This blog frequently discusses the rules governing qualification
for Medicaid payment of long-term care costs for the elderly. Medicaid is the
primary source of public support for families who are struggling to meet the
needs of a loved one who needs care and support services on a long term basis.
But I realized that some of the readers of this blog may be unfamiliar with the
Medicaid program. And many well informed people continue to confuse Medicaid
with Medicare. So, I thought I should take a few moments to give readers
an overview of the Medicaid program.
Medicaid is a joint federal/state program that provides medical
assistance to eligible persons. The federal Medicaid statute is found in Title XIX
of the Social Security Act which is codified in federal law beginning at 42
U.S.C. § 1396. Unlike Medicare, Medicaid is not a
uniform federal program. It is partially funded and administered by the states
and each state has its own distinct program. “While state participation in the
program is voluntary, participating states must adopt plans that comply with
certain requirements imposed by federal statutes and regulations.” [1] Although they all must conform to federal requirements, individual state Medicaid programs vary widely. The Pennsylvania
Medicaid program is called “Medical Assistance” (or MA for short).
Medicaid is means-tested, with eligibility for benefits dependent
upon the applicant’s income and resources. Asset transfers may also affect
financial eligibility for Medicaid long-term care benefits. States are given
some latitude in establishing these financial eligibility criteria.
Medicaid is our country’s largest health-care program. It is the
primary way we finance health care for our most vulnerable and needy persons,
including long-term care for the elderly and disabled. It is our health-care
program of last resort. For most people on Medicaid, there is no other program
to take its place.
First established in 1965, “Medicaid has evolved from a program
providing medical assistance to the welfare population to a broad and
multifaceted safety net addressing the needs of low income families, the
elderly, and those with chronic, disabling health conditions. In the face of these
challenges, Medicaid has achieved remarkable success in helping to close gaps
in access to care and served as an essential safety net for long-term care
services in the community and in institutions.”[2] Medicaid has become the nation’s fundamental source of financing
health-care and long-term care services for over 58 million low-income
Americans.
A significant expansion of the Medicaid rolls is set to take place
in 2014 as a part of the Affordable Care Act
(ACA). It is estimated that approximately 16 million low income people will be
added to the program in 2014 as a primary means of extending health coverage to
most Americans. Although this expansion will be financed almost entirely by the
federal government, some states have objected. The legality of this Medicaid portion
of the ACA is one of the issues is being debated this week (March 26, 2012) before
the United States Supreme Court. If the ACA
law is allowed to take effect, the Congressional Budget office estimates that
95% of Americans will have health insurance by 2019.
Many elder law attorneys spend a lot of their time working on
Medicaid benefits for persons over age 65 (and disabled younger persons) who
require long-term care services in a nursing facility or in their homes. Most,
but not all, skilled nursing facilities accept Medicaid as a form of payment. Whether
a particular nursing home is a participant in the program should be established
by inquiring of the facility prior to admission.
Readers are cautioned that Medicaid rules are variable, complex,
and ever changing. Changes may have occurred after the date of publication of anything
you read online about Medicaid. States are constantly making political and
administrative choices about the level of resources they are willing to devote
to Medicaid funded health care and long term care. As a result program
revisions are pretty much continuous. Case
and administrative rulings may also result in program modifications. Consumers
who need advice about Medicaid eligibility rules should consult a Certified
Elder Law Attorney or other lawyer in their state who focuses on this area
of legal practice and stays current as the program requirements undergo change.