Medicaid Long Term Care Programs
It’s important for (potential) Medicaid-Planning clients to understand that “Medicaid” is an umbrella term used for multiple programs. In a long-term care context, there are three basic Medicaid programs that elder law attorneys tend to focus: Medicaid’s Nursing Home or Institutional Care Program (ICP); Medicaid Waiver or Home and Community Based Services (HCBS) for senior citizens aged 65 and up, or disabled; and Qualified Medicare Beneficiaries (QMB).
Medicaid ICP and Waiver programs require applicants to pass and asset and income test in order to qualify. The eligibility standards for ICP and HCBS may be the same, while QMB will have a different income and asset test.
Medicaid planning services are centered around assisting those with excess assets or income to legally and ethically qualify for these programs. Elder needs attorneys also assist those who are already one of these programs to preserve their benefits if they are coming into new assets (e.g. from a personal injury settlement, inheritance, or the sale of a house).
Nursing Home Medicaid | Medicaid ICP
This long-term care Medicaid program is for those who require skilled-nursing / rehab / nursing home level of care only. There is no wait-list for this program and approval will be granted in the same month the ICP applicant is financially qualified, medically qualified, AND submits a Medicaid application.
Once approved, the Medicaid recipient will pay their “patient responsibility” or “patient share of cost” (usually nearly all of their income, only keeping a small personal needs allowance per month for incidentals). The Personal Needs Allowance ranges from $30.00 to $200.00 per month depending on your state. In Florida, where I practice, the PNA is $130.00). After retaining the personal needs allowance, a nursing home Medicaid applicant will contribute the rest of their monthly income to the nursing home and Medicaid will pay the entire difference for the cost of a semi-private room.
If the Medicaid recipient is married to a non-Medicaid recipient (known as the Community Spouse), the Community Spouse may be entitled to a portion of the Medicaid recipient’s income as part of Medicaid’s anti-spousal impoverishment policy (this is known as the Minimum Monthly Maintenance Needs Allowance, or MMMNA). The MMMNA also has a range that differs per state.
Medicaid Waiver | Home & Community Based Services
Home & Community Based Services Medicaid are often referred to as “Medicaid Waiver.” The point of this program is to allow someone who would normally need to be in an institutional nursing home to receive their care in the community.
This long-term care Medicaid program is for those who only require Assisted Living Facility (ALF) level of care OR are able to reside at home and would benefit from some home-health care. In some states, there is a waitlist for this program, and the waitlist can be quite long.
Note that the type of support received under a waiver program varies widely from state-to-state. If your state does not cover ALF care, such care may be available through a different need-based program. In addition, for some states, there are different eligibility standards compared to their nursing home Medicaid program.
The Medicaid Waiver wait-list gives priority to those who need services the most. Your elder needs attorney may be able to ethically explain how to obtain a higher priority score to minimize time on the waitlist. The Medicaid waiver application is usually not submitted until the client is called off the waitlist. Once the application is submitted (and the client is otherwise eligible), Medicaid waiver services can begin on the first day of the following month.
Once approved for waiver benefits, the Medicaid recipient keeps 100% of their income (although a portion may need to be diverted into an income trust, which can still be used to pay expenses).
If in an ALF: Medicaid may only contribute a portion of the cost for a participating ALF.
If at home: Different states vary widely in terms of the number of hours of home-health care that Medicaid will cover.
Links to Author’s Resources
Free Webinars: https://www.elderneedslaw.com/webinars
YouTube Channel: https://www.youtube.com/@elderneedslaw
Medicaid Planning Book: https://www.amazon.com/Medicaid-some-your-long-term-expenses/dp/1513634712