Marshall, Parker & Weber LLC > News & Articles > Articles > You need to Understand Medicaid if you need Nursing Home Care

You need to Understand Medicaid if you need Nursing Home Care

Posted · Add Comment

The Medicaid program is the largest single source of payment for nursing home costs. It can pay for most of the cost of your nursing home care. If you are facing a nursing home admission, you need to know about Medicaid.

To get Medicaid benefits a nursing home resident must require the level of care provided in a nursing home and qualify under the strict financial requirements of the state Medicaid program. Medicaid program rules differ from state to state. The Pennsylvania version of the Medicaid program is called “Medical Assistance.”

One of the primary advantages of Medicaid is that unlike Medicare, the Medical Assistance program will pay for non-skilled long term nursing home care over extended periods of time.

Not everyone qualifies. An applicant for Medicaid nursing home benefits must have limited available financial resources and a doctor must certify that they need the level of care provided by a nursing facility. An assessment is completed to confirm that the resident requires a nursing home level of care. The financial qualification rules are complicated and include a requirement that neither the applicant nor his or her spouse have made disqualifying transfers of assets within the prior five years.

Why Plan for Medicaid?

Long term care refers to a range of personal assistance services that people need over an extended period of time. The help may involve fundamental tasks like bathing, dressing, using the toilet, incontinence, transferring to or from a bed or chair, and eating. Other common long term care services involve help with other everyday tasks such as housework, managing money, taking medication, preparing meals, and shopping.

Studies show that most people will come to need long term care assistance over an extended period of time as they age. When our care needs grow beyond what our families can provide, we need to turn to paid help. That help is very expensive. For example, nursing home costs can easily exceed $100,000 a year.

This is why planning for the high cost of long term care (whether provided in the home, a nursing home, or another facility) is a crucial element of estate and financial planning for all but the wealthiest seniors. As life expectancy and long term care costs continue to rise, we all need to consider how we will be able to pay for the services we will most likely need someday.

Few people can afford to pay the cost of nursing home care for long. Those who are able to pay privately at the start usually find that their life savings are quickly depleted. Fortunately, the Medicaid program is there to help if you qualify. Unfortunately, because Medicaid is limited to those who can demonstrate financial need, applicants must meet the program’s complex financial eligibility requirements.

The Medicaid qualification requirements/limitations are constantly changing. But optimizing your Medicaid benefits is too important to ignore, or to leave to nursing home staff or others who are not necessarily looking out for your financial best interests. Expert help from an experienced elder law attorney is needed by those seeking to preserve some savings and financial security and dignity for themselves and their families. The sooner you plan, the more options are available.

Once long term care is required, an elder law attorney can help you determine how to get the best care in the most appropriate setting without going broke. If you reside in Pennsylvania, please talk with one of the experienced elder law attorneys at Marshall, Parker & Weber (www.paelderlaw.com).