Get prepared with assistance through Medicaid.
Before beginning a description of how we assist families with Medicaid planning it is important to make a few distinctions and define a few terms.
Medicare – Most people are familiar with Medicare and its associated supplemental plans. Medicare is a federal health care plan designed to provide normal health care insurance for those 65 and older (and in some instances younger than 65). There are various parts to Medicare (A, B, C, and D) that cover many medical needs such as hospital care, regular checkups, prescription needs, etc. Medicare is not designed for, nor will it provide for, long term care needs. Some people think that if they need to live in a nursing home that Medicare will provide for the cost of the nursing home. While Medicare will in some instances cover a limited stay in a skilled nursing facility, it will not pay for long term care at a skilled nursing facility.
Medicaid – Many people never consider Medicaid when planning for the future because they either confuse it with Medicare or they have been led to believe that they would not qualify for Medicaid because they have too many assets or too much income. Most of these people have been told horror stories such as you have to be bankrupt to get Medicaid or that Medicaid will take your house. None of these myths are true. With proper planning, almost anyone can receive assistance through Medicaid. The same planning that can help an individual become eligible to receive Medicaid can also provide for the individual when Medicaid fails to cover a needed supply or service. Unlike Medicare, Medicaid is designed to provide for long term skilled nursing care in a variety of settings.
At Home Care
A little known component of the Medicaid system is what is the PASSPORT Program. PASSPORT is actually an acronym for Pre-Admissions Screening System Providing Options and Resources Today. The Passport Program is designed to allow the recipient of care to stay at home and receive necessary care to a limited degree. To qualify for PASSPORT an individual must meet many of the same requirements as those for nursing home Medicaid benefits. Obviously one of the biggest benefits of this program is the ability for the recipient to remain at home surrounded by love ones and support networks.
Independent Living Facility Care
An Independent Living Facility is one that provides minimal assistance to those able bodied seniors while they reside at the facility. Unlike Assisted Living Facilities (discussed below), Independent Living Facilities do not have a specific structured system that residence must follow. Residents are free to come and go as they please and exercise independent living. Where Medicaid comes in is again through the PASSPORT Program. Just as if the resident was living at home, PASSPORT can provide a limited degree of assistance to a resident of an Independent Living Facility. This again allows the senior to maintain a high level of independence but still received much needed assistance.
Assisted Living Facility Care
An Assisted Living Facility is one that provides a structured environment for the resident. Meals, cleaning, etc., are provided on a routine basis for the senior. Unlike an Independent Living Facility (as described above), Medicaid assistance is not typically accepted at an Assisted Living Facility. There are however exceptions. One of those exceptions is the Medicaid Waiver Program. The Medicaid Waiver Program is designed to provide seniors with an alternative to a skilled nursing home when they are unable to remain in an independent living environment. However, not all Assisted Living Facilities are participants in the Medicaid Waiver Program so you must first check to see if the facility you are interested in is a participant. Second, the requirements to participate in the Medicaid Waiver Program are much the same as those of the Medicaid Program in general. So once again, proper Estate Planning is necessary to qualify for these benefits.
Skilled Nursing Facility Care
The final option is that of a Skilled Nursing Facility. Typically in a Skilled Nursing Facility a senior is no longer able to care for themselves and cannot sustain an independent living. When residing in one of these facilities the senior may be eligible to receive Medicaid assistance to pay for the cost of such care. According to the State of Ohio, the average cost of care at a Skilled Nursing Facility is $6,570 per month*. In reality the cost can range from $8,000 to $10,000 per month once everything is said and done. Under Ohio’s assumption ($6,570/month) a family can expect to spend $78,840 per year for a loved one residing in a Skilled Nursing Facility. In fact that number can be as high as $120,000 per year.
*Ohio Medicaid Eligibility Procedure Letter No. 118
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