes, as an alternative to nursing home placement.
The same financial eligibility rules that apply to Medicaid coverage for nursing homes apply to waiver programs. Thus, in 2019 an individual applicant cannot have monthly income greater than $2,313. Assets are limited to $2,000 for an individual and $4,000 for a couple with both spouses applying (each spouse is allowed up to $2,000).
The Home and Community Based Waiver for the Frail Elderly (HCBW-FE, formerly the CHIP program) of Nevada's Aging and Disability Services Division (ADSD) provides non-medical services to older persons to help them maintain independence in their own homes instead of going into a nursing home.
Applicants for the HCBW-FE waiver must:
Note that the HCBW-FE program provides only non-medical services, so care from a nurse is not included in this program.
A licensed social worker will be assigned to each individual to determine what services he or she needs. The social worker will then coordinate and oversee the needed services. Some of the services provided under this waiver program include assistance with personal care such as bathing, grooming, transferring, eating and homemaker help with meal preparation, laundry, and shopping. This program also will provide some services for adult day care (not medical day care), an adult companion, and a personal emergency response system (for reporting falls). ADSD will hire all of the service providers in this program, and participant direction of services is permitted in just a limited capacity. You should contact ADSD for more details.
There are limited slots available for this waiver program. The ADSD uses a waitlist to prioritize applicants. When funding becomes available, the applicant will be processed based upon the level of care needed, the risk factors for that individuals, and the date of the waiver application.
The Nevada Home and Community-Based Waiver for Persons with Physical Disabilities (HCBW-PD), or the Physical Disabilities Waiver (WIN), is a waiver serving Nevadans of all ages who have a documented physical disability and who maintain the required level of care. This program offers services similar to those the HCBW-FE program offers, and recipients must meet applicable functional and financial requirements.
Medicaid’s Personal Care Services (PCS) program provides services to Nevadans who, due to a chronic health issue or disability, need assistance to continue living at home. The PCS program provides assistance with activities of daily living and instrumental activities of daily living to support and maintain individuals who live at home but need help with things like bathing, dressing, grooming, toileting, eating, mobility and ambulation, light housekeeping, laundry, and other similar activities as authorized by the program.
For more information about the PCS program and eligibility requirements, visit the Nevada Division of Health Care Financing and Policy web page. For more general information about all of these programs and to apply, you should contact your local Nevada Aging and Disability Services Division office.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for LTC.
In Maryland, Medical Assistance provides LTC coverage under certain circumstances. Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet specified income and resource qualifications. Maryland also operates certain Medicaid waiver plans, known as Home and Community-Based Services (HCBS) waivers, including programs that allow elderly individuals in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home.
If you are age 65 or older, blind, or disabled and meet income and resource requirements, Maryland Medicaid provides coverage for nursing home residents under certain circumstances. To obtain coverage for nursing home care, not only do you have to be financially eligible, but you must also need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services. To determine the level of care (LOC) that you need, Maryland Medicaid requires a physician's certification that such services are needed.)
For more information about Medical Assistance, visit Maryland’s Department of Human Services (DHS) or contact your local Maryland DHS office. You can access the DHS benefits portal, applications, and information site for more services and assistance. Additionally, the MDH maintains web sites that answer Medicaid eligibility questions and provide additional Medicaid application resources.
Before you apply for Medicaid coverage, make sure that to the best of your knowledge you meet the eligibility criteria. Typically, your nursing care facility can assist you with the Medicaid application process. For other questions about LTC Medical Assistance, you can call the Maryland DHS main office at (800) 332-6347.
In Maryland, whether you are single or a married person with one or both spouses applying, to qualify for Medicaid-paid nursing home care, your income cannot exceed the cost of institutional care. This income limit for nursing homes may be different than the income limit for those applying for other health care benefits from Medicaid, such as for in-home Medicaid or Medicaid waiver services (discussed below). For example, though the monthly income limit is $350 for regular Medicaid, the limit is $2,349 per month for Medicaid waiver programs.
For purposes of determining Medicaid LTC eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to keep a minimum monthly needs allowance, which may range from $2,155 to $3,216.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Maryland Medicaid allows nursing home residents receiving Medicaid to keep only $82 per month as a personal needs allowance.
Maryland also provides a Medically Needy pathway, or “spend-down” program, that allows applicants otherwise over the income limit to qualify for Medicaid services. Individuals with high, recurring medical expenses can spend down their income that exceeds the medically needy income limit, effectively reducing their income level to the point that they become eligible for Medicaid to assume coverage.
Medicaid for long-term care has asset resource rules, which you must satisfy to be eligible for coverage, that may be different from those for other Maryland Medicaid programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, bank accounts, and cash. You will have to total up all of your non-exempt, countable assets to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 or $2,500 in assets, depending on the Medicaid program to which you are applying, with a few allowable exclusions such as a car and your home (up to a value of $595,000 in 2020). If you are married, your non-applicant spouse at home can keep up to $128,640 worth of joint assets.
Maryland residents may be eligible for Medicaid long-term care services that are delivered outside of the nursing home facility setting. The state has programs with different eligibility requirements that offer certain other benefits so that seniors at home or in the community can obtain needed services. These programs can provide services to promote home- and residence-based independent living.
Maryland Medicaid offers certain Home and Community-Based Services (HCBS) waiver programs that afford individuals LTC services assistance so that they can remain living independently—in their homes and communities—instead of in nursing homes. For example, the Community Options Waiver provides services like assisted living, medical day care, case management, transitional services, supports planning, and nurse monitoring for eligible individuals who need help with activities of daily living and meet a nursing facility level of care. Maryland’s Increased Community Services Program is a related program that offers similar services but has different financial eligibility requirements.
Another program, Community First Choice, allows eligible participants in need to receive at-home services featuring personal assistance with activities of daily living like bathing, grooming, dressing, meal preparation, and transportation. Individuals must meet an institutional level of care and qualify financially. Under this program, participants can actively self-direct care and can even hire family members to deliver care and receive compensation through Maryland Medicaid. Community Personal Assistance Services, a related program, is designed to serve eligible individuals who live at home and need assistance in areas like personal hygiene, bathing, and meal preparation. These services are delivered by an approved provider and subject to nurse case monitoring.
For general information about these programs, contact the MDH at (410) 767-1739. To learn more about the Community Options Waiver, Community First Choice, Community Personal Assistance Services, and related programs, contact your local Maryland Access Point (MAP) office or call MAP at (844) 627-5465.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for LTC. Oregon Health Plan provides LTC assistance under certain circumstances.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet specified income and resource qualifications. Oregon Health Plan also operates certain programs that allow elderly individuals in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home. These include Medicaid waiver plans, known as Home and Community-Based Services (HCBS) waivers, and other specific Oregon programs.
If you are age 65 or older, blind, or disabled and meet income and resource requirements, Oregon Health Plan provides coverage for nursing home residents under certain circumstances.
To obtain coverage for nursing home care, you must be financially eligible and you must need the kind of care that nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services. OHP will look at the limitations you have on your "activities of daily living" to determine your eligibility for a Medicaid-paid nursing home.
For more information, visit the Oregon Health Authority OHP web page. You can also apply for Medicaid assistance online through the state’s Oregon Eligibility (ONE) website.
Typically, your nursing care facility can assist you with the Medicaid application process. For other questions about the Oregon Health Plan and nursing home coverage, call OHP Customer Service at (800) 699-9075.
In Oregon, a single person can have a monthly income up to only $2,349 in 2020 and qualify for Medicaid-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,698 per month in 2020. These LTC income limits may be higher than the income limit for those applying for other health care benefits from Medicaid.
For purposes of determining Medicaid LTC eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to a minimum monthly needs allowance, which may range from $2,155 to $3,216.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all of your income on your care. Oregon Health Plan allows nursing home residents receiving Medicaid to keep about $64 per month as a personal needs allowance.
Medicaid for LTC has different resource rules, which you must satisfy to be eligible for coverage, than those for other Oregon Health Plan programs. Resources are assets like real estate, personal property, life insurance with a cash value, vehicles, motorhomes, boats, bank accounts, and cash. You will have to total up all of your non-exempt, countable assets to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in assets with a few allowable exclusions such as a car and your home (up to a value of $595,000 in 2020). If you are married, your non-applicant spouse at home can keep up to $128,640 worth of joint assets.
Oregon residents may be eligible for Medicaid LTC services that are delivered outside of the nursing home facility setting. The state has programs with different eligibility requirements that offer certain other benefits, so that seniors at home or in the community can obtain needed services.
For example, through the Aged and Physically Disabled (APD) waiver, Oregon provides waiver case management and transition services for eligible elderly and physically disabled individuals. This program is designed to assist individuals qualified to live in an institutional setting, like a nursing home, and receive nursing home care but who prefer to return to live in the community. The APD waiver offers recipients services such as transitional services (moving costs, housing application fee assistance, security and initial deposits, purchases of household items and essentials, and similar other items), case management, and wellness education.
Under Oregon’s K Plan, also known as the Community First Choice (CFC) Option, the state offers another alternative to institution-based nursing care and provides certain long-term home and community supports to eligible individuals. This plan offers supportive services for individuals who require nursing home-level care and need benefits such as adult day care, meal delivery and preparation, activities of daily living, or even home modifications, among others.
For more information about the K Plan, you can contact the Oregon Department of Human Services.
Oregon offers other related programs that can provide Medicaid recipients further flexibility and options for receiving and managing care outside of the nursing facility setting. The Client-Employed Provider Program (CEP) and Independent Choices Program (ICP) allow eligible individuals to act as employers of and manage their care providers, who assist with certain daily living activities. Oregon’s Spousal Pay program pays non-applicant spouses to provide care to their in-need spouses, also including assistance with activities of daily living.
For more information about Oregon’s CEP, ICP, and Spousal Pay programs, you can contact your local Area Agencies on Aging (AAA) or Aging and People with Disabilities (APD) office. You can also call the Aging and Disability and Resource Connection of Oregon at (855) 673-2372, or the Oregon Department of Human Services at (503) 945-5600.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for LTC.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet specified income and resource qualifications. Indiana also operates a Medicaid waiver plan, known as a Home and Community-Based Services (HCBS) waiver, that allows elderly individuals in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home.
If you are age 65 or older, blind, or disabled and meet income and resource requirements, Indiana Medicaid provides coverage for nursing home residents under certain circumstances.
To obtain coverage for nursing home care, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services.
For more information and to apply for Indiana Medicaid, visit the Indiana FSSA benefits portal or request an application by mail. You can also visit your local FSSA Division of Family Resources (DFR) office and apply in person, or call DFR for assistance at (800) 403-0864.
Before you apply for Medicaid coverage, make sure that to the best of your knowledge you meet the eligibility criteria. Typically, your nursing care facility can assist you with the Medicaid application process. For other questions about Indiana Medicaid and nursing home coverage, call the Indiana FSSA at (800) 457-8283.
In Indiana, a single person can have a monthly income up to only $2,349 in 2020 and qualify for Medicaid-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,698 per month in 2020. These LTC income limits may be higher than the income limit for those applying for other health care benefits from Medicaid.
For purposes of determining Medicaid LTC eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to a minimum monthly needs allowance, which may range from $2,113.75 to $3,216.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Indiana Medicaid allows nursing home residents receiving Medicaid to keep only $52 per month as a personal needs allowance.
Indiana Medicaid for LTC has resource rules, which you must satisfy to be eligible for coverage, that can be different from those for other Indiana Medicaid programs. Resources are assets like real estate, personal property, life insurance with a cash value, vehicles, motorhomes, boats, bank accounts and cash. You will have to total up all of your non-exempt, countable assets to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in assets with a few allowable exclusions such as a car and your home (up to a value of $595,000 in 2020). If you are married, your non-applicant spouse at home can keep up to $128,640 worth of joint assets.
Indiana residents may be eligible for Medicaid LTC services that are delivered outside of the nursing home facility setting. The state has programs with different eligibility requirements that offer certain other benefits, so that seniors at home or in the community can obtain needed services.
For example, Indiana offers a Home and Community-Based Services (HCBS) Medicaid waiver program that affords individuals LTC services assistance so that they can remain living independently—in their homes and communities—instead of in nursing homes. The Indiana Aged and Disabled (A&D) Medicaid waiver program offers nursing home services to recipients living (or wising to return to living) at home, in foster homes, or in assisted living facilities. This program allows individuals access to a range of benefits and services, such as adult day care, personal care assistance, assisted living, attendant care, transportation services, home-delivered meals, and personal emergency response systems, among others.
For more information about the Indiana A&D Medicaid waiver program, visit the FSSA A&D waiver webpage. You can also go to your local Area Agency on Aging or call at (800) 986-3505.
Structured Family Caregiving (SFC) is a related state benefit that can provide a caregiver to a waiver participant in the home of either the participant or the caregiver. Under this program, relatives of the individual in need—such as adult children, for example—can serve as caregivers, and be compensated for the services they provide, to a person who would otherwise need care in an LTC facility.
Indiana has also designed and implemented a Program of All-Inclusive Care for the Elderly (PACE) to provide community-based care to eligible individuals. To qualify for PACE, you must be 55 or older and live in an area served by a PACE provider. You must also require a nursing home level of care, and you must be able to live safely in the community with PACE services. You can review a list of Indiana’s PACE program providers, with whom the Indiana FSSA has partnered, and access additional Indiana PACE information here.
PACE participants receive their services from an interdisciplinary team of professionals including physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. Under this model, Indiana Medicaid pays for services offered in the PACE program under a managed care arrangement with its partner entities. If you are interested in a PACE program, apply directly to the one you are interested in, and the program will help determine your eligibility.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care (LTC) for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for LTC.
Wisconsin Medicaid will pay for skilled nursing facilities or intermediate care facilities for individuals who are determined by Medicaid to need this functional level of care for 30 days or more, if they meet specified income and resource qualifications.
Wisconsin also operates certain Medicaid waiver plans, known as Home and Community-Based Services (HCBS) waivers, including programs that allow elderly individuals in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home.
If you are age 65 or older, blind, or disabled and meet income and resource requirements, Wisconsin Medicaid provides coverage for nursing home residents under certain circumstances. To obtain coverage for nursing home care, you must be financially eligible, and you must need the kind of care that nursing homes provide. Nursing homes provide 24-hour supervised nursing care, therapy, personal care, nutrition management, organized activities, and other services.
Wisconsin uses a tool called the "Long-Term Care Functional Screen" (LTCFS) to determine whether a patient needs assistance with enough "activities of daily living," such as bathing, dressing, transferring, and administering medicines, to qualify for a Medicaid-paid facility.
In Wisconsin, a single person can have a monthly income up to only $2,349 in 2020 and qualify for Medicaid-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,698 per month in 2020. These LTC income limits may be higher than the income limit for those applying for other health care benefits from Medicaid.
For purposes of determining Medicaid LTC eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that the non-applicant spouse has enough funds on which to live. If the non-applicant spouse doesn't have any income, he or she is entitled to keep a minimum monthly needs allowance, which may range from $2,818.34 to $3,216, from the applicant spouse's income.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Wisconsin Medicaid allows nursing home residents receiving Medicaid to keep only $45 per month as a personal needs allowance.
Note that Wisconsin also provides a Medically Needy pathway, or “spend-down” program—the Medicaid Deductible Program—that allows applicants otherwise over the income limit to qualify for Medicaid services. Individuals with high, recurring medical expenses can “spend down” their income that exceeds the medically needy income limit, effectively reducing their income level to the point that they become eligible for Medicaid to assume coverage.
Medicaid for long-term care has different resource rules, which you must satisfy to be eligible for coverage, than those for other Wisconsin Medicaid programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, bank accounts and cash. You will have to total up all of your non-exempt, countable assets to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in assets with a few allowable exclusions such as a car and your home (up to a value of $893,000 in 2020). If you are married, your non-applicant spouse at home can keep up to $128,640 worth of joint assets.
You can apply for Medicaid assistance online through the state’s ACCESS website. For more information, visit Wisconsin’s Department of Health Services Medicaid Programs for Seniors page.
Before you apply for Medicaid coverage, make sure that to the best of your knowledge you meet the eligibility criteria. Typically, a nursing care facility can answer questions and assist you with the Medicaid application process. For other questions about Wisconsin Medicaid and nursing home coverage, call the Department of Health Services at (608) 266-1685.
Wisconsin residents may be eligible for Medicaid LTC services that are delivered outside of the nursing home facility setting. The state has programs with different eligibility requirements that offer certain other benefits, so that seniors at home or in the community can obtain needed services.
For example, through the Medical Assistance Personal Care program, Medicaid-eligible individuals can receive assistance with daily activities. This program provides recipients living at home, in foster care homes, or in assisted living facilities the opportunity to obtain help with activities such as dressing, grooming, toileting, meal preparation, and food shopping.
Wisconsin Medicaid also offers Home and Community-Based Services (HCBS) waiver programs that provide individuals with LTC services assistance so that they can remain living independently—in their homes and communities—instead of in nursing homes.
Family Care and Family Care Partnership are Medicaid LTC programs that offer managed care services featuring self-directed supports, so that individuals can direct their own care. Participants can also designate family members as caregivers and, through these programs, available support services may include adult day care, personal care assistance, durable medical equipment, and personal emergency response systems. A primary difference between these two programs is that Family Care covers non-medical services, and Family Care Partnership covers medical and prescription drug services.
Another waiver program, IRIS (“Include, Respect, I Self-direct”), is a consumer-directed program through which participants, with case manager assistance, create and budget for their own LTC plans. IRIS, designed for Wisconsin’s Medicaid-eligible frail elders and adults with disabilities, also allows participants to hire family members to provide personal care services. IRIS benefits may include services such as adult day care, adult family home, day services, nursing services, transportation, and home modifications, among others.
For more information about Wisconsin Family Care, Family Care Partnership, or IRIS programs, or to apply, contact your local Aging and Disability Resource Center. You can also call the Family Care program office at (608) 267-7286.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for LTC.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet certain income and resource qualifications. Missouri also operates certain Medicaid waiver plans, known as Home and Community-Based Services (HCBS) waivers, which include programs that allow elderly individuals in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home.
If you are age 65 or older, blind, or disabled and meet income and resource requirements, MO HealthNet provides coverage for nursing home residents under certain circumstances.
To obtain coverage for nursing home care, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services.
For more information, visit Missouri’s MO HealthNet (Medicaid) for Seniors page or call (855) 373-4636. You can also access an MO HealthNet application form here.
Before you apply for Medicaid coverage, make sure that to the best of your knowledge you meet the eligibility criteria. Typically, your nursing care facility can assist you with the Medicaid application process. For other questions about MO HealthNet and nursing home coverage, call the Missouri DSS at (800) 735-2966. You can also click here (then scroll down to “Find an Office”) to identify and contact your local Family Support Division (FSD) resource center.
In Missouri, to qualify for Medicaid-paid nursing home care, known as “vendor coverage,” all of a single applicant’s income must go towards the cost of care. For an eligible individual, MO HealthNet would pay the cost of skilled nursing or intermediate care in excess of the person’s income. Note that these LTC income rules may be different from the income limits for those applying for other health care benefits from Medicaid. For example, applicants for HCBS Medicaid waiver programs, discussed below, must meet a 2020 monthly income limit of $1,370.
For purposes of determining Medicaid LTC eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to keep a minimum monthly needs allowance, which may range from $2,113.75 to $3,216.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. MO HealthNet allows nursing home residents receiving Medicaid to keep only $50 per month as a personal needs allowance.
Medicaid for LTC has different resource rules, which you must satisfy to be eligible for coverage, than those for other MO HealthNet programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can have only up to $4,000 in assets with a few allowable exclusions such as a car and your home (up to a value of $595,000 in 2020). If you are married, your non-applicant spouse at home can keep up to $128,640 worth of joint assets.
Missouri residents may be eligible for Medicaid LTC services that are delivered outside of the nursing home facility setting. The state has programs with different eligibility requirements that offer certain other benefits, so that seniors at home or in the community can obtain needed services.
For example, MO HealthNet offers programs to eligible state residents who require nursing care but choose to live at home. Missouri operates a Medicaid HCBS waiver program, which is designed to provide eligible individuals assistance so that they can remain living independently—in their homes and communities—instead of in nursing homes. The HCBS entitlement program, also referred to as the Missouri Care Options (MCO) program, provides financial assistance to individuals receiving services at home or in the community.
MO HealthNet has a similar program, the Aged and Disabled Waiver (ADW), that is not an entitlement but rather offers assistance on a limited-availability basis. The ADW program offers in-home services to eligible individuals who would require nursing home care if they did not receive assistance with chores, homemaking, respite care, and meals. Like those receiving services under the HCBS program, ADW program participants may access adult daycare, personal care assistance, alternative care facilities, in-home support services, and others.
MO HealthNet also offers a Consumer Directed Services (CDS) program, or self-directed care, through which eligible applicants can hire, train, and supervise care providers who assist them at home. The CDS program provides consumer-directed personal care assistance, at home, that is not medical but rather aids with certain activities of daily living. The Independent Living Waiver (ILW) program is similar to CDS, requiring that applicants meet the same eligibility criteria, and offers eligible recipients other services such as environmental accessibility adaptations, specialized medical equipment and supplies, financial management services, and case management.
Finally, MO HealthNet operates the Supplemental Nursing Care (SNC) financial assistance program, providing a cash benefit to help eligible individuals pay for residential care. Program participants may receive payments in varying amounts, depending on whether the particular recipient lives in an assisted living facility or a residential care facility.
For general information about MO HealthNet waiver programs, visit the Missouri DSS website. You can find more information about Missouri independent living options in the DHSS brochure, as well. To find out more about the ILW, call the Missouri Department of Health and Senior Services at (573) 751-6400, or visit the DSS website for basic information.
You can find out more about the SNC program by contacting your county Family Support Division (FSD). For more information, call the FSD information center at (855) 373-4636 or visit the FSD contact information web page.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, LTC for persons who meet certain requirements. Other types of Medicaid services have different eligibility guidelines than the rules for long-term care.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet certain income and resource qualifications. Washington, D.C. also operates a Medicaid waiver plan, known as a Home and Community-Based Services (HCBS) Waiver, including a program that allows elderly individuals in need of assistance to remain living independently, in their homes and communities, instead of in a nursing home.
Medicaid is available to people with limited income and resources. If you are age 65 or older, blind, or disabled and meet income and resource requirements, D.C. Medicaid provides coverage for nursing home residents under certain circumstances.
To obtain coverage for nursing home care, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services. To qualify, you must need a lot of help with your "activities of daily living." To read more about D.C. Medicaid coverage of LTC services, consult this D.C. Department of Human Services (DHS) brochure.
Before you apply for Medicaid coverage, make sure that to the best of your knowledge you meet the eligibility criteria. Typically, your nursing care facility can assist you with the Medicaid application process. Or, you can call (202) 724-5506 to apply for Medicaid coverage for nursing home services or ask questions about coverage.
In Washington, D.C., a single person can have a monthly income up to only $2,349 in 2020 and qualify for Medicaid-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,698 per month in 2020. These LTC income limits may be higher than the income limit for those applying for other health care benefits from Medicaid.
For purposes of determining Medicaid eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. If the non-applicant spouse does not have sufficient funds of their own, he or she is entitled to a minimum monthly needs allowance, which may range from $2,113.75 to $3,216.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. The District allows nursing home residents receiving Medicaid to keep only $70 per month as a personal needs allowance.
Note that D.C. also provides a Medically Needy pathway, or “spend-down” program, that allows applicants otherwise over the income limit to qualify for Medicaid services. Individuals with high, recurring medical expenses can “spend down” their income that exceeds the medically needy income limit, effectively reducing their income level to the point that they become eligible for Medicaid to assume coverage. For more on the financial eligibility requirements, see D.C.’s DHCF LTC web page or call (202) 442-5988.
Medicaid for long-term care has different resource rules, which you must satisfy to be eligible for coverage, than those for other D.C. Medicaid programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can have up to only $4,000 in assets, with a few allowable exclusions, such as a car and your home (up to a value of $893,000 in 2020). If you are married, your non-applicant spouse at home can keep up to $128,640 worth of joint assets.
Washington, D.C. operates a Medicaid Home and Community-Based Services (HCBS) waiver program, which is designed to provide eligible individuals assistance so that they can remain living independently—in their homes and communities—instead of in nursing homes. Assistance offered under one of these program waivers, called the Elderly and Individuals with Physical Disabilities (EPD) Waiver, may include adult day care, personal care assistance, alternative care facilities, in-home support services, and personal emergency response systems, among others.
Generally, the EPD Waiver program offers services that accompany or add to services applicants receive through D.C. Medicaid, other government programs, and family- and community-based supports.
Notably, the EPD Waiver offers a component called “Services My Way” for program participants who live in their homes to retain more choice and control of their Medicaid LTC services. Services My Way, or Participant-Directed Services (PDS), allows EPD Waiver enrollees the option to choose and oversee their service-providers.
To qualify for the EPD Waiver, applicants must meet certain financial and program criteria, and they must be willing to receive services in the home or community. For more information about the EPD Waiver, visit the DHCF web page or contact the EPD Waiver program at (202) 724-5626.
Washington, D.C. offers, in addition to those services available through the EPD Waiver program, Personal Care Aide (PCA) Services and Adult Day Health Program (ADHP) services through D.C. Medicaid and the DHCF. Eligible enrollees can receive assistance with activities of daily living in their homes through PCA Services, and they can receive similar services at adult day health facilities through the ADHP.
PCA Services are rendered by home health agencies, and ADHP services are provided at daytime facilities. These benefits and services may be available to individuals enrolled in D.C. Medicaid, provided they meet financial and functional eligibility criteria.
For more information about PCA Services, refer to the DHCF PCA quick-reference sheet, contact the Aging and Disability Resource Center (ADRC) at (202) 724-5626 or ask.adrc@dc.gov, or call DHCF LTC Administration at (202) 442-5988. For more about ADHP options or to enroll, contact the ADRC or DHCF LTC, or refer to the DHCF ADHP quick-reference sheet.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for LTC. Health First Colorado, Colorado’s Medicaid program, administered by the Colorado Department of Health Care Policy and Financing, provides LTC assistance under certain circumstances, discussed below. Additionally, in Colorado, the state’s LTC Partnership, an alliance between the private insurance industry and the state government, helps residents plan for future LTC needs without depleting all of their resources to fund their care.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet certain income and resource qualifications.
To obtain coverage for nursing home care under Health First Colorado, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services.
For more information and to apply for Medicaid coverage for nursing home services, you can seek assistance from the state’s Health First Colorado web page or call Health First Colorado at (800) 221-3943. Typically, your nursing care facility can assist you with the Medicaid application process. You can also contact your local county Department of Human Services office for assistance.
In Colorado, a single person can have a monthly income up to only $2,313 in 2019 and qualify for Medicaid-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,626 per month in 2019. These LTC income limits may be higher than the income limit for those applying for other health care benefits from Medicaid.
For purposes of determining Medicaid eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to a minimum monthly needs allowance, which may range from $2,113.75 to $3,160.50 (if the non-applicant spouse doesn't have this amount of income, part of the applicant spouse's income can be saved for this purpose).
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Colorado allows nursing home residents receiving Medicaid to keep only $84.41 per month as a personal needs allowance.
Medicaid for long-term care has different resource rules than those for other Health First Colorado programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in assets, with a few allowable exclusions such as a car and your home (up to a value of $585,000 in 2019). If you are married, your non-applicant spouse at home can keep up to $126,420 worth of joint assets.
Colorado offers a Long-Term Care Partnership program, under which qualified LTC policyholders can protect a portion of their assets if they choose to apply for Health First Colorado. Under this program, for each dollar that a policy pays in LTC benefits, the policyholder who applies for Medicaid can protect a dollar of personal assets. To the extent protected, those assets are disregarded during eligibility review and at estate recovery. To be eligible to receive the asset protection offered under the LTC Partnership program, an applicant must hold an LTC insurance policy that meets specified program requirements.
For more information about the Colorado LTC Partnership, visit the state’s program web site.
Colorado has a state Medicaid waiver plan, known as a Home and Community-Based Services (HCBS) Waiver, that allows elderly individuals in need of assistance to remain living independently instead of in a nursing home.
Colorado has a Medicaid Home and Community-Based Services (HCBS) waiver program, which is designed to provide assistance to eligible individuals so that they can remain living independently – at home and in assisted living facilities – instead of in nursing homes. Assistance offered under this program, called the Elderly, Blind, and Disabled (EBD) Waiver, may include adult day care, personal care assistance, alternative care facilities, in-home support services, and personal emergency response systems.
Generally, the EBD Waiver program offers services that accompany or add to services applicants receive through Health First Colorado, other government programs, and family- and community-based supports. To qualify for the EBD Waiver, applicants must meet certain financial and program criteria, and they must be willing to receive services in the home or community. The EBD Waiver program has rules and requirements in addition to those of Health First Colorado, and the program may have waitlists.
If you are already enrolled in Health First Colorado, you can start the waiver application process by contacting your local Single Entry Point (SEP) Agency. Individuals not yet enrolled in Health First Colorado can apply here.
The CDASS program is an option available to EDB Waiver participants who live in their own homes. CDASS allows recipients to direct and manage the LTC services they receive and to hire, train, and manage caregivers of their choice. Participants who are in stable health and able to direct their own services may do so, instead of working through an agency, or participants can otherwise assign an Authorized Representative to whom they would delegate certain management responsibilities.
The CDASS program option gives individuals greater control over their Medicaid-funded home services, as they can use those funds for hiring and paying for attendant services. Attendants can be friends and family members, or agency staff meeting an individual’s specific qualifications, and program recipients determine payment for services.
For more information, visit the Colorado CDASS web page.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for, among other things, long-term care for persons who meet certain requirements, such as being over 65, disabled, or blind. Long-term care Medicaid services have different eligibility guidelines than the rules for other types of services covered by Medicaid.
In Arizona, Medicaid is called the Arizona Health Cost Containment System (AHCCCS), and the Arizona Long-Term Care System (ALTCS, pronounced “ALL-Tecs”) provides LTC insurance for services in an institution, home, or community-based setting.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet ALTCS income and resource qualifications (and are age 65 or older, blind, or disabled).
To obtain coverage for nursing home care, you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, nutrition management, therapy, personal care, organized activities, and other services.
For more information and to apply for Medicaid coverage for nursing home services, you can seek assistance from the state’s ALTCS web page or call ALTCS at (888) 621-6880. Typically, your nursing care facility can assist you with the Medicaid application process. You can also contact your local ALTCS office for assistance.
Before you apply for ALTCS coverage, make sure that to the best of your knowledge you meet the income and asset eligibility criteria.
In Arizona, a single person can have a monthly income up to only $2,313 in 2019 and qualify for Medicare-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,626 per month in 2019. These LTC income limits may be higher than the income limit for those applying for other health care benefits from Medicaid.
For purposes of determining Medicaid eligibility, virtually all income an applicant receives, from any source, is considered. You may, however, deduct the amount you spend on medical insurance premiums or medical expenses not paid for by ALTCS, such as eye glasses, dental care, and hearing aids. Also, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, if the non-applicant spouse doesn't have enough income on his or her own, he or she is entitled to a minimum monthly needs allowance, which may range from $2,113.75 to $3,160.50.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Arizona allows nursing home residents receiving Medicaid to keep only $116.65 per month as a personal needs allowance.
Medicaid for long-term care in Arizona has different resource rules than those for other AHCCCS programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in assets, with a few allowable exclusions such as a car and your home (up to a value of $585,000 in 2019). If you are married, your non-applicant spouse at home can keep up to $126,420 worth of joint assets.
For those with long-term care insurance, Arizona offers a Long Term Care Partnership Program, under which ALTCS will not count certain of an applicant’s assets to determine Medicaid eligibility, provided the applicant's LTC insurance policy meets program requirements. To calculate whether an individual is eligible for ALTCS, AHCCCS will not count the individual’s resources in an amount equal to the LTC insurance benefits received through the month before the person applied for ALTCS. Furthermore, that same amount will be protected from AHCCCS recovery under the Arizona Estate Recovery Program. Contact your local ALTCS office for more information about the Long Term Care Partnership Program.
Arizona’s options for paid caregivers though ALTCS include programs allowing elderly participants to be actively involved in choosing their attendant caregivers and other service providers in the home or in an alternative residential care setting (such as assisted living). These "member-directed" options, which allow participants to direct the provision of their at-home care to a greater degree than they would otherwise be able, include Arizona’s Agency with Choice (AWC) and Self-Directed Attendant Care (SDAC) programs.
The AWC program is an option available to ALTCS participants who live in their own homes. Not available to program members who live in nursing facilities or other alternative residential settings, AWC allows a program provider agency and an ALTCS member to share employer-based responsibilities for the paid home caregiver. Through this option, elderly participants can choose their own caregivers, through a provider agency, instead of having to accept an assigned home health aide.
AWC applicants must meet ALTCS functional and financial eligibility requirements. In sharing responsibilities, the provider agency maintains hiring, firing, and training authority and oversight, and the program member (or his or her individual representative) may choose to assume certain employer-based responsibilities over the caregiver providing home-based services. Through AWC, ALTCS members who prefer receiving care in their home, as opposed to a nursing home or other LTC facility, can receive self-directed home care.
The SDAC program allows members, or their legal guardians, to serve as legal employers of paid home caregivers and assume all employment responsibilities for those caregivers.Under this model, participants gain flexibility to decide which services they need and to hire, fire, train, and manage those caring for them at home.
Utilizing this variation of member-directed option, the member or his or her guardian works with case managers to develop care plans that best meet the member’s needs. SDAC pays the costs associated with the at-home services provided, as the member receives support from a Fiscal Employer Agent that manages taxes, payroll withholding, and actual payment to caregivers. Under SDAC, family members and friends can also be hired as caregivers, subject to certain program restrictions and provided all requirements are met.
For more information on ALTCS member-directed options, visit the AHCCCS program web page.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for medical care for persons who meet certain requirements, such as being over 65, disabled, or blind. Medicaid's long-term care program has different eligibility guidelines than other types of Medicaid services.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet the income and resource qualifications of Tennessee's Medicaid program.
There are also some limited services available for Tennesseans who still live at home but would otherwise require a nursing home. These are called home-based waiver programs, for which similar income and asset rules apply. A few other programs exist in Tennessee for those who might not require or want nursing home services but still need assistance with daily activities.
Tennessee's Medicaid program, called TennCare, provides coverage for nursing home residents who are age 65 or older, blind, or disabled and meet income and resource requirements. To obtain TennCare coverage for nursing home care, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services.
To apply for Medicaid coverage for nursing home services, you can seek assistance from the state’s TennCare Connect web portal. You can review additional information and submit an application online or by calling TennCare Connect at (855) 259-0701. You can also submit a paper application. Typically, your nursing care facility can assist you with the Medicaid application process or you can apply directly with TennCare Connect.
In Tennessee, a single person can have a monthly income up to $2,313 in 2019 and qualify for TennCare-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,626 per month in 2019. These LTC income limits are higher than the income limit for those applying for other health care benefits from Medicaid, meaning that it's easier to qualify financially for Medicaid-paid long-term care than other Medicaid services.
For purposes of determining Medicaid eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to a minimum monthly needs allowance, which may range from $2,113.75 to $3,160.50. (If the non-applicant spouse's own income falls beneath this minimum monthly needs allowance, he or she is allowed to keep some of the income belonging to the spouse living in the nursing home.)
If you live in a nursing home paid for by Medicaid, you'll be expected to spend almost all income on your care. Tennessee allows nursing home residents receiving Medicaid to keep only $50 per month as a personal needs allowance.
Medicaid has different resource rules for long-term care than those for other TennCare programs. Resources are assets like real estate, personal property, life insurance with a cash value, vehicles, motor homes, IRAs, bank accounts, and cash. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in assets, with a few allowable exclusions such as a car and your home (up to a value of $585,000 in 2019). If you are married, your non-applicant spouse at home can keep up to $126,420 worth of joint assets.
Tennessee’s Medicaid program structure recognizes that individuals who qualify for nursing home coverage might prefer to live in their homes or alternate care environments, such as assisted living residences. Living outside of a nursing facility could be less expensive for the state and more convenient and desirable for the individuals, for various reasons.
Medicaid Home and Community-Based Services (HCBS) "waiver" programs will pay for some services to individuals who can appropriately be cared for at home or in an adult group care facility, for example. These programs can help individuals maintain their independence, sometimes in their own homes, as an alternative to nursing home placement.
The same financial eligibility rules that apply to Medicaid coverage for nursing homes apply to waiver programs. (In 2019, an individual applicant cannot have monthly income greater than $2,313, and the eligible applicant’s assets are limited to $2,000.)
TennCare offers state residents HCBS through a Medicaid waiver program called CHOICES in Long-Term Services and Supports (CHOICES). CHOICES provides coverage for home and community-based options, which can be delivered in the home, in the home of a caregiver or family member, in an adult foster home, in an assisted living community, or elsewhere in the community, to assist with daily living activities and allow qualified applicants to be actively involved in their communities. CHOICES provides care in a nursing home, too, if this is needed.
CHOICES provides personal care services to assist eligible individuals with daily activities like bathing, dressing, toileting, eating, grocery shopping and cooking, among others. The consumer-directed nature of the CHOICES program gives participants the option to select their care providers, which may allow for friends, neighbors, and family members to serve as caregivers.
You can find specific information about the CHOICES program by visiting the TennCare CHOICES website, contacting your local Area Agency on Aging, or calling (866) 836-6678. Please note that because the CHOICES program has limited enrollment, waiting lists may exist.
Tennessee Adult Day Care provides certain non-Medicaid services to adults who do not need institutional care services like those nursing homes provide, but still require some daily supervision and social activity. Adult Day Care programs also provide relief and assistance to caregivers, who may need rest and time to care for themselves. To learn more about Adult Day Care, visit the Tennessee Department of Human Services website or call (615) 532-6250.
Tennessee’s OPTIONS for Community Living (OPTIONS) program provides personal care, meals, home maintenance, and other care and support services to seniors who require care and want to remain living at home. Eligible participants over 60 years of age must need assistance performing their activities, and instrumental activities, of daily living, such as bathing, dressing, toileting, eating, grocery shopping and cooking, among others. Although OPTIONS does not have an absolute income limit, the program might give priority to persons with assets valued below applicable Medicaid limits, and it applies a sliding scale for cost-sharing for services, based on an applicant’s income. Those with income over 600% of the SSI payment level ($771 in 2019) are responsible for the complete cost of services rendered.
The Tennessee OPTIONS program is funded by the state, and the state’s Commission on Aging & Disability administers OPTIONS. OPTIONS is available to eligible residents through Tennessee Area Agencies on Aging and Disability. For more information and enrollment in OPTIONS, contact your local Area Agency on Aging and Disability, or call (866) 836-6678.
]]>Medicaid is a medical assistance program funded by the federal and state governments to pay for LTC for persons who meet certain requirements, such as being over 65, disabled, or blind. Other types of Medicaid services have different eligibility guidelines than the rules for LTC.
Patients who live in skilled nursing facilities, intermediate care facilities, or hospitals for 30 days or more and are determined by Medicaid to need this care may qualify for Medicaid benefits, if they meet the income and resource qualifications of Washington's Medicaid program.
There are also some limited services for people who still live at home but would otherwise require a nursing home. These are called home-based waiver programs. Similar income and asset rules apply for these programs.
As referenced above, Medicaid is a government health insurance program available to people with limited income and resources. If you are age 65 or older, blind, or disabled and meet income and resource requirements, Washington's Medicaid program, called Apple Health, provides coverage for nursing home residents under certain circumstances.
To obtain Apple Health coverage for nursing home care, you must be financially eligible, and you must need the kind of care nursing homes provide. Nursing homes provide 24-hour supervised nursing care, personal care, therapy, nutrition management, organized activities, and other services.
To apply for LTC Medicaid for nursing home coverage, you must submit an application to the Washington Department of Social and Health Services (DSHS), either in paper or online. In general, you must meet financial requirements and require a level of care that cannot be met anywhere but in a nursing home.
Typically, your care nursing facility can assist you with the Medicaid application process or you can apply directly with the DSHS. Before you apply, make sure that to the best of your knowledge you meet the eligibility criteria.
In Washington, a single person can have a monthly income up to only $2,313 in 2019 and qualify for Apple Health-paid nursing home care. (This is 300% of the SSI payment level.) The Medicaid income limit for a married couple, with both spouses applying, is $4,626 per month in 2019. These LTC income limits are higher than the income limit for those applying for other health care benefits from Medicaid.
For purposes of determining Medicaid eligibility, any income an applicant receives, from any source, is considered. However, when only one spouse of a married couple applies for Medicaid, the income of the non-applicant spouse is not counted, so that he or she has enough funds on which to live. Additionally, the non-applicant spouse is entitled to a minimum monthly needs allowance, which may range from $2,057.50 to $3,160.50.
If your income is above the limit, you still might be able to qualify for Medicaid if your medical expenses are higher than the amount of extra income you have. In Washington, under the state’s “medically needy” program, people who are 65 or older, blind, or disabled can use medical bills that they incur each month to “spend down” their income and qualify for Medicaid.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Washington allows nursing home residents receiving Medicaid to keep only $70 per month as a personal needs allowance.
Medicaid for LTC has different resource rules than those for other Apple Health programs. Resources are assets like real property, personal property, life insurance with a cash value, vehicles, motorhomes, boats, IRAs, bank accounts and cash. You will have to total up all of these to determine how much you have in resources.
If you are a single person, you can have only up to $2,000 in resources with a few allowable exclusions such as a car and your home (up to a value of $585,000 in 2019). If you are married, your non-applicant spouse at home can keep up to $126,420 worth of joint assets.
Apple Health covers nursing home care for Washington residents who meet applicable financial and functional need criteria, as described above and determined by the Washington DSHS. Washington’s Medicaid program structure also recognizes, though, that individuals who qualify for nursing home coverage might prefer to live in their homes or alternate care environments, such as assisted living residences. Living outside of a nursing facility could be less expensive for the state and more convenient and desirable for the individuals, for various reasons.
Therefore, Medicaid "waiver" programs will also pay for some services to individuals who can appropriately be cared for at home or in an adult group care facility. These programs can help individuals maintain their independence, sometimes in their own homes, as an alternative to nursing home placement.
The same financial eligibility rules that apply to Medicaid coverage for nursing homes apply to waiver programs. Thus, in 2019 an individual applicant cannot have monthly income greater than $2,313, and the applicant’s assets are limited to $2,000.
Apple Health offers certain Medicaid waiver programs that provide coverage for home and community-based options. For example, the Community First Choice Option (CFCO) program makes available to program participants personal care assistance, personal emergency response systems, respite care, and transitional services from residential living back into the community. Program participants can choose their own care providers, as well. Because CFCO is an entitlement program, there are no waitlists and any eligible applicant may receive services. CFCO primarily provides participants assistance with personal health and care needs, such as activities of daily living and instrumental activities of daily living, like eating, dressing, toileting, bathing, grocery shopping, and meal preparation.
Apple Health also offers a waiver program called the Community Options Program Entry System (COPES), which in recent years has largely replaced Washington’s Medicaid Personal Care (MPC) program. Through the COPES home and community-based program, individuals requiring nursing home-level care can obtain care in their home or alternative care environment, along with other supports to enable a successful transition to independent or assisted living. These supports include coverage for adult day care and assisted living, case management, durable medical equipment, home health care, certain home or vehicle modifications, personal emergency response services, and transportation assistance, among others. Because COPES is not an entitlement program, only a limited number of slots are available and there may be waiting lists to receive services.
Under certain circumstances, program participants can receive assistance simultaneously under CFCO and COPES. If you are a Washington resident who needs Medicaid assistance but are unsure whether you meet the relevant income and asset limits, you can read more about eligibility and consult the Washington State Health Care Authority for more guidance.
You can find specific information about CFCO on the Washington DSHS website, and you can learn how to apply through your local Area Agency on Aging. To learn more about and to apply for COPES, visit the COPES program web page.
Washington’s Medicaid Alternative Care (MAC) program provides support to individuals at home and their caregivers, helping recipients continue living in their homes or the homes of relatives. The MAC program has eligibility requirements related to age, living arrangement, function, and finances, including requirements that apply to both the participant and his or her caregiver. Those who are eligible to receive services under the MAC program must choose between receiving those benefits or more traditional LTC services, such as those offered through the COPES and CFCO waiver programs.
Through the MAC program, Medicaid-eligible individuals can receive services such as light housecleaning, grocery shopping and delivered meals, respite care, adult day care, personal emergency response systems, and transportation. Visit the DSHS web site for more information about the MAC program, and apply by visiting your local Community Living Connections office.
For seniors age 55 or older who are “at risk” of needing long-term services and supports, and who are not currently eligible for Medicaid, the Tailored Supports for Older Adults (TSOA) program may provide assistance. The TSOA program allows for services similar to those available under the MAC program, another family caregiver support program, but TSOA is designed for non-Medicaid recipients. Therefore, if you need LTC but are financially ineligible for Medicaid, you might want to learn more about TSOA and find out whether you meet program requirements.
]]>If you receive Medicaid, the program will pay for some limited home care services such as skilled nursing care or therapy services. For Medicaid to pay for home health services, they must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you.
If you need ongoing home health services to help you perform activities of daily living or manage your medications, Medicaid will not cover that type of help unless you qualify for Michigan’s Medicaid Waiver program, called MI Choice. To qualify for MI Choice, you must have income at or below 300% of the monthly SSI Federal Benefit Rate, or $2,313 in 2019. You also must have less than $2,000 in assets. (If you're married, Medicaid allows your spouse to keep more income and assets.)
To receive MI Choice, you must also show that you would have to live in a nursing home if you did not receive MI Choice waiver services. You also have to show that you can live safely at home with the services. If you do qualify for MI Choice, you can receive assistance through a wide variety of services, including nursing services, respite services, adult day health services, transportation, chore services, home-delivered meals, and changes to make your home more accessible.
To apply for MI Choice, contact the waiver agency in your region.
Michigan also operates a program called Home Help Services for seniors who need extra assistance to stay in their own homes. In Home Help Services, you hire your own provider to help you with tasks of daily living that you need assistance with, like bathing, eating, getting around inside your home, light housework and laundry, and some shopping. Medicaid pays the cost of your provider.
To qualify, you must meet Medicaid’s income and asset requirements, and your doctor must submit a form saying that you need help in your home. Then an assessor from the Michigan Department of Health & Human Services will visit you and evaluate how much assistance you need with activities around your house. Medicaid will tell you how many hours of assistance it will pay for in a month.
To apply for Home Help Services, contact your local office of the Department of Health & Human Services.
If you are enrolled in Medicaid or MI Choice (see above), your regular benefits will cover some of your expenses while you live in an assisted living facility, like physical therapy or prescription costs. However, Michigan does not have a Medicaid program that will pay for room and board in an assisted living facility.
Michigan operates a Program of All-Inclusive Care for the Elderly (PACE). To qualify for PACE, you must be 55 or older and live in an area served by a PACE provider. You must also require a nursing home level of care, and you must be able to live safely in the community with PACE services. You can see a list of Michigan’s 18 PACE centers here.
PACE participants receive their services from an interdisciplinary team of professionals like physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. Medicaid pays for all the services offered in the PACE program. If you are interested in a PACE program, apply directly to the one you are interested in, and the program will help determine your eligibility.
If you don't qualify for Medicaid and do not meet the nursing home level of care, you may still qualify for some personal assistance services if you are physically disabled and need help with activities of daily living like eating, dressing, or bathing. Michigan’s Area Agencies on Aging administers a supportive program. Contact your local AAA to apply.
1 | 2
]]>There are many different ways to become eligible for Medicaid, and there are specific eligibility rules for long-term care services like nursing homes. To apply for Medicaid in Michigan, contact your local office of the Michigan Department of Health & Human Services. You can also apply online.
Michiganders who are sixty-five or older, disabled, or blind can qualify for Medicaid if they also meet income and asset limits. People who receive SSI automatically qualify to receive Medicaid in Michigan, but if you are elderly, blind, or disabled and not receiving SSI, then your monthly income must be less than 138% of the federal poverty level (FPL) to qualify for Medicaid. In 2019, that is $1,436 per month for an individual.
If your income is above this limit, you still might be able to qualify for Medicaid if your medical expenses are higher than the amount of extra income you have. In Michigan, people who are sixty-five or older, blind, or disabled can use medical bills that they incur each month to “spend down” their income and qualify for Medicaid.
If you qualify for Medicaid and live in a nursing home, you will be expected to spend almost all income on your care. Michigan allows nursing home residents receiving Medicaid to keep only $60 per month as a personal needs allowance.
If you have unpaid bills for medical expenses that were incurred in the three months before you applied for Medicaid, you may be eligible for retroactive benefits that could pay those bills. You will need to submit a separate application for retroactive benefits and show proof of the bills.
To qualify for Medicaid in Michigan, you must have no more than $2,000 in resources. Resources are assets like money and property. Some property does not count toward the resource limit. In Michigan, one car is exempt, and household goods are exempt. Your primary residence and any attached acreage is an exempt resource. However, if you need Medicaid for long-term care, then you cannot have more than $585,000 in equity in your home in 2019. Retirement accounts are counted as assets to the extent you can withdraw money from them.
If you have a spouse who is going to continue to live independently, then Michigan will allow you to keep more income and assets to support that spouse. This is called spousal maintenance.
Your spouse will be allowed to keep some income each month. The amount will depend on how many dependents and expenses he or she has. In 2019, the minimum amount your spouse can keep is $2,057.50, and the maximum is $3,090. If your spouse needs more than the Department of Health & Human Services decides to allow, then you can go to court and ask a judge to order more.
You will also be allowed to keep more than $2,000 in resources if you have a spouse who will remain in the community. The Department of Human Services does a complicated calculation to determine how many assets your spouse can keep.
When you are admitted to a nursing home, you will complete a form called an “Assets Declaration,” and the staff will do ask you about all of your assets in an “Initial Asset Assessment” (IAA). Michigan assumes that half of your IAA should belong to your spouse, subject to a limit that changes annually. In 2019, the minimum "Protected Spouse Amount" ("PSA") is $25,284, and the maximum is $126,420. When you apply for Medicaid, your PSA is subtracted from your countable assets at the time of your application.
Mr. Brown has $40,000 in countable assets when he moves into a nursing home on February 1st. His IAA is $40,000. Mrs. Brown continues to live in the couple’s home. Mr. Brown’s PSA is $25,284, because half of his IAA is only $20,000, and that is below the minimum allowed. Mr. Brown uses his own savings to pay for his nursing home care until April 1st, when he applies for Medicaid. On April 1st, Mr. Brown has $26,000 in countable assets (after spending $14,000 on the nursing home). To determine his Medicaid eligibility, the Department of Human Services subtracts his PSA of $25,284 from his countable assets of $26,000. His assets are $716, which is below the $2,000 resource limit. Mr. Brown meets resource eligibility criteria for Medicaid.
Medicaid will pay for a nursing home only when it is medically necessary. You must show that you require a “nursing home level of care,” meaning that you have a physical or mental condition that requires nursing supervision and assistance with activities of daily living (ADLs).
Within the first two weeks after you are admitted to a nursing facility, Medicaid requires that you have a "Level of Care" ("LOC") determination. In Michigan, nursing facility staff do the LOC determination using an online state system.
To determine the level of care you need, nursing facility staff will ask you questions to determine how much assistance you need with your ADLs. The ADLs that Michigan uses to determine whether you meet the nursing home level of care are: bed mobility, transfers, eating, toileting, short-term memory, cognitive skills for decision-making, and making yourself understood. For each, the assessor will decide how much assistance you need and assign you a functional level. The levels are: Independent, Supervision, Limited Assistance, Extensive Assistance, Total Dependence or Activity Did Not Occur. For example, if you usually cannot get up from a chair without someone helping you, then the assessor may say that you need limited assistance with transfers.
When assigning a functional level, the assessor will look at your activities in the last seven days and will also look at whether you need skilled nursing services to treat a medical condition, or physical therapy or other therapy services.
Medicaid uses the information in your screening to decide whether you need a nursing home and, if so, what kind of nursing home is appropriate for you. In general, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution.
Read on to find out whether Michigan's Medicaid program will cover assisted living facilities and home health care.
1 | 2
]]>Most Massachusetts residents living in assisted living facilities pay their own costs. However, if you have little income and few assets, you may qualify for programs that help pay for some of the costs of assisted living facilities.
If you receive MassHealth and need help with at least one activity of daily living, you may qualify for a benefit called Group Adult Foster Care (GAFC). GAFC pays for personal care services for individuals living in GAFC-certified housing. Some assisted living facilities are GAFC-certified.
Massachusetts licenses GAFC housing. You can find GAFC-approved housing in your area by calling the Executive Office of Elder Affairs at 800-243-4636. GAFC does not pay for housing expenses (that is, room and board) in an assisted living facility, just personal care expenses.
If you receive SSI and qualify for GAFC, you may qualify for a supplement called SSI-G, administered by the Social Security Administration. This subsidy program funds housing expenses at GAFC and assisted living facilities. But you need to make sure the facility you want to live in accepts GAFC and SSI-G, since not all do.
If you already receive Medicaid through MassHealth, the program will pay for some home care services through its Personal Care Attendant Program. To qualify, you must have a disability or chronic condition that causes you to need help with two or more of the following activities of daily living: mobility, including getting into or out of bed, or a chair or wheelchair; taking medications; bathing and grooming; dressing or undressing; range-of-motion exercises; eating; and toileting. In addition, you doctor must prescribe personal care services for you. If you qualify, MassHealth will pay for a certain number of hours of personal care services for you each month, depending on your needs. You can either hire the personal care attendant that you want or you can get help finding and supervising someone.
Another way to get home health services is through one of Massachusetts’s Medicaid Waiver programs.
To qualify for one of MassHealth's Waiver programs, you must have income at or below 300% of the SSI Federal Benefit Rate, or $2,313 per month in 2019. You also must have less than $2,000 in assets. If you are married, MassHealth looks at only your individual income and assets, not those of your spouse. If you have too much income, you can still qualify for MassHealth Waiver programs by meeting a deductible.
To receive waiver services in Massachusetts, you must also show that you would be institutionalized in a nursing home if you were not receiving waiver services. To do that, you must show either that you need at least one skilled nursing or therapy service daily (such as help with injections, catheters, feeding tubes, or physical or occupational therapy) OR that you need a nursing service at least three times per week, plus two "other" services. Other services can be additional nursing services or assistance with activities of daily living like bathing, dressing, toileting, getting in or out of a bed or chair, walking, or eating.
If you meet the above financial and level of care requirements, you may qualify for Massachusetts’s Frail Elder Waiver Program. To qualify, you must be 60 or over, but if you are under age 65 you must be disabled.
When you apply for the Frail Elder Waiver, an assessor from your local Aging Services Access Point (ASAP) will visit your home and decide how much help you need every month and with which tasks. Then MassHealth will pay for the cost of services to meet those needs every month. Services provided under the Frail Elder Waiver include personal care services; housekeeping, chore, and laundry services; home health and skilled nursing; adult day programs; grocery shopping and delivered meals; transportation; respite care; and accessibility adaptations to your home.
If you meet the criteria for the Frail Elder Waiver Program, but you are at imminent risk of being institutionalized in a nursing home unless you receive help, you might qualify for the Community Choices Waiver Program. You must have a serious condition evidenced by one of the following:
You can show imminent risk of nursing home placement if you:
If you qualify for the Community Choices Waiver Program, you can receive case management services, nursing services, personal care services, skilled therapy services, changes to your home to make it more accessible, emergency response systems, home-delivered meals, adult day health care, respite care, and transportation.
To find out more about the Frail Elder and Community Choices Waivers, contact your local Aging Services Access Point (ASAP) or call 800-AGE-INFO to find the ASAP that serves your community.
Massachusetts has other Waiver programs for individuals with developmental disabilities and with traumatic brain injuries. For more information about those, contact MassHealth Waiver Information at 866-281-5602.
If you are 60 or older and your annual gross income is less than $28,410 ($2,368 per month), then you may qualify for Massachusetts’ Home Care Program (HCP). You can also qualify for HCP if you are under 60 if you have a diagnosis of Alzheimer’s Disease and need respite services.
The HCP will assign you a caseworker and evaluate your needs to create an individualized care plan. Depending on your needs, HCP can offer personal care services, home health services, skilled nursing care, adult day care, homemaker services, home delivered meals, transportation, chore services, adaptations to your home, and personal emergency response systems.
In the HCP, you may be required to contribute a copayment, depending on your income. Individual copayments can range from $10-$141 per month. If your annual income is too high to qualify for the HCP permanently, you still might qualify for "respite services" under the program. Respite services are any of the HCP services, offered on a temporary basis.
In Massachusetts, Programs of All-Inclusive Care for the Elderly Elder Service Plans (PACE ESPs) operate in certain service areas throughout the state. To qualify for PACE, you must be 55 or older, live in an area served by a PACE ESP, meet the nursing home level of care, and be able to live safely in the community with PACE ESP services. If you do not qualify for MassHealth, you can pay for PACE ESP services on your own.
PACE ESP participants receive their services from an interdisciplinary team of professionals including physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. If you receive MassHealth and participate in the PACE ESP Program, Medicaid pays for all of the services recommended by your care team. Services can include transportation, personal care services, home health services, skilled nursing, delivered meals, adult day care, and emergency response systems. If you are interested in a PACE program, contact it directly to apply. You can find a PACE program in your community here.
Massachusetts has operated a program called the Money Follows the Person (MFP) demonstration to help people move out of institutions and into less restrictive settings. The MFP demonstration was designed to provide support and connect members to home- and community-based services to assist in the transition from long-term facilities back into the community.
The MFP Demonstration grant ended support for new transitions as of 2017, so individuals can no longer enroll to participate. Although the specific supports available through the MFP demonstration have ended, the grant continues to fund community-based services. Additionally, the HUD 811 Project Rental Assistance Program, a program related to the grant, continues to identify housing opportunities suitable for those leaving nursing and long-term facilities.
For more information on the MFP demonstration, call the MFP Project Office at 617-573-1647 or email MFP@state.ma.us.
1 | 2
]]>There are many different ways to become eligible for MassHealth, and there are specific eligibility rules for long-term care services like nursing homes (rather than for doctors’ appointments, hospitalizations, and so on). For application information, visit MassHealth online or by phone at 800-841-2900.
If you are 65 or older, you can qualify for MassHealth if your income is at or below 100% of the federal poverty rate, or $1,041 per month in 2019. People who receive SSI already qualify to receive MassHealth.
If your income is above the limit but you need help with nursing home costs, you still might be able to qualify for Medicaid if you're already paying for a nursing home or have other significant medical expenses. A MassHealth worker will determine your excess monthly income to see if you qualify. Excess monthly income is income left over after subtracting Medicare or other health insurance premiums, a personal needs allowance, and any spousal or family maintenance needs allowances. That amount, multiplied by six, is the "deductible" that you must meet in a six-month period to be eligible for MassHealth. You must show proof that your nursing home costs or medical expenses equal the required deductible amount. Once you show medical expenses that equal your deductible, then you are eligible for MassHealth for the entire six-month period.
To qualify for any type of Medicaid coverage in Massachusetts, you must have no more than $2,000 in resources, or $3,000 for a married couple. Resources are assets like money and property.
Some property does not count toward the resource limit. In Massachusetts, one car of any value is exempt, as long as a household member is using it. Personal belongings are also exempt. Your home is exempt up to an equity value of $878,000 (in 2019). You can exempt more equity if you have a spouse or a minor or adult disabled child living in the home.
Retirement accounts, stocks, bonds, certificates of deposit, life insurance policies with cash value, and bank accounts are all counted as resources.
If you have a spouse who is going to continue to live independently (meaning not in an institution, also known as a "community spouse"), then Massachusetts will allow you as a couple to keep more income and assets to support that spouse.
Your spouse will be allowed to keep some income each month, known as a monthly maintenance needs allowance. The amount will depend on how much income the community spouse has. As of January 2019, the minimum community spouse income allowance is $2,057.50 per month, and the maximum is $3,160.50 per month. If your spouse needs more income than the maximum allowed, you can request a hearing to ask for more.
If you and your spouse together have $126,420 (as of 2019) or less in assets, then your spouse will be allowed to keep all of the assets. This amount is known as the community spouse resource allowance. If you have more than $126,420 in assets, you will be required to spend down your assets until you reach the $126,420 eligibility limit for a community spouse. If you need to be able to keep more than $126,420 in assets in order to support your community spouse while remaining eligible for Medicaid, you can request a hearing to request that this amount be raised.
If you receive MassHealth and live in a nursing home, you will be expected to spend most of your income on your room, board, and medical care. Nursing home residents receiving MassHealth can keep only $72.80 per month as a personal needs allowance.
MassHealth will pay for a nursing home only when it is medically necessary. You must show MassHealth that you "meet the nursing facility level of care," meaning that you need the kind of care that can only be provided in a nursing home. In Massachusetts, there are two ways to meet the nursing home level of care. First, you can show that you need at least one "skilled service" daily. Skilled services are usually provided by nurses. Examples of skilled services are injections, wound care, catheter care, and monitoring of unstable conditions.
The second way to meet the nursing home level of care is by showing that you have a medical or mental condition that requires a small amount of skilled nursing help but substantial assistance with activities of daily living. (Activities of daily living include bathing, dressing, toileting, eating, transferring, and mobility.) You must show that you need skilled nursing services at least three times a week.
Read on to find out when MassHealth pays for assisted living facilities and home health care.
1 | 2
]]>There are different ways to become eligible for Medicaid, and there are specific eligibility rules for LTC services like nursing homes. To apply for Medicaid, contact your local Ohio Department of Job and Family Services (ODJFS). You can also fill out an application for services before going to the office.
If you are 65 or older, blind, or disabled, and you need long-term care in a nursing home, then you must have income at or below $2,313 per month (as of 2019) to qualify for Medicaid. The 2019 monthly income limit for a married couple with both spouses applying is $4,626. (Ohioans who receive SSI already qualify to receive Medicaid.)
If your income is above the limit, you still might be able to qualify for Medicaid if the income you have over the limit doesn't cover your medical expenses. In Ohio, unlike some other states, people who are sixty-five and older, blind, or disabled can use unpaid medical bills, premiums, or nursing facility bills to “spend down” their income and qualify for Medicaid. A worker from ODJFS will determine how much your monthly spend-down amount is. You have to satisfy the spend-down to be eligible for Medicaid each month. You can satisfy your spend-down by showing proof that your medical expenses equal the spend-down amount or by paying the amount directly to ODJFS.
In addition, to qualify for Medicaid in Ohio, you must have no more than $2,000 in resources (or up to $3,000 for a married couple with both spouses applying). Resources are assets like money and property. Some property does not count toward the resource limit. In Ohio, for example, your car can be exempt, and your home is exempt up to an equity value of $585,000 in 2019. If you have more equity in your house, it will be counted toward the resource limit. Personal belongings are also exempt. Retirement accounts are counted as assets only to the extent you can withdraw money from them.
If you have a spouse who will continue to live "in the community" (at home), then one car is exempt with no restrictions on its value. In addition, your home is exempt so long as your spouse still lives there.
If you have a spouse who is going to continue to live independently, then Ohio will allow you and your spouse to keep more income and assets to support that spouse.
Your spouse will be allowed to keep some income each month. The amount will depend on how many dependents and expenses he or she has. In 2019, the minimum monthly Community Spouse Income Allowance is $2,057.50, and the maximum is $3,160.50.
Ohio assumes that half of the assets that you had at the time of your first admission to a nursing home (called the "Community Spouse Resources Allowance" (CSRA)) should belong to your spouse, subject to a limit that changes annually. For married couples, as of 2019 the CSRA is up to a maximum of $126,420. When you apply for Medicaid, ODJFS will tell you how much your community spouse is entitled to keep.
When you apply for Medicaid, your CSRA is subtracted from your countable assets at the time of your application. For example, say Mr. and Mrs. Johnson have $80,000 in countable assets when he moves into a nursing home on February 1st. Mrs. Johnson continues to live in the couple’s home. On that date, Mrs. Johnson's CSRA is calculated to be $40,000. The Johnsons use their savings to pay for Mr. Johnson's nursing home care until December 1st, when he applies for Medicaid. On December 1st, Mr. and Mrs. Johnson have $40,000 left in countable assets. Because Mrs. Johnson's CSRA is $40,000, she is entitled to keep the $40,000. Mr. Johnson then has no countable assets, and he meets the resource eligibility criteria for Medicaid.
If you receive Medicaid and live in a nursing home, you will be expected to spend almost all of your income on your care. Ohio allows nursing home residents receiving Medicaid to keep only $50 per month as a personal needs allowance.
Medicaid will pay for a nursing home only when it is medically necessary. In other words, you must show that you require a “nursing facility level of care,” meaning that you need the kind of care that can only be provided in a nursing home. In Ohio, there are two nursing facility levels of care: intermediate and skilled. To receive Medicaid-paid nursing facility services in Ohio, you must need at least an intermediate nursing facility level of care. This generally means you must show that you need hands-on assistance with at least two of the following activities: bathing, dressing, eating, grooming, moving around, using the bathroom, and taking your medication.
You can meet the skilled nursing facility level of care by showing that you need daily skilled nursing or therapy services for an unstable medical condition. For a skilled nursing facility, you have to require the kind of services that can only be provided by a licensed therapist or nurse. Your condition is considered unstable if you require extensive monitoring and adjustments to your treatment, and if your condition is unpredictable and might require immediate interventions.
Medicaid will decide which type of facility is appropriate for you and will only pay for a facility that is adequate for your level of care needs.
Read on to find out whether Ohio's Medicaid program pays for assisted living facilities or home health care.
1 | 2
]]>To qualify for any of Ohio’s waiver programs, you must have income at or below 300% of the SSI Federal Benefit Rate, or $2,313 per month in 2019. You also must have less than $2,000 in countable assets (see our article on Ohio Medicaid's coverage of long-term nursing care for more detail). If you are married, Medicaid allows your spouse to keep more income and assets.
For some Medicaid recipients, Ohio's Department of Aging administers the Assisted Living Waiver Program to pay the costs of nursing care in an assisted living facility. To qualify, you must be 21 or older, meet the financial eligibility rules described above, and require a nursing facility standard of care.
To receive any waiver services in Ohio, you must show that you require an intermediate nursing facility level of care. To do that, you must show that you need hands-on assistance with at least two of the following activities: bathing, dressing, eating, grooming, moving around, using the bathroom, and taking your medication. You can also meet the level of care requirement by showing that you need skilled nursing care for a medical condition.
If you qualify, Medicaid will pay for many of the services you receive in an assisted living facility, but you will still have to pay your own room and board expenses.
If you already receive Medicaid, the regular Medicaid program will pay for some limited home care services. The services must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you. If you need ongoing home health services to help you perform activities of daily living or manage your medications, Medicaid will not cover that type of help unless you qualify for one of Ohio’s Medicaid Waiver programs or its PACE Program.
If you meet the above financial and level of care requirements, if you are 60 or over, and if your doctor certifies that you are able to live at home safely with assistance, then you may qualify for Ohio’s PASSPORT Waiver Program. In the PASSPORT Program, you can receive help with chores like laundry, help with personal care like bathing and toileting, home-delivered meals, adult day care, emergency response, medical equipment and supplies, counseling, nutritional counseling, independent living assistance, transportation to medical appointments, and nursing care.
After you apply, an assessor will visit your home and decide how much help you need every month and with which tasks. Medicaid will pay for the cost of those services every month. You can have a case manager hire and supervise your care providers, or you can do it yourself under a consumer-directed option. Depending on your income, you may be required to make a monthly contribution to the cost of your services.
If you are 59 or younger, meet the above financial requirements and require a nursing facility level of care, but can stay in your home if you get assistance, you may qualify for Ohio’s Home Care Waiver Program. You must show that you would have to move to a nursing facility if you did not receive the waiver services in your home. If you qualify, you can receive case management services, nursing services, personal care services, skilled therapy services, changes to your home to make it more accessible, assistive devices, emergency response systems, home-delivered meals, adult day health care, respite care, and transportation.
To find out more about the PASSPORT or Home Care Waiver programs, contact the Area Agency on Aging serving your community.
Ohio has other waiver programs for individuals with developmental disabilities. For more information about those, contact your county’s Board of Developmental Disabilities.
Ohio operates a Program of All-Inclusive Care for the Elderly (PACE), serving the Cleveland area. To qualify for PACE, you must be 55 or older, live in the Cleveland area, meet the nursing home level of care, and be able to live safely in the community (at home) with PACE services. If you do not qualify for Medicaid, you can pay for PACE services on your own.
PACE participants receive their services from an interdisciplinary team of professionals like physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. If you receive Medicaid and participate in the PACE Program, Medicaid pays for all of the services recommended by your care team. If you are interested in the PACE program, contact PACE directly to apply.
Ohio operates a program called HOME Choice that helps people move out of institutions and into less restrictive settings. If you have lived in an institution for at least 90 days, meet the nursing facility level of care, but want to live in your home or in a community-based setting, then you might qualify for assistance from the HOME Choice program.
HOME Choice provides funding for things like moving expenses, transportation costs, modifications to your home or vehicle, medical supplies, and other services intended to help you live independently.
To find out more, contact your local Area Agency on Aging.
If you don't qualify for Medicaid or don't meet the nursing home level of care, you may still qualify for some personal assistance services if you need help with activities of daily living like eating, dressing, or bathing. Ohio’s Area Agencies on Aging administer various programs that offer services like transportation, meals, and personal care services. Contact your local Area Agency on Aging to find out more.
1 | 2
]]>In addition to providing health insurance coverage to qualifying individuals, Minnesota Medical Assistance may also cover the costs of long-term care, including home health services and nursing homes. To determine eligibility for state long-term care coverage, Minnesota requires that applicants participate in a MnCHOICES assessment (formerly known as a long-term care consultation, or LTCC). The MnCHOICES assessment is a comprehensive, web-based application combining assessment and support planning for those seeking access to Minnesota’s long-term care services and supports. Agency officials also use the MnCHOICES assessment to perform state-mandated screening of individuals prior to their admission to Medicaid-certified nursing facilities.
Over the last several years, Minnesota has followed the path of many other states by seeking to shift resources away from costly institutional services such as nursing homes, toward more flexible and less expensive home- and community-based alternatives.
Medical Assistance will pay for home health services that are medically necessary, authorized by a physician, part of a written treatment plan, and performed in the patient's residence or in the community. Some of the more common home health services include:
A registered nurse from a home health agency will typically perform an evaluation to determine the nature and frequency of home-based services and to establish a treatment plan. For example, an individual who needs assistance with at least one activity of daily living (bathing, dressing, grooming, toileting, eating, or mobility) may receive daily visits from a home health aide or Personal Care Assistant.
To qualify for nursing home services, an individual must first be screened as part of the long-term care consultation and MnCHOICES assessment process. Minnesota law provides that a person will be found eligible for nursing home care if he or she:
Minnesota also has a number of waiver programs that provide funding for home-based service to individuals who meet the eligibility criteria for nursing home care but wish to remain in the community. The Elderly Waiver (EW) program, for example, provides funding for services not typically covered by Medical Assistance, including adult day care, assisted living, home-delivered meals, transportation, and modifications to a residence. Similar services exist under waiver programs for individuals with traumatic brain injuries, developmental disabilities, and other conditions.
If you are denied Medicaid coverage of long-term care services by Medical Assistance, you can appeal a denial of coverage by requesting an administrative hearing. For more information, read Nolo's article on Medicaid appeals.
To qualify for Minnesota's Medical Assistance, unmarried individuals over 65 may have no more than $3,000 in assets, subject to certain exclusions. If both members of a married couple are applying for Medical Assistance, total assets may not exceed $6,000. Special "spousal impoverishment" rules apply where one spouse resides in a nursing home or qualifies for services under the Elderly Waiver program while the other spouse lives in the community.
Items that are not counted in determining your total assets include a primary residence (equity value under $585,000 in 2019), household goods, one motor vehicle, the cash value of life insurance policies, burial funds, and some jointly owned assets.
There are also income requirements that must be met to qualify for Medical Assistance. The limits vary depending on household size, number and ages of children, whether an individual is pregnant, blind, disabled, or over 65. In 2019, the income limit for blind, disabled, and elderly applicants in single-member households is $1,012 per month. For those in two-member households, the limit is $1,372 per month. As with the asset limits, certain categories of income are exempt from the total.
Even if your income exceeds the applicable threshold, you may still qualify for Medical Assistance with a "spend-down," which operates similar to an insurance deductible. With a spend-down, you must pay a specified portion of your income toward medical expenses before Medical Assistance will provide coverage.
For more information about Medical Assistance or to apply for long-term care coverage, contact your county's Department of Human Services office.
]]>There are many different ways to become eligible for Medicaid, and there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care services. To apply for Medicaid in New Jersey, contact the Board of Social Services in the county where you live or your local Area Agency on Aging (AAA) Aging & Disability Resource Connection.
New Jerseyans who are 65 or older (or disabled or blind) can qualify for Medicaid if they meet certain income and asset limits. If you receive SSI, you already qualify to receive Medicaid in New Jersey. But if you are elderly, blind, or disabled and not receiving SSI, then your monthly income in 2019 must be less than $1,041 per month (for an individual).
There is a higher income limit for seniors (and disabled or blind individuals) who need assisted living or home health services. If you are 65 or older, blind, or disabled, you can qualify for Medicaid long-term care services as long as your monthly income is no more than $2,313 per month for 2019. The limit for a couple is $4,626 per month.
If your income is above the limit, you still might be able to qualify for Medicaid if you have a lot of medical expenses. With New Jersey’s Medically Needy Program, you can use medical bills that you incur each month to “spend down” your income and qualify for Medicaid. The Medically Needy spend-down income limit is $367 per month for an individual in 2019. If you have a household of two people, the income limit is $434 per month. You must show that you have incurred medical expenses each month that would leave you with no more than those amounts. You do not actually have to pay the bills, just receive them. Because nursing homes are so expensive, it can be easy for nursing home residents to qualify for the Medically Needy Program -- their nursing home bills help them spend down their income.
The Medically Needy Program determines eligibility over a period of six months. For example, if you are living alone and have $650 per month in income, then you are $283 per month over the income limit ($650 - $367 = $283). You must show medical expenses of $1,698 within a six-month period ($283 per month x 6 months) to qualify for the Medically Needy Program. You do not have to wait for the end of six months to qualify, though. If you incur a $2,000 medical bill in the first month, for example, then you would qualify for the program.
You must have few resources (assets like money and property) in order to qualify financially for Medicaid. In New Jersey, applicants for long-term care can have assets up to $2,000, or $3,000 for a married couple with both spouses applying. For applicants to regular Medicaid (aged, blind, and disabled), the resource limits are higher, so that an individual can have up to $4,000 in resources and still qualify. A couple with both spouses applying can have up to $6,000 in assets.
People who qualify for the Medically Needy Program are also allowed up to $4,000 in resources, or $6,000 for a couple with both applying. Keep in mind that if you are entering a nursing home and your spouse is not, you will be allowed to keep extra income and resources to support your spouse, according to New Jersey's "community spouse allowance" rules.
Not all property counts toward the resource limit. In New Jersey, your home (up to a value of $878,000 in 2019) is an exempt resource as long as it is your principal residence. But when you live away from your home for six months (for example, in a nursing home), it is presumed to not be your principal residence anymore -- unless your spouse still lives there. Also, one car is exempt regardless of its value, as long as you or a family member uses it for transportation.
In addition to paying only for those with low income and assets, Medicaid will pay for a nursing home only when it is medically necessary. You must show that you need a “nursing home level of care,” meaning that you have a physical or mental condition that requires nursing supervision and assistance with several activities of daily living (ADLs) like bathing, dressing, toilet use, transfer, locomotion, and eating. In other words, you must show that you cannot care for yourself.
Before Medicaid will pay for nursing home care, you must have a "pre-admission screening." In New Jersey, the pre-admission screening is administered by Long-Term Care Field Office counselors for the Office of Community Choice Options. Screenings are usually done by nurses or social workers who visit you wherever you are living when you apply for help. The screener asks you questions to determine whether you need help with your ADLs.
Medicaid uses the information in your screening to decide whether you need a nursing home and, if so, what kind of nursing home is appropriate for you. Medicaid also assesses whether you could stay in your home or in a community-based setting if you were to receive supportive services. In general, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is available only in an institution.
New Jersey recently changed its Medicaid-based system for providing assisted living and home health care services to Medicaid recipients. The idea is that this change will allow more people to delay going to Medicaid-paid nursing homes and instead to rely on assisted living facilities (which are generally less expensive and less medically intensive than nursing homes) or home health care (which can include skilled nursing or therapy services, home health aide services like medication management or bathing assistance, and personal care aide services like meal preparation or cleaning).
In the past, New Jersey served elderly and disabled individuals needing home- and community-based long-term care services through several different Medicaid Waiver programs. More recently, because long-term care is so expensive and accounts for a large part of New Jersey’s Medicaid expenditures, the state transitioned long-term care recipients into a Managed Long-Term Services and Supports (MLTSS) program.
With MLTSS, New Jersey no longer pays for each long-term care expense for every Medicaid recipient. Instead, it pays a fixed amount to private companies to manage the long-term care needs of its Medicaid recipients. In MLTSS, Medicaid recipients enroll with one of New Jersey Medicaid's NJ FamilyCare managed care organizations (MCOs) or a Program of All-Inclusive Care for the Elderly (PACE).
If you are 65 or older, disabled, or blind, meet the financial criteria for Medicaid, and need a nursing home level of care, then you qualify for MLTSS. As noted above, New Jersey defines the nursing home level of care as needing help with activities of daily living such as bathing, grooming, using the toilet, and getting around.
MLTSS emphasizes individual care coordination and has increased funding for home and community-based long-term care services like assisted living facilities and home health services. MLTSS offers a full range of long-term care options, from nursing homes to in-home services and supports, depending on the needs of the individual Medicaid recipient. In fact, every MCO must offer personal care services, respite care, care coordination, home and vehicle modifications, home-delivered meals, personal emergency response systems, mental health and addiction services, assisted living, community residential services, and nursing home care.
Not all MCOs are available statewide. You can get more information about choosing an MCO here, and you can get help choosing an MCO by contacting your local Aging and Disability Resource Center.
New Jersey also offers a PACE program. PACE is available only in certain locations in the state. PACE participants receive their services from an interdisciplinary team of professionals like physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. PACE participants must be at least 55 years old and meet the nursing home level of care but be able to live safely in the community at the time of enrollment. If you are interested in a PACE program, apply directly to the one you are interested in, and they will help determine your eligibility. Medicaid will pay for PACE programs for individuals who qualify.
]]>If you receive Medicaid, the program will pay for some limited home health care services. The services must be prescribed by your doctor as part of a plan of care for a particular problem, and the services must be directed at curing or rehabilitating you.
If you need ongoing home services to help you do activities of daily living or manage your medications, Medicaid will not cover that type of help. Instead, you should consider whether you qualify for any of Virginia’s several Medicaid Home and Community Based Care Waiver (CBC) programs or its Program for the All-Inclusive Care of the Elderly (PACE) that provide home and community-based care services to low-income residents. To qualify for most of Virginia’s waiver programs for home care, you must meet the nursing home level of care, as discussed in Nolo's article on when Virginia's Medicaid program pays for nursing homes.
Virginia’s Commonwealth Coordinated Care (CCC) Plus Waiver, a combination of the waivers formerly known as the Elderly and Disabled with Consumer Direction (EDCD) Waiver and the Technology Assisted Waiver (Tech) Waiver, helps seniors and disabled individuals receive long-term care services in the community.
The CCC Plus Waiver program provides care in the home and community, rather than in a nursing or other specialized care facility, to those who require a hospital or nursing home level of care. To eligible individuals who are 65 or older or disabled, and certain others who are functionally dependent and have medical nursing needs, the CCC Plus Waiver program offers services like adult day health care, respite care, personal care, medication monitoring, private-duty nursing, environmental modification, assistive technology, emergency response systems, and case management for those who live at home. (Adult day health care provides medical and rehabilitative services in a group setting during the day.) Depending on your income, you may have to pay a portion of the cost of your services under this program. In this program, you can choose to either have an agency hire and supervise your personal care attendants, or you can choose to hire and supervise your own. If you choose the “consumer-directed” model, the state will assign a services facilitator to help you coordinate your own care.
Other waiver Programs are available for Virginians with intellectual or developmental disabilities. For more information about those, contact your local Community Services Board.
Virginia offers a Program for All-Inclusive Care for the Elderly (PACE). PACE is only available in certain locations in the state. PACE participants receive their services from an interdisciplinary team of professionals like physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. PACE participants must be at least 55 years old, meet the nursing home level of care, and be able to reside safely in the community with the help of PACE services. If you are interested in a PACE program, apply directly to the one you are interested in, and the program staff will help determine your eligibility.
If you enroll in one of the above waiver or PACE programs after you have been in a nursing home for more than 90 days, then you may be entitled to additional services aimed at transitioning you back to your home. You can get assistance making modifications to your house and with temporary rental payments while home modifications are being completed. These services are provided under Virginia’s Money Follows the Person (MFP) program, a demonstration project administered by the Virginia Department of Medical Assistance Services. You can get these services if you are moving into your own home or apartment, your family’s home or apartment, or a small community-based group home containing no more than four unrelated people.
If you do not qualify for Medicaid and do not meet the nursing home level of care, you may still qualify for some personal assistance services if you are physically disabled and need help with activities of daily living like eating, dressing, or bathing. Virginia’s Department for Aging and Rehabilitative Services offers personal assistance services through the Personal Assistance Services (PAS) Program. Note that you cannot participate in the PAS program if you qualify for any of Virginia’s Medicaid waiver programs. To apply, contact Virginia’s PAS program.
1 | 2
]]>In Virginia, Medicaid is a very common source of funding for long-term care, particularly when people have already used up all of their own assets to pay for care. Approximately 70% of nursing home residents nationwide use Medicaid to pay for their nursing home care.
There are many different ways to become eligible for Virginia's Medicaid program, and there are specific eligibility rules for long-term care services like nursing homes, assisted living facilities, and home health care.
Virginians who are 65 or older, disabled, or blind can qualify for Medicaid if they also meet income and asset limits. Most people who receive SSI already qualify to receive Medicaid in Virginia. To qualify for basic Medicaid in Virginia (not long-term care), if you are elderly, blind, or disabled and not receiving SSI, then your monthly income must be less than 80% of the federal poverty level (FPL). (In 2019, 80% of the FPL is $833 per month for an individual. With Medicaid expansion effective in 2019, Medicaid is now also available to certain non-elderly Virginia residents earning up to 138% of the FPL, or $17,237 per year for an individual in 2019.)
Fortunately, there is a higher income limit for seniors (and some others) who need long-term care services. If you are 65 or older, blind, disabled, pregnant, under age 19, or a parent living with a child under 18, then you can qualify for Medicaid for long-term care as long as your monthly income is no more than 300% of the SSI amount for an individual, or $2,313 per month for 2019.
If your income is above the limit, you still might be able to qualify for Medicaid for long-term care if you have a lot of medical expenses. Going through Virginia’s Medically Needy Program, you can use medical bills that you incur each month to “spend down” your income and qualify for Medicaid.
The Medically Needy spend-down income limit varies depending on the county in which you live. As a general guideline, however, the spend-down limit is 47% of the FPL—in 2019, $489 per month for a single person and $662 per month for a married couple—meaning that you must show that you have incurred medical expenses each month that would leave you with no more than those amounts. Once you show that you have those expenses, you qualify for Medicaid coverage for the rest of that month. You do not actually have to pay the bills with your income, just incur them.
To qualify for Medicaid in Virginia, you must have no more than $2,000 in resources. Resources are assets like money and property. Some property does not count toward the resource limit; for instance, in Virginia, one car is exempt, and household goods are exempt.
The state follows complicated rules to decide whether your house is exempt or not. If you are living in your home, it is exempt. If you have land surrounding your home that is worth more than $5,000, that land is counted as a resource if you qualified for Medicaid by meeting the 300% FPL limit. If your qualifying income is less than 80% of the FPL, then your home and all surrounding land is exempt.
If you need Medicaid for long-term care, then you cannot have more than $585,000 in equity in your home in 2019. In addition, your home is only an exempt resource for the first six months that you are in an institution. If your spouse, dependent child, disabled adult child, or disabled parent continues to live there, then your home is exempt indefinitely. If your income is below 80% of the FPL, your home can also remain exempt after six months if you intend to return to it or if selling it would cause undue hardship to a co-owner.
These rules are confusing; you should talk to an elder care lawyer if you need help determining if the equity in your home counts as a resource.
Medicaid will pay for a nursing home only when it is medically necessary. You must show that you require a “nursing home level of care,” meaning that you have a physical or mental condition that requires nursing supervision and assistance with activities of daily living (ADLs). You must show that you cannot care for yourself.
Before Medicaid will pay for nursing home care, you must have a "pre-admission screening." These screenings are usually done by a nurse or social worker who visits you wherever you are living when you apply for help. The screener uses a form, called the Virginia Uniform Assessment Instrument, to help evaluate whether you need help with certain activities, including bathing, eating, taking medication, using the bathroom, moving around, and dressing. The screener will decide how much assistance you typically need to get those activities done. Whether you meet the nursing home level of care depends on the combination of the number of things you need help with and the level of help you need.
Medicaid uses the information in your screening to decide whether you need a nursing home and, if so, what kind of nursing home is appropriate for you. In general, for a nursing home to be considered medically necessary, you must have a medical condition that is so serious that you need the level of nursing care that is only available in an institution.
If you receive Medicaid and live in a nursing home, you will be expected to spend most of your income on your care. Virginia allows nursing home residents receiving Medicaid to keep only $40 per month as a personal needs allowance. If you receive Medicaid and get home- and community-based Medicaid Waiver services (discussed on the next page), then you are allowed to keep $1,272 per month as your personal needs allowance.
Read on to find out when Virginia Medicaid will cover assisted living facilities and home health care.
1 | 2
]]>In North Carolina, Medicaid is administered by the Division of Medical Assistance (DMA). To apply for Medicaid, contact the Department of Social Services office in your county. You can also apply online.
Not everyone can get Medicaid to pay for nursing home care in North Carolina, however. You must medically require skilled nursing care, and your income and assets must fall under the state Medicaid limits. The eligibility rules for long-term care services like nursing homes are different than for other Medicaid services.
Medicaid will pay for a nursing home only when it is medically necessary. You must show that you "meet the nursing facility level of care," meaning that you need the kind of care that can only be provided in a nursing home.
To show that you meet a nursing home level of care, your physician must think you need the kind of services that are only offered in a skilled nursing facility. For example, you can meet the nursing facility level of care by showing that you need the services of a registered nurse for several hours a day, or by showing that you need daily assessments of your condition by a licensed nurse, or by showing that you need medication administered frequently by a nurse. If you have a nasogastric tube, require dialysis, frequent injections, or respiratory therapy, you are more likely to meet the nursing facility level of care.
If you need only custodial care such as help with activities of daily living (bathing, dressing, eating, getting in or out of a bed or chair, and using the bathroom), you are not likely to meet the nursing home level of care. (In this case, you may want to read the second part of this article on when North Carolina Medicaid will pay for assisted living or home health care.)
People who receive SSI already qualify to receive Medicaid long-term care in North Carolina. If you don't receive SSI, and you are 65 or older, blind, or disabled, you must have income below $1,012/month for a household of one or $1,372/month for a household of two (in 2018).
If your income is above the limit, you still might be able to qualify for Medicaid if you have medical expenses that meet or exceed the amount of extra income you have. The Division of Medical Assistance (DMA) will calculate how much your monthly income exceeds the Medicaid income limit and then will multiply that amount by six. This amount is your Medicaid deductible. Once you satisfy your deductible, you are eligible for Medicaid for a period of six months. After six months, DMA will assess another deductible.
You can satisfy your deductible by showing DMA that you have medical expenses, including nursing home charges, that equal or exceed your deductible. You do not have to pay medical bills for them to count towards your deductible; you just need to show proof that you incurred the expenses. Because nursing homes are so expensive, the Medicaid deductible is a common way for nursing home residents to become eligible for Medicaid.
To qualify for Medicaid in North Carolina, you must have no more than $2,000 in resources (assets like money and property). Some property does not count toward the resource limit. In North Carolina, your home is exempt up to an equity value of $585,000 (in 2019), as long as you intend to return there or if your spouse or another dependent relative lives there. In addition, one car is exempt if it is used for transportation for yourself, your spouse, or a dependent relative. Personal belongings and household goods are also exempt. Retirement accounts are counted as assets to the extent you can withdraw money from them.
If you have a spouse who is going to continue to live independently while you go to a nursing home, then North Carolina will allow you and your spouse to keep more income and assets to support that spouse.
Income. First, your spouse (called the "community spouse") may be allowed to keep some of your income each month. The amount that DMA determines that your spouse can keep will depend on how much separate income your spouse has and also how much he or she spends on housing. In 2019, the minimum monthly "community spouse income allowance" is $2,058, and the maximum is $3,090.
In addition, if you have dependents who will remain in the community while you go to a nursing home, these dependents might be entitled to keep some of your income. This is called the dependent family member allowance. Your dependents must be claimed as dependents on your tax return to qualify for this allowance. The amount your dependent can keep from your income depends on whether they have income of their own. The maximum that a dependent can keep is $686/month.
The amounts that DMA calculates for your community spouse’s income allowance and your dependents’ family member allowance reduce the amount of your Medicaid deductible. So, if you have a spouse receiving $3,090 and a dependent receiving $686 (for a total of $3,776/month), then your six-month Medicaid deductible is reduced by $22,656 ($3,776/month for six months).
Assets. North Carolina assumes that half of the assets that you had at the time of your first admission to a nursing home (called the “community spouse resource allowance,” or CSRA) belong to your spouse, subject to a limit that changes annually. The limit for the CSRA in 2018 is $123,600. The minimum is $24,730. When you apply for Medicaid, DMA will tell you how much your community spouse is entitled to keep. If your spouse needs more, you can go to court and ask a judge to allow a higher CSRA.
When you apply for Medicaid, your CSRA is subtracted from your countable assets at the time of your application. For example, say Mr. has $80,000 in countable assets when Mr. Brown moves into a nursing home on February 1st. Mrs. Brown continues to live in the couple’s home. Mr. Brown uses half of his savings to pay for his nursing home care until December 1st, when he applies for Medicaid. On December 1st, Mr. Brown has $40,000 in countable assets. Because Mrs. Brown’s CSRA is $40,000, she is entitled to keep the $40,000. Mr. Brown then has no countable assets, and he meets the resource eligibility criteria for Medicaid.
If you receive Medicaid and live in a nursing home, you will be expected to spend almost all of your income on your care. North Carolina allows nursing home residents receiving Medicaid to keep just $30/month as a personal needs allowance.
Read on to find out about when Medicaid will pay for assisted living or home health care in North Carolina.
1 | 2
]]>Assisted living facilities are generally less expensive and less medically intensive than nursing homes, but are not cheap by any means. Most North Carolina residents living in assisted living facilities pay their own costs. Generally speaking, Medicaid does not cover room and board fees in assisted living facilities. However, if you have little income and few assets, you may qualify for a program that helps pay for assisted living facilities.
If you receive SSI and live in an assisted living facility, you may qualify for a benefit called Special Assistance (SA) that will pay for room and board expenses, up to $1,182/month, at adult care homes (also known as assisted living facilities). People with dementia who live in specialized care units can receive more money each month ($1,515). You will also recive a $46 per month personal needs allowance.
If you don't receive SSI, your income must be lower than $1,229 per month (in 2018) and you must have less than $2,000 in countable assets (excluding your car, home, and personal effects). Those seeking to live in special care units must have income less than $1,561 per month.
A separate program, called Special Assistance In-Home (SA/IH), provides a similar benefit for low-income people who could reside in an assisted living home but want to stay in their own homes. To apply for SA or SA/IH, contact your local county Department of Social Services office.
Home health care can include skilled nursing or therapy services, home health aide services like medication management or bathing assistance, and personal care aide services like meal preparation or cleaning. If you already receive Medicaid in North Carolina for doctor's and hospital visits, the program will pay for some home health services like nursing, therapy, medical supplies, and equipment. Your doctor must prescribe home health services for you as part of a plan of care for a particular condition.
Medicaid may also pay for personal care services, but only as prescribed by your doctor according to a plan of care, and only up to 80 hours/month. To qualify for personal care services, you must show that you need assistance with your activities of daily living.
Waiver programs. If you have an ongoing need for personal care services, you should apply for assistance from one of North Carolina’s Medicaid waiver programs or its PACE Program (see below). North Carolina’s two waiver programs are Community Alternatives Program for Disabled Adults (CAP/DA) and Community Alternatives Program/Choice (CAP/Choice).
To qualify for either waiver, you must be 65 or older, blind, or disabled. In addition, you must show that you meet the nursing facility level of care and that you are at risk of institutionalization within 30 days.
CAP/DA. If you qualify for CAP/DA, you can receive a wide range of services like adult day health, personal care aide, home modification and mobility aids, meal preparation and delivery, respite services, personal emergency response services, transition services, assistive technology, and case management. In CAP/DA, an agency arranges your services and oversees your plan of care for you.
CAP/Choice. If you prefer to select and train your own service providers, you can participate in CAP/Choice. CAP/Choice offers all of the services that CAP/DA offers, but you have a larger role in directing your own care. To help you, CAP/Choice also pays for people to advise you, like a personal assistant, a care advisor, and a financial manager. To find out more about the CAP/DA and CAP/Choice programs, contact the Lead Agency for CAP in your area. (You can download a list of of agencies here.)
Developmental disabilities. North Carolina has other waiver programs for individuals with developmental disabilities and for children with fragile medical conditions. For more information about these waivers, contact the Department of Health and Human Services Customer Service Center at 800-662-7030.
Programs of All-Inclusive Care for the Elderly (PACE) currently operate in several communities in North Carolina. To qualify for PACE, you must be 55 or older, live in an area served by a PACE agency, and meet North Carolina's nursing home level of care standard, and you must be able to live safely in the community with PACE services. If you do not receive Medicaid, you can use Medicare to pay for PACE, or you can pay for the program yourself.
PACE participants receive their services from an interdisciplinary team of professionals like physicians, nurses, and social workers, whose role is to coordinate individualized care and services to keep seniors in their own homes and communities. If you receive Medicaid and participate in a PACE, Medicaid pays for all of the services recommended by your care team. If you are interested in a PACE program, contact it directly to apply. You can find a PACE program in your community here.
North Carolina operates a program called the Money Follows the Person (MFP) that helps people move out of institutions and into less restrictive settings. If you are elderly or disabled, have lived in an institution for at least 90 days, and meet the nursing facility level of care, but want to live in your home or in a community-based setting, then you might qualify for assistance from the MFP program.
MFP provides a variety of services designed to help a recipient live independently in his or her home, including homemaker and chore help, day services, home accessibility adaptations, and home health aide services. To apply, call the North Carolina Money Follows the Person Project at 855-761-9030.
If you do not qualify for Medicaid and do not meet the nursing home level of care, you may still qualify for some services like transportation, meals, and in-home help. North Carolina’s Area Agencies on Aging administer various programs that offer support to seniors.
1 | 2
]]>