Website design By BotEap.comMedicaid is one of the most complicated and confusing areas of the law, and I often think it’s done that way on purpose to keep people from qualifying or discourage them from trying to qualify. It is the government medical program for the poor.

Website design By BotEap.comMedicaid is often confused with Medicare, which is the federal government’s medical program for seniors. Almost all seniors qualify for Medicare, as long as they have contributed to the system during their working lives. Those older adults who do not qualify have the opportunity to “buy” the system by paying premiums established by the federal government. Medicare benefits are limited; therefore, seniors can purchase “Medigap” or Medicare supplemental insurance policies that pay benefits where Medicare ends.

Website design By BotEap.comMedicaid, on the other hand, is a joint program between the federal government and the states to provide health care to the poor. As such, it is regulated first by Congress and then by state legislatures. Those lawmakers have established the standards by which Americans and permanent residents (and only those classes of individuals, not “illegal aliens,” to dispel a rumor) can qualify for government-paid health care. While qualifications may vary from state to state, there are several concepts that apply across the board.

Website design By BotEap.comAlthough Medicaid has programs for poor people of all ages, my law practice focuses on the elderly and those are the programs I focus on. Depending on the state, Medicaid may offer nursing home care and/or home care for seniors in need. Most people are aware of nursing home care programs, but home care programs, if they exist in your state, can offer a great alternative to nursing home care. New York, for example, offers nursing home care and also has an ambitious “community” or in-home Medicaid program; Florida, on the other hand, offers nursing home care and leaves it up to individual counties to provide whatever type of home care they can afford.

Website design By BotEap.comThe program most people are familiar with is nursing home care, called “Chronic Care Medicaid” in New York and “Institutional Care Medicaid” in Florida. If a person becomes so ill that they cannot perform certain activities of daily living (ADLs), it is not safe to live at home, and they need medical assistance, they may need ongoing care in a nursing home. Contrary to popular belief, Medicare (the program for the elderly) does NOT pay for nursing home care; it only pays for limited “skilled nursing care,” which often takes place in a nursing home with a rehabilitation facility. A good “Medigap” policy will pick up where Medicare leaves off, paying for up to 100 days total for skilled nursing care.

Website design By BotEap.comHowever, if a senior needs permanent care in a nursing home, they will have to pay for it out of pocket, with long-term care insurance, or by qualifying for Medicaid. For those who are able to pay for their own care in a nursing home, congratulations to you. For those who own or are contemplating buying long-term care insurance policies, be smart shoppers: Those policies typically pay a flat daily rate (a fraction of the full daily rate, especially over time) for nursing home care. for a set period of time (usually just a couple of years) and often don’t take effect until the person has been in the nursing home for that many days. It is important to read those policies carefully and understand them.

Website design By BotEap.comThe last option, Medicaid, is for the poor or those with modest assets. Whether an ill senior will qualify for Medicaid to pay for nursing home care depends on whether they did advance Medicaid planning or whether their current financial status immediately qualifies them. Sometimes a person has to “spend down” some of their assets before they qualify, although there are certain ways some assets can be protected.

Website design By BotEap.comIf you or your loved one is interested in learning more about Medicaid and proper planning for future qualification, schedule an appointment to see a senior attorney who can review your financial situation and devise a strategy to help meet your needs. future.