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4 Basic Queries about Assisted Medical Living

Assisted Medical Living

Medicaid is a state-sponsored public health insurance scheme that aims at offering healthcare benefits to families or persons having low incomes, as per federal norms. This popular government-aided program for long-lasting care and assisted living renders health cover to a significant percentage of Americans. These include disabled persons, children, pregnant women, low-income groups, and elderly adults.

Both states and the federal government jointly fund this program. Now, if you’re planning on availing the option of assisted living, then you can make payment via Medicaid.

Refer to the following details to know more about the 4 common questions that are sought by people about Medicaid, which helps to pay for assisted living.

1. Can Medicaid help to pay for Assisted Living?

With Medicaid, your costs of assisted living are covered. These include Alzheimer’s care and improving memory. However, the patrons have to meet the given eligibility norms to qualify for Medicaid. The program benefits and available programs differ from state to state.

This program also covers the costs of practiced and emergency response systems. Even so, Medicaid does not cover board and room costs, which constitute around half the cost of assisted living.

The majority of states have a basic state Medicaid program, coupled with Home and Community Based Services (HCBS) Medicaid Waivers. States offer personal care aid via Medicaid – either through state plans, waivers, or a combination of both.

2. Medicaid Pays For Assisted Living to what extent?

The amount that can be availed under Medicaid depends on many aspects:

  • State of residence
  • The state plans of the Medicaid scheme
  • Degree of requisite care

For calculating the number of hours that Medicaid cover, a needs assessment is required. For instance, those groups who have a larger need for assistance can avail more hours of caregivers every month.

3. How to assess if I am eligible for Medicaid

Different states vary in eligibility criteria. The basic requirements are as follows:

  • Expenditure of all current assets towards healthcare
  • Come in the low-income groups, or have medical-linked expenses that are beyond their income limit
  • Reside in states that are offering these benefits
  • Permanent US citizen

Financial need

Normally, state-based Medicaid plans restrict applicant income to be 100% of the Federal Benefit Rate (FBR) or the Federal Poverty Level (FPL). To avail Medicaid waivers, the candidate’s income should not exceed 300% of the FBR. Generally, assets are restricted to $2000 in the case of both Medicaid waivers and state-administered plans.

Functional need

Applicants should need nursing care or be undergoing institutionalization. Different states vary in norms.

In some states, the applicants should need assistance including two daily activities like:

  • To dress and undress
  • Cutting food during mealtimes
  • Using and cleaning toilets
  • Shifting from bed to chair

Some programs ask for a statement by a physician. More so, if the person is diagnosed with Alzheimer’s, they do not automatically qualify for benefits.

Browse the Medicaid website to know more about the eligibility criteria and further information about:

  • Eligibility norms and the application process
  • Locating a Medicaid office
  • How to avail both Medicaid and Medicare simultaneously (dual enrolment)

Besides, you can contact a State Medical Assistance Office for additional information.

4. Which services come under Medicaid?

The range of services that Medicaid covers vary as per the different states. However, the standard services that Medicaid covers under assisted living are:

  • Personal care aid, which is inclusive of bathing, eating, dressing, and toileting
  • Qualified home care services that include grocery shopping, preparing meals, laundry, house cleaning, among other essentials
  • Personalized emergency response systems
  • Case supervision
  • Transport

Room and board charges of assisted living do not come under Medicaid.

Last modified: July 14, 2020
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