Medicaid for Long-Term Care

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Medicaid may help pay for long-term care in a facility, your community or your home.

It is important to understand additional requirements for long-term care programs. For example, there are restrictions on income and resources. There are also rules on transferring assets and estate recovery. Below is some general information about options that may be available to you.

Your county Division of Social Services will help determine if you are eligible for long-term care and which program fits your needs.

Nursing Facilities

Your income must be less than the cost of care in the facility at the Medicaid rate. Medicaid must approve the need for the level of care. You must use some of your income to help pay for the cost of care. This is called the “patient monthly liability.” Medicaid will pay the rest to the facility.

Your spouse can keep all of the income he/she receives for himself. He or she may be able to receive some of your income as well.

Community Alternatives Programs

Community alternatives programs (CAP) offer home- and community-based services to children and adults with disabilities who are at risk for institutionalization in a nursing home. There are two primary programs:

A third option, CAP/Choice, provides adults with more control over the types of services received, when and where they are provided and who delivers the services. Choice is available under the CAP/DA program.

Money Follows the Person

Money Follows the Person helps Medicaid-eligible individuals who live in hospitals, nursing homes or intermediate care facilities for people with intellectual or developmental disabilities return to their own homes and communities.

Program for All-Inclusive Care for the Elderly (PACE)

PACE provides care to the individual in the home, such as in-home personal care services and home health care. PACE provides a PACE Center that includes a primary care clinic, therapy, personal care and dining.

To be eligible to participate in PACE, you must:

  • Be 55 years of age or older
  • Need the same level of care for Medicaid nursing facility services
  • Live in a PACE organization’s service area
  • Be able to live in a community setting without jeopardizing your health or safety
  • Meet other conditions listed in the PACE organization’s agreement.

Additional Long-term Care Requirements

  • Transfer of Assets. If you or your representative give away assets or sell them for less than market value, you may be ineligible to receive Medicaid for 3-5 years. The sanction period is based upon the value of the assets transferred out of your name. There are certain circumstances where assets may be given away without penalty. Your county Division of Social Services office can provide more information.
  • Estate Recovery. When a Medicaid recipient receiving any of the above long-term care services dies, Medicaid seeks to recover certain expenses. There will be a claim filed against the estate. Under certain circumstances, estate recovery may not apply. Your county Division of Social Services can provide more detail information.