Medicaid Your Coverage Options

Medicaid coverage of home and community-based care

Written by Diane Archer

If you would like to remain in your home as long as possible–sometimes called “aging in place“–Medicare will be of only limited help. Medicare pays for only a small amount of home care in situations where it would be difficult for you to leave home on your own and you require skilled nursing or therapy services. That said, Medicaid can be of enormous help if you qualify.

No matter where you live, if you qualify, Medicaid covers home and community-based services (HCBS). These services include coverage to fill gaps in Medicare and to allow you to remain in your home or a community-based setting, such as an assisted living facility. Medicaid provides services that Medicare will not cover. (Medicare always pays first if it covers the service.) How much care you get and the types of care you get depend upon the state you live in.

Medicaid services that Medicare does not cover include:

  • Personal care, such as cooking or grocery-shopping
  • Homemaker services, such as cleaning
  • Home modifications
  • Help with chores
  • Case management
  • Adult day care

Medicaid services that Medicare also covers, include:

How can you qualify for Medicaid HCBS? You should plan ahead and understand the rules in your state. You may be able to move some of your assets into a trust to help you qualify or spend down your income and assets if they are above the Medicaid eligibility threshold, depending upon where you live. You also may be able to set aside some money for your spouse, if you are married, to bring down your assets. If you own your home, you need to understand how the value of your home will affect your Medicaid eligibility.

Of course, you will need to meet your state’s eligibility requirements for Medicaid home and community-based services, which generally means that you need nursing home level care. Also, keep in mind that your state may have a limit on the number of people for whom it provides home and community-based services. If so, you may be put on a waiting list.

Contact your local Medicaid office or Area Agency on Aging to learn more.

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  • In order to qualify for Medicaid funding of nursing home, assisted living and home care you must meet means testing. Your income and assets must be under a certain level, as determined by your individual state. Usually this is based on the Federal Poverty Level guidelines. When someone applies for Medicaid to cover the costs of nursing home care, a caseworker will investigate their financial status to help make a determination as to if the applicant meets the qualifications for coverage. Income includes wages and pension payments, and assets can include items such as savings, cars, homes, and valuables that may be owned by the applicant. If they fail to qualify they may enter a facility by paying out of their assets until they have “spent down” to the level that qualifies for Medicaid.
    The Deficit Reduction Act (DRA) which was signed into law on February 8, 2006, included section 6021. This provision authorized states to offer special Medicaid asset disregards for persons purchasing and using qualified private long term care insurance policies — which have come to be known as ‘Partnership’ policies. These policies will often include benefits for such things as home modification allowing the beneficiary to remain in their own home.

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