There are a few publicly financed programs that help individuals pay for long-term care services, and each has its own specific set of rules and/or income criteria associated with it. Following are the largest publicly funded programs that help pay for long-term care.
Medicare
Medicare is a Federal program that covers health care for peopled age 65 and older, or for certain individuals with disabilities under the age of 65. While Medicare does not cover most long-term care services, it does help pay for limited skilled nursing services in a facility, hospice care and other home health care services under certain conditions.
Medicare pays for services in a skilled nursing facility when:
- you were just discharged from a hospital where you stayed for at least 3 days,
- you are admitted to a Medicare-certified nursing facility within 30 days of your hospital discharge,
- you need skilled services like wound dressing, physical therapy, occupational therapy, etc.
Medicare will pay 100% of the costs for the first 20 days, then a portion of your costs up to 100 days. You are responsible for the entire cost after day 100.
Home Health Care
Medicare coverage for home health care is limited to medically necessary, doctor ordered part-time nursing care, home health aides, physical therapy, occupational therapy, and speech-language pathology services. Coverage includes social services, wheelchairs, walkers, oxygen, and related medical equipment. Medicare will continue coverage so long as the service and equipment is medically necessary.
Hospice Care
Coverage for hospice services is available to people with a terminal illness that are not expected to live more than 6 months. Hospice services include drug coverage, medical support, social services, etc.
You can learn more about Medicare Coverage by downloading the Medicare and You Handbook.
Medicaid
Medicaid pays for long-term services in both institutional settings and in the home. Coverage begins when the individual meets Medicaid’s general eligibility, functional, and financial eligibility requirements. Services in the home are covered so long as the individual would need those services in an institution if not provided in the home. The specifics of Medicaid coverage varies from state to state. The application process can be confusing for some. Contact your Area Agency on Aging or your state’s Medicaid Office for more information, find them through the Resources by State page.
Veterans Affairs
The Department of Veterans Affairs provide long-term care services to veterans that are eligible, typically through meeting certain disability criteria, or to those who have service-connected disabilities. Visit the Department of Veterans Affairs to see what programs and services are available to you.
{ 5 comments }
The Department of Children and Families usually handles Medicaide. In Florida, there is a program called the Nursing Home Diversion Program. It offers limited service and it’s name is greatly exagerated. It can, however, be a big help if you are not getting any services and have extrememly limited resources.
There is also a sub program of the nursing home diversion/Medicaid waiver program, and it’s available in many states. In Florida, this program is called CDC+. This program appears to be the answer to countless caregiver prayers.
Once it is determined the amount of services the patient needs, a dollar amount is set for the patient. Then, rather than just sending in agencies and paying them directly, to program put the money into the patient’s hand to spend on services as he/she sees fit.
This means that, if in the best interest of the patient, the caregiver can start to be paid for taking care of the loved one full time.
Check your state web site to see if the program exists where you live.
Relying on publicly financed programs to pay for long-term care can be a challenge when it comes to figuring out if you qualify, and also unattractive when it comes to the criteria you must first meet. Often, people are forced to “spend down” their assets in order to qualify for Medicaid, making it an unappealing option to those hoping to leave a legacy.
As you point out, Medicare will only pay for skilled nursing if it the patient is expected to recover. In my experience, the earlier people plan for long-term care expenses, the better off they are.
Read about another alternative to paying for long-term care: http://www.bluegoosemaine.com/blog/?p=376
Thanks for the post!
-Paul
What provisions has medicaid made for medically challenged adults who as children had skilled nursing care provided at home by medical assistance?
That’s a tough question to answer without a lot more specific information, what those needs are, income level, state-specific laws, etc. You should call your state Medicaid agency and ask for eligibility.