Medicaid and Long-Term Care: What You Need to Know About Eligibility, Benefits, and Application

As you or your loved ones age, you may reach a point where you need assistance performing activities of daily living (ADLs) such as dressing, using the bathroom, and bathing. Sometimes, you can receive skilled nursing help in your home, while other situations may require the help of an assisted living facility where skilled nursing care is available around the clock. For many, this level of care can represent a financial burden, which is why it is important to understand all your options for assistance. Specifically, the U.S. government provides aid for these services through its Medicaid program. But navigating the ins and outs of the eligibility and application process can be confusing.

At Brickyard Healthcare, we want to make it easier for our residents to access the care and benefits they need to live productive, happy lives in their golden years. Here, we’ll uncover what you need to know about Medicaid and long-term care so you can take advantage of the benefits offered under this program to help you or your loved ones get needed services and support.

A (Quick) Primer on Medicaid for Long-Term Care

Having access to long-term care benefits through the Medicaid programs can help relieve the significant financial and emotional stress that can accompany the need for a higher level of nursing care as we age. Having access to Medicaid benefits can ensure you or your loved one has appropriate, personalized care that allows for an enriching, fulfilling life. Here are some things to be aware of when beginning the process of application:

Eligibility Requirements

To gain access to Medicaid benefits, you must be qualified both financially and medically. Eligibility requirements differ from state to state and vary according to your age group and the specific program. However, there are some basic qualifications:

Medical Qualification Overview 

In general, a person who is mentally impaired with dementia or is unable to care for themselves or requires skilled nursing care on an ongoing basis will qualify. If you do not need skilled nursing care, then Medicaid will consider the number of ADLs with which you require assistance. Each state will have a definition of nursing home level of care.

Financial Qualification Overview 

Medicaid considers both income and assets when determining financial qualification for services. There are two ways states determine whether you have met your income limits for Medicaid. If you are in an income cap state, then you may not have an income greater than three times your SSI payment amount, an amount which varies per state. In non-income cap states, applicants can qualify for Medicaid assistance even if they are over the income cap if they have high medical bills in relation to their income.

In addition to medical and financial qualifications, to access Medicaid benefits you must also be 65 or older, have a permanent disability, or be blind.

Medicaid Benefits for Long-Term Care

Once you qualify for Medicaid, you can begin receiving benefits through the program. Long-term care benefits can be provided through home care or through an institutional setting. If you or your loved one intends to reside in a skilled nursing facility, that facility must be Medicaid certified to be covered through the program. While states can impose limitations on services, federal rules require that a minimum level of specific services are offered at no cost to Medicaid recipients. Typically, benefits include:

• Services related to skilled nursing care
• Rehabilitative services for residents with mental illness or intellectual disability that are outside of other state programs
• Social services that are medically related
• Assistance with receiving and administering drugs and other pharmaceuticals
• Individualized dietary services
• An activity and enrichment program that meets resident interests and needs and is directed by a professional
• Routine and/or emergency dental services
• Services relating to the maintenance of room and bed
• Access to items and services relating to personal hygiene

In addition, some Medicaid programs provide home health services, adult day care, case management, and respite care.

How to Start the Enrollment Process

If you think you qualify for Medicaid for long-term care, you must begin the enrollment process by contacting your state’s Medicaid agency and then filling out an application that is available through the Health Insurance Marketplace. Please note that you must be a resident of the state in which you apply.

Typically, applications will ask for basic information used to determine qualifications such as a birth certificate, social security card, health insurance cards, and proof of income. Additional proofs such as property deeds, vehicle titles, and other assets will be required as well as a list of your expenses.

Brickyard Healthcare Provides Medicaid Recipients with Care Excellence

At Brickyard Healthcare, we understand how difficult the process of transitioning from a home to a skilled nursing facility can be—or how confusing it can be to get the home health services you need. To help all our residents navigate the next steps in their life’s journey, we work closely with Medicaid to provide an unparalleled standard of care.

In fact, our care centers offer private suites for Medicaid-eligible residents that include a full range of amenities in addition to around-the-clock skilled nursing care. From rehabilitation and spiritual services to social activities, dining services, monthly live entertainment and access to an on-site beautician, our centers provide consistently excellent care in a beautiful, private environment. If you would like to learn more about our Medicaid-eligible services, call us at 855-855-8113 or contact us here.