Medicaid and VA Eligibility

Medicaid is a co-op program involving federal and state agencies that provide long-term care assistance. Although Medicaid is authorized by Federal law and partially funded by the US Government — it is fully administered at the state level — as a result, each state has their own unique version of Medicaid eligibility requirements.

The federal government allows the state of residence to determine who receives assistance and what types of coverage the state Medicaid program will pay for. Because each state has been granted this authority, it is not uncommon to see up to 50 different programs in place covering the individual states.

Sometime those who have the greatest need are the ones who suffer most because they are often in the dark about who is eligible and how to qualify for Medicaid coverage. Medicaid has always been considered an institutionally biased program — denying many recipients home care options — or requiring extremely long waiting periods for home care based services. Unfortunately, this bias is what requires many seniors in need to leave the privacy and dignity of their own homes to receive Medicaid benefits and move into a 24 hour nursing care facility.

So at best, most resident rely on myths and bad information to make these important decisions. With that, let’s examine the Medicaid rules.

What Does Medicaid Cover?

Medical Coverage

Upon approval for Medicaid, nearly all healthcare related bills are paid by the program. This includes their prescription drugs, hospital stays, nursing care, etc.

One important note: Medicare may overlap this coverage and in that case, Medicare will pay for some things while Medicaid picks up the remainder.

Here is a list of services offered by Medicaid:
• inpatient hospital services
• outpatient hospital services
• physician services
• medical and surgical dental services
• nursing facility services for individuals age 21 or older
• home health care for persons eligible for nursing facility services
• lab and x-ray services
• family nurse practitioner services

Homebound Care

If the applicant is living in their home then they may qualify for a program called “HCBS,” which stands for “Home and Community Based Services.” Until recently, a state wishing to provide Medicaid assistance to elderly people outside the nursing home had to apply to the federal government for a specific “waiver” of the usual Medicaid rules.

Here is a typical list of services offered by HCBS:
• case management
• personal care services
• respite care services
• adult day health services
• homemaker/home health aide services
• rehabilitation (i.e., assists people in furthering their skills in the areas of mobility, social behaviors, self-care, basic safety, housekeeping, personal hygiene, health care, and financial management)

Nursing Homes

Medicaid will typically pay the entire nursing home costs, including room, board, and all nursing care. It is an important fact to consider that not every nursing home accepts Medicaid as the payer source.

It is against the law for a nursing home to evict a resident because they run out of money, and end up transferring from self-pay to Medicaid. Nursing homes that won’t accept Medicaid for new residents is one thing, but most will allow a resident to convert to Medicaid after a period or private pay.

However, it’s best to confirm a nursing home’s policies during the Medicaid planning process.

Legacy Care Planning offers professional planning, case design and benefit access services for individuals and families that wish to protect assets — preserve a legacy and obtain state and / or Federal benefits.