Medicaid Benefits Help to Pay for Long Term Care

~ By Eileen Doherty, MS ~

DENVER, CO. – Today, most Americans have had experience with a loved one who has suffered from Alzheimer’s, a stroke or other debilitating chronic disease that has forced them to seek long term care. Long term care is often seen as a death sentence. For many people, the opportunity to age in place in their own home is the best option, but sometimes people need more care than is available.

Paying for long term care is always a challenge. Many people have spent much of their life saving for their later years and still don’t feel they have adequate funding either for their retirement or their need for care in their later years.

In the seventies and early eighties, alternatives to care such as home care was almost non-existent. Assisted living, hospice care, adult day programs, and retirement communities were not available options for older adults to seek help as their health conditions deteriorated. As these options for health care have evolved, so have the costs of care increased.

In 1974, the cost of a nursing home bed was approximately $12.50 per day. Today, a private pay patient will pay upwards of $250 per day for the same bed in the same facility. Many older adults spend more than a half million dollars in long term care costs using most, if not all of their funds. Many times families do not seek help because they are afraid they can’t afford to pay for care or are unaware there is help to help pay for care.

For those individuals who use all of their funds, Medicaid can help with paying for the cost of long term care. To qualify for Medicaid, the individual must have less than $2000 in assets excluding their house, car, a revocable burial policy and term life insurance. If the individual is married, the spousal allowance is an additional $120,900 in cash or other resources, so as to not totally impoverish the spouse.

In addition to meeting the resource qualification, the individual must meet the income requirements of less than $2205 per month from all sources including Social Security, pensions, and investment income. If the individual makes more than $2205 and still needs long term care, a Medicaid Qualifying Trust can be established. The income and resource information must be submitted to the county department of human services in which the older adult lives on their approved form.

The last qualification to receive Medicaid benefits for long term care is to meet the functional requirements. An assessment is conducted by the Options for Long Term Care agency working in the county in which the older adult resides to determine if your loved one meets the criteria for nursing home care.

If your loved one meets the income, resource, and functional requirements, Medicaid can help to pay for care in the home, in an assisted living or in a nursing home. There are a number of Medicaid approved programs that can help to provide services in the home, including having someone come into your home, paying a family member to provide care, or directing your own home care with an aide of your choice. The same program will also pay for care in an assisted living or nursing home.

The application for Medicaid can be overwhelming and cumbersome. Records needs to be provided to prove income, resources, and expenses. A physician must certify your loved one needs more care. Selecting a home care agency, an assisted living and/or a nursing home can be challenging as well.

For more information on applying for Medicaid, talking about long term care options, or choosing help for your loved one, call 303-333-3482 and ask to talk with a counselor. You may also visit our website at www.senioranswers.org or pick up a copy of the Senior Resource Guidebook at your local library.

Eileen Doherty

Eileen Doherty

Eileen Doherty, MS is the Executive Director of the Colorado Gerontological Society. Her areas of expertise include management and administration of nonprofit organizations, education and training on issues related to older adults, advocacy and policy development on senior issues, and clinical practice in working with seniors and families to manage their lives in the later years. She has been the Director of the Society since 1982. She teaches Nonprofit Management for Fort Hays State University.