need attention and care outside the scope of our capabilities. It is important, should we have to make that ultimate decision to seek a remedy through assisted living toward the comfort and aid of those in our care—that we know what resources are available and what are the prerequisites for their use.
Medicare pays for short-term rehabilitation, and not long-term care. Medicaid, the nation’s low and no income public medical insurance program, on the other hand, does pay for long-term care. However, Medicaid does maintain a means test for the allocating of funds for nursing home care. This means test, which measures the recipient’s income level against a set percentage of the national poverty level, determines the recipient’s financial requirement for his own care. Income, for the purpose of this test, is considered to be any actual income, any real property, vehicles, and non-essential possessions; Medicaid has the right to request the sale of any property that belongs to the recipient to meet the recipient’s contribution to his long-term care. Furthermore, in part due to the Debt Reduction Act, the program utilizes a five years “look-back” to investigate any transfer of property to family members; these properties are also considered recipient income and can be seized for the payment of care.
As far as Medicaid assisted living benefits, neither Medicaid nor the United States’ Department of Health and Human Services has an official policy toward the payment of assisted living services or a particular predisposition toward the issue. According to AARP—formerly the American Association of Retired Persons (http://www.aarp.org/health/medicare-insurance/info-09-2010/ask_ms_medicare_question_89.html) –the individual states may, at their discretion, implement a waiver program to allow funding for assisted living facilities. Medicaid has admitted that these waiver programs are more economical than full nursing home care, and the cost saving justifies the states’ free hand in this matter.
Information on Medicaid state enrollment and the states’ waiver programs can be found at http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/By-State.html. Arkansas, California, Delaware, Florida, Iowa, Indiana, Maryland, Mississippi, Missouri, Nebraska, New Jersey, Ohio, Rhode Island, Vermont, Virginia, Washington, and West Virginia are the only states that currently accept all Medicaid waivers. Other states may have other long-term care programs, such as New York’s Long Term Home Health Care Program; but, funds are not specifically apportioned for assisted living care.
Choosing the right care for yourself or an elderly loved one can be overwhelming. However, it is a relief to know that the care we need can be readily available depending on our income, location and other factors. If you are looking for assisted living communities and using Medicaid, be sure to explore what options are available to you in your state, whether through a waiver program or otherwise. Checking with your local council on Aging or other elder health organization should be able to provide you with further details for your unique situation.